Figure 1: Initial

Figure 1: Initial

Orthodontic technologies abound for every aspect of treatment. There are options for bracket designs, wire types, slot sizes and widths, and each brings more precision to treatment to satisfy doctors’ needs and desires to deliver effective and efficient treatment. Besides all of the breakthroughs for braces, an innovation in aligner seating has the potential to help make clear aligner treatment quicker and more predictable. An aligner-seating device, the VPro5™ by Propel Orthodontics (Ossining, NY), is showing very positive results in my practice, both clinically and from my patients’ feedback.

Vibration appliances have been on the market for many years. In the past, I chose not to implement them into my practice because they seemed to me to be cost prohibitive. As a clinician, not only did I not want to incur the cost of keeping them in my inventory, but also I did not feel that it constituted a sound business model to pass that cost along to my patients. However, when the VPro5 appeared in the marketplace at a very attractive price point, I decided to try this technology on clear aligner patients. It is a price point that has been well accepted by my patients.

This vibration device operates at a high frequency of 120 Hz, and patients wear it for only 5 minutes per day. This makes it easier for patients to comply with treatment. At each visit, I can plug the device in and use the software included to check if the patient is using it for the appropriate amount of time. Knowing the orthodontist can check on the patient’s compliance is a form of motivation for the patient to have a positive role in his/her own treatment. This device is smaller than others on the market, making it convenient and portable—a plus for people who travel or busy parents who are always on the go.

The theory behind the VPro5 is that it leads to better aligner seating, which helps ensure that the aligner fulfills its intended function properly. As a clinician, I witnessed the results in my own practice. After using VPro5 each day, patients came to their follow-up appointments reporting reduced discomfort when switching out aligners. Several of these patients had an opportunity to compare their experience of switching their aligners before using VPro5 and after adding it to their treatment plan. These patients reported a marked difference in pain, with little to no discomfort when switching out aligners.

When patients wore their VPro5 for 5 minutes each day, I noticed that their aligners were seating very well on the teeth, with treatment goals being set with the patient. This worked so well, in fact, that I was able to allow these patients to switch aligners every week instead of the usual 2 weeks. When aligners seat better and fit more precisely to the teeth, I have noticed that these patients have not called in for emergency appointments asking me to check for a correct fit. Before using VPro5, some patients would call or email a selfie of their mouth with their aligners in, asking why there is a space between the tooth and the aligner. Often they wanted to come to the office for an extra appointment so that I could examine the space. These issues do not seem to arise as often when the aligners seat better. From a practice management standpoint, this helps reduce after-hours phone calls, which is beneficial for both the practice and the patient. Though not clinically proven, I believe retention may also be a potential benefit to aligner seating because of the heightened contact between appliance and greater tooth-surface area.

The following anecdotes present patients who have progressed quickly and accurately through their aligner treatments.

Figure 2: Patient at 16-week progress, aligner #13. Patient reported no pain when switching aligners using VPro5. Observed that aligners  t and sat well.

Figure 2: Patient at 16-week progress, aligner #13. Patient reported no pain when switching aligners using VPro5. Observed that aligners t and sat well.

Patient 1

This patient was special to all of us at the office since she is also our receptionist. She had mild-to-moderate crowding on the upper and lower anterior teeth, a Class I malocclusion, and 4 mm of crowding in the upper and lower anterior arches (Figure 1). At first, she began treatment without VPro5. After wearing the first two aligners, she was eager to speed up the process, so I suggested this new technology to ensure proper aligner seating.

Figure 3: Final

Figure 3: Final

We incorporated VPro5 for aligner #3, and she proceeded through 13 stages of aligners in a total of 16 weeks (Figures 2 and 3). Patients will vary, and not all will have results this good, but this particular patient reported a much lower pain experience using the high frequency vibration than before when she was not using the device. The VPro5 was worthwhile.

An interesting side effect to this patient’s treatment is the positive internal marketing aspect of having a happy patient who also is a front-desk team member. She enthusiastically shares her delight with this vibration device with potential patients on the phone, parents at the front desk, and all others within listening range who could also benefit.

Figure 4: Initial

Figure 4: Initial

Figure 5: Patient at 9 months progress to re nement. Patient started VPro5 3 months into treatment, saving 6 months of treatment time. Patient underwent re nement scan at 9 months instead of 15.

Figure 5: Patient at 9 months progress to re nement. Patient started VPro5 3 months into treatment, saving 6 months of treatment time. Patient underwent re nement scan at 9 months instead of 15.

Patient 2

This patient had a Class III edge-to-edge that was treated with Invisalign® (Align Technology Inc, San Jose, Calif) and Class III elastics (Figure 4). This patient also started treatment without using the vibration device, and, after the first few months, started using VPro5. He was pleased with the device (Figure 5).

Figure 6: Initial

Figure 6: Initial

Patient 3

This patient’s pre-cosmetic treatment plan involved placing veneers on tooth numbers 7, 8, 9, and 10 (Figure 6). We intended to intrude the teeth on his edge-to-edge bite in order to create freeway space. Before implementing the VPro5 vibration, we decided to try to accelerate treatment by using manual osteoperforations (MOPs) by Propel. The MOPs increased local levels of cytokine activity around the tooth, which has been shown to increase bone remodeling. The cytokine cascade results in a marked increase in osteoclast activity, allowing the teeth to move more easily.1 After this, VPro5 was added to the regimen. Overall, this patient has been experiencing excellent results (Figure 7).

Figure 7: Patient at 4 months progress with 1 MOP procedure and VPro5. Note the intrusion of the upper anterior teeth.

Figure 7: Patient at 4 months progress with 1 MOP procedure and VPro5. Note the intrusion of the upper anterior teeth.

The VPro5 vibration device enhances compliance with aligner therapy. When aligners are seated properly, the results are more predictable. In addition, there is the potential ability to complete aligner treatment on the expected timeline or sooner. And all that with only 5 minutes per day of patient compliance. OP

Reference

1. Teixeira CC, Khoo E, Tran J, et al. Cytokine expression and accelerated tooth movement. J Dent Res. 2010;89(10):1135-1141.

 

JonathanNicozisisJonathan Nicozisis, DMD, MS, has been in the specialty practice of orthodontics since 1999 in Princeton, NJ. He completed his dental education at the University of Pennsylvania before attending Temple University for his orthodontic residency. Nicozisis is a member of the Angle Society and Invisalign® National Speaker’s Bureau and Clinical Research Network. He is also the founding orthodontist and former scientific advisory board member of BAS Medical (now Corthera), a development stage company founded in 2003 with a mission to develop and market a novel technology to accelerate and improve the stability of orthodontic treatments. In February 2010, Corthera was acquired by Novartis. He offers consulting services on Smile Assist and YourOrthoCoach.com. Most recently, he co-authored a textbook chapter on Invisalign with the former chairman of Temple University Department of Orthodontics and the director of R&D at Align Technology Inc.

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