Armando Chavez

Anabel Mendoza

Low Intensity Pulse Ultrasonic

LIPUS (Low Intensity Pulse Ultrasonic), is an advanced, under utilized method that will help in

accelerating OTM (orthodontic tooth movement) and bone growth with minimal PDL damage. The faster

and noninvasive movement of the teeth will help decrease root resorption, decalcification, caries

prevention, gingival inflammation, and can even help in repairing hair-line fractures, it can also help with

dental implants and people with osteoporosis. The purpose in demonstrating how LIPUS works is to

educate the dental community regarding this new FDA intervention, and under utilized treatment for

accelerating bone growth. We will discuss what LIPUS is, what it helps prevent and fix, side effects, and

purpose of treatment with LIPUS.

LIPUS is a form of physical energy that can be delivered into living tissue as ultrasonic

vibrations.( Acar. Et al. 2016) The alternating pressure is translated into an extracellular mechanical

force at the cell membrane, where it is transduced into intracellular electrical and/or biochemical

proteins,(Uchida. Et al. 2016) which stimulates the production of morphogenic proteins. The cellular

metabolism of these proteins helps regulate the cells in accelerating the production of the osteocytes.

This means LIPUS helps generate bone growth at a cellular level by stimulating osteoblast production.

During bone remodeling, bone resorption and new bone formation are induced along the dominant

local loading direction, suggesting that local regulation of bone remodeling is mediated by mechanical

stimuli.(Rego, et al. 2012) Mechanical stimulus to bone is of great importance for maintaining the bone

mass and structural stability of the skeleton. When bone is mechanically loaded, such as during

orthodontic work, movement of fluid within the spaces surrounding bone cells generates fluid shear

stress that stimulates osteoclasts and osteoblasts, resulting in enhanced anabolic activity for bone
remodeling. This mechanotransduction process, by which osteoclasts and osteoblasts convert the

external stimulation from fluid shear stress in to biochemical changes, remains unclear.( Acar. Et al.

2016)

Osteoblasts are of mesenchymal origin and are responsible for bone formation during

embryonic development, growth, bone remodeling and fracture healing.(Acar. Et.al 2016)) The

osteoblasts, which maintain direct contact with osteocytes, respond to these signals and initiate bone

apposition, and this increased production of osteoblasts leads to faster bone growth.(Manaka. Et. Al.

2014) This can be a significant advancement for orthodontic patients who often experience bone loss

and root resorption. Physiologically, the periodontal ligament is constantly being subjected to

mechanical stress by occlusal forces, and remodeling of the periodontal ligament and alveolar bone

occurs in response to orthodontic forces. The use of LIPUS can help decrease this treatment time, where

traditional braces can take 2 to 3 years, orthodontics used in conjunction with LIPUS has been shown to

decrease time to 1 year. The increase in bone production by LIPUS also has great uses for patients with

implants, since strong and healthy bone is needed to keep the implant in place. The increased cellular

metabolism encourages stronger and faster rejuvenating bone, and along with various dental benefits,

LIPUS can also help heal fractures in other bones, such as the jaw.

The treatment of LIPUS will help trigger cellular response, which in turn will help bone resorption by

osteoclasts in the pressure sites, and bone formation by osteoblasts in the tension sites. It has been

shown that LIPUS stimulation accelerates OTM by increasing osteoclast numbers and activity, likely by

enhancing the expression of RANKL on the pressure sites.(Acar. Et.al. 2016) Tooth movement efficiency

is directly linked quantitatively and qualitatively, to recruitment, differentiation, activation and

maintenance of these cells in different sites. (Andrada. Et.al. 2014) The general effective standards of

LIPUS are frequencies varying between 0.5 to 1.5 MHz pulses at 5-20 minutes per day. The frequencies

differ between the amount of necessary signals needed to deposit the bone matrix.
Today, LIPUS is an under utilized therapeutic method despite being used since 1990, and many studies

have shown no side effects, however this may be due to the varying degrees of results in patients. Since

the underlying reason for how cellular activity initiation is still unclear, further research needs to be

done to fully understand this method of treatment. On the plus side, LIPUS has been presented with low

toxicity, low immunogenicity, non-invasive, highly targeted selectivity and repeated applicability. (Rego

et. Al 2012) However, a higher frequency can lead to destruction of tissue and cells.

Although, the usage of LIPUS hasn't been used much in dentistry, studies have shown

that it could improve bone regeneration with no documented side effects. LIPUS is not the only

method of regenerating bone, they have been others methods applied as well. Tooth movement

has been accelerated by local injection of biomodulators, application of laser therapy,

mechanical vibration and gene therapy, as well by corticotomies. Some of these approaches can

be applied clinically; but others, such as cortectomy, laser therapy and vibration are somewhat

already part of the therapeutic arsenal. LIPUS has many clinical advantages, it is a biological

stimulus, easy to use and noninvasive, in addition to being widely used in clinical medicine. In

the future, LIPUS could be a more widely used technique if further research is done to

understand exactly how it works and more convenient intraoral devices are created.