Accelerated Orthodontics: Methods to Speed Up Braces Treatment

Micro-Osteoperforation (Propel)

Micro-osteoperforation (MOP) involves making tiny perforations in the alveolar bone (the bone that holds the teeth) near the roots of the teeth being moved. The Propel device is the most widely used tool for this procedure. The small punctures trigger a localized inflammatory response called the regional acceleratory phenomenon (RAP), which temporarily increases bone turnover and allows teeth to move faster.

The procedure is performed in the orthodontic office and takes about 10 to 15 minutes. Local anesthesia is used to numb the area. The Propel device creates 3 to 5 small perforations in the bone near the target teeth. Most patients report mild soreness for 1 to 2 days, similar to a routine orthodontic adjustment.

Clinical studies have shown that micro-osteoperforation can increase the rate of tooth movement by 2 to 3 times in the treated area. A 2013 study in the American Journal of Orthodontics and Dentofacial Orthopedics found a 2.3-fold increase in tooth movement rate following micro-osteoperforation.

Vibration Devices (AcceleDent, VPro5)

AcceleDent and VPro5 are handheld devices that deliver low-frequency vibrations (micropulses) to the teeth and surrounding bone. The patient bites down on a mouthpiece connected to the device for 20 minutes per day. The theory is that gentle cyclic forces stimulate bone cells and accelerate the remodeling process.

AcceleDent received FDA clearance as a Class II medical device. However, the clinical evidence for vibration-based acceleration is mixed. Some studies report modest improvements in tooth movement speed and reduced patient-reported discomfort. Others, including a 2015 randomized controlled trial published in the Journal of Dental Research, found no significant difference in treatment time between vibration users and controls.

Vibration devices are non-invasive and carry no known risks beyond the time commitment. They may be a reasonable option for patients who want to try every available tool, but the evidence does not strongly support clinically meaningful time savings.

Piezocision

Piezocision is a minimally invasive surgical technique in which a periodontist or oral surgeon makes small incisions in the gum tissue and uses a piezoelectric knife to create shallow cuts in the bone between tooth roots. Like micro-osteoperforation, this triggers the regional acceleratory phenomenon.

Piezocision is more invasive than micro-osteoperforation but less invasive than traditional corticotomy surgery. It is typically performed under local anesthesia and can be combined with bone grafting if the patient has thin bone. Recovery involves mild swelling and soreness for 3 to 7 days. Studies suggest piezocision can reduce treatment time by 30% to 50%.

Corticotomy-Assisted Orthodontics

Corticotomy-assisted orthodontics (also called Wilckodontics or PAOO, Periodontally Accelerated Osteogenic Orthodontics) involves a surgical procedure where the periodontist or oral surgeon lifts the gum tissue and makes deliberate cuts in the outer layer (cortical plate) of the bone around the teeth. Bone graft material is often placed around the roots.

This is the most invasive accelerated orthodontic technique and produces the most dramatic acceleration, with some case reports showing treatment completed in as little as 3 to 8 months. However, the surgery requires flap elevation, suturing, and a recovery period of 1 to 2 weeks. It is typically reserved for complex adult cases where significant time reduction is a priority.

Low-Level Laser Therapy (Photobiomodulation)

Low-level laser therapy (LLLT) applies specific wavelengths of light to the tissue around teeth being moved. The light energy is thought to stimulate cellular activity and bone remodeling. Some early studies show promising results, but the evidence base is still developing. Protocols (wavelength, duration, frequency) vary widely across studies, making it difficult to draw firm conclusions about effectiveness.

Consultation and Treatment Planning

During your initial orthodontic consultation, discuss your interest in accelerated options. The orthodontist will evaluate your case complexity, bone health, gum condition, and treatment goals to determine whether an accelerated approach is appropriate and which method may be most effective.

Not every case benefits equally from acceleration. Patients with healthy bone and gums who have moderate treatment needs tend to see the best results. Patients with active gum disease or very thin bone may not be candidates for surgical acceleration methods.

The Acceleration Procedure

For micro-osteoperforation (Propel), the procedure is done during a regular orthodontic appointment. Local anesthetic numbs the area, and the perforations take only a few minutes. You can return to normal activities immediately.

For piezocision or corticotomy, the procedure is typically scheduled separately with a periodontist or oral surgeon. These require more preparation and a short recovery period. Your orthodontist will coordinate the timing with your ongoing braces adjustments.

During Active Treatment

After an acceleration procedure, your orthodontist may schedule more frequent adjustment appointments (every 3 to 4 weeks instead of the usual 6 to 8 weeks) to take advantage of the increased rate of tooth movement. The biological acceleration window typically lasts 2 to 4 months, so timely adjustments are important to maximize the benefit.

For vibration devices, daily use continues throughout treatment. Compliance is important because the potential benefit depends on consistent daily use.

Micro-Osteoperforation Recovery

Minimal recovery. Mild soreness at the perforation sites for 1 to 2 days. Over-the-counter pain medication is usually sufficient. No dietary restrictions beyond what braces already require. Most patients feel normal by the next day.

Piezocision Recovery

Moderate recovery. Expect mild swelling and tenderness for 3 to 7 days. A soft food diet is recommended for the first few days. Prescription pain medication may be provided but is often not needed beyond day 2. Minor gum incisions heal quickly, usually within 7 to 10 days.

Corticotomy Recovery

More involved recovery. Swelling, bruising, and discomfort for 1 to 2 weeks. A soft or liquid diet for the first 5 to 7 days. Follow the surgeon's instructions for wound care and medications. Most patients return to work or school within 3 to 5 days, though strenuous physical activity should be avoided for about 2 weeks.

Long-Term Retention

Accelerated orthodontics does not change the retention requirements after treatment. Retainer wear is still required for the same duration and with the same consistency as traditional orthodontic treatment. Teeth that are moved quickly may actually be at slightly higher risk of relapse if retainers are not worn faithfully.

Typical Additional Costs

These costs are in addition to the standard braces or aligner fee.

• Micro-osteoperforation (Propel): $500 to $2,000 per treatment session (may need 1 to 3 sessions)
• AcceleDent or VPro5 device: $600 to $1,000 (one-time purchase)
• Piezocision: $1,500 to $3,000 (surgeon fee)
• Corticotomy (PAOO): $2,000 to $5,000 depending on extent of surgery
• Low-level laser therapy: Often included in the orthodontic office fee if available, or $500 to $1,500 separately

Insurance Coverage

Most dental insurance plans do not specifically cover accelerated orthodontic procedures. These are generally considered elective enhancements to standard orthodontic treatment. The base orthodontic treatment (braces or aligners) may be partially covered if your plan includes orthodontic benefits, with typical lifetime maximums of $1,000 to $2,500.

HSA and FSA funds can usually be applied to the full cost of orthodontic treatment, including accelerated procedures.