Orthotown August 2017 - 40

Fig. 8

Fig. 7

In cases where specifically greater tooth movement was necessary,
laser exposure could be directed on those teeth by applying the
bleaching wand over only those roots. If neighboring teeth were not
needing as much movement, the laser application could be omitted
from those areas, thus allowing these areas to act as anchors (with
the classical slow movement compared to the lased areas).

Applying research results to even more patients
Back in 2004 when first applying lasers, it was noticed that more-rapid
movement was seen at the first reactivation appointment. After many
cases with reduced treatment times, a decision was made to irradiate
once per month, rather than only on the first day of orthodontic
treatment. The laser exposure each month resulted in cases being
completed much more quickly: Cases that would have taken two to
three years in standard orthodontic treatment were being comfortably

Our 78-year-old
female patient
with osteoporosis
who had treatments
every two weeks
completed treatment
and movement
in four months
and remained
perfectly comfortable
and happy during the
course of treatment.
40

JULY/AUGUST 2017 // orthotown.com

Fig. 9

completed in six to eight months (Figs. 1 and 2, p. 38). On reactivation
appointments, the tremendous and often remarkable movement was
discussed by the staff. Quite often, the enthusiasm and excitement by
the staff and the patient were identical. When changing out wires, the
teeth were usually found to be nonmobile. This made it actually quite
difficult to use interproximal polishers when incisor "slenderising"
was necessary. This was shocking after 25 years of seeing anterior
teeth extremely mobile and reactivation appointments once the arch
wires were removed. Radiographs revealed very good bone formation
around the teeth that had moved great distances. It was also noted that
the usual enlarged periodontal ligament (PDL) seen during classical
nonlaser orthodontics appeared to have completely healed with the
bone. These "normal"-looking PDLs appeared as if no orthodontics
was being done on them at all (Fig. 3, p. 38).
The next change in adjustment of the protocol was to the
interval of reactivation appointments. Decreasing the waiting time
to two weeks proved to accelerate movement at an even greater rate.
As the photographs were examined and the movement assessed, it
was amazing that such rapid orthodontic changes could be seen
and in most cases, painless or very little pain was noted. Our
78-year-old female patient with osteoporosis completed treatment
and movement in four months and remained perfectly comfortable
and happy during the course of treatment (Figs. 4 and 5, p. 39). At
four months, radiographs revealed bone that had filled in a large
diastema between the central incisors, and it appeared to be very
dense bone. The anterior incisors had normal nontreatment-sized
periodontal ligaments (Fig. 6, p. 39).
Because of the patient's osteoporosis, banding remained on her
teeth for an additional month for safety, and then retainers were
made. It was noted in this and all other cases that the lower anteriors,
which were going through major changes in movement, had virtually
no mobility when arch wires were removed. It was very difficult to
polish these teeth interproximally; even standard floss was very tight.
The next time the protocol changed was to schedule reactivation
appointments at one-week intervals. Because elastic ties, chains and
power arm elastic loops often lose their active elastic energy applied
to the teeth in five to seven days after placement, replacing them
at one-week intervals appeared to be the next logical adjustment
to the rapid tooth movement protocol.
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