Dr. Shivam Mehta, B.D.S., M.D.S., M. Dent. Sc. is a high-level orthodontic researcher with over twenty-nine publications in peer-reviewed journals. He has received four grants, published twenty-five abstracts, and delivered fifteen scientific presentations in tandem with other acclaimed researchers from around the world.
It’s rare that we have the opportunity to speak with an orthodontic professional, but Mehta was happy to help us look at orthodontic research through the lens of one of our most common themes here on the site: the ways in which technology continues to impact our lives.
Mehta’s work is inseparably intertwined with technology– not simply for the sake of being seen as ahead of the curve but rather for the purpose of being more efficient and more accurate, looking for new ways to challenge old ideas.
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“Orthodontic research and technology are totally intertwined. Orthodontic tooth movement is a complex process and well-conducted scientific research is essential to generating results that can be used by clinicians in making evidence-based decisions for their patients.”
Mehta is a clinician-scientist, and he has been an active researcher for many years. Though research can occasionally feel removed from real-world implementation, Mehta combats this by keeping a sharp focus on what’s called translational research, which aims to translate research results in a way that directly benefits the people who need it.
Orthodontic research frequently looks at new treatment methods for existing conditions, many of which are made possible by relatively recent technological advances.
As with any medical treatment option, new orthodontic techniques have to be thoroughly tested before they can actually be offered to patients.
So in other words, researchers like Mehta are responsible for discovering and evaluating treatments for viability and efficacy, especially in relation to existing treatments.
Mehta himself has invested a great deal of time and expertise into the research of a palatal expansion technique called mini-screw assisted rapid palatal expansion, which we’ll be referring to from here on out as MARPE.
Publicly, orthodontia is probably most strongly associated with tooth alignment. Braces, joined in recent years by clear aligners, are a very visible example of orthodontia at work.
However, as anyone who has received orthodontic treatment can tell you, it’s common that treatment also requires additional steps, and one of the most common processes is expansion.
Palatal expansion widens the upper jaw, helping the top and bottom rows of teeth align with each other. MARPE is a newer expansion technique that uses mini-screws, as the name implies.
According to Mehta, prior to MARPE, mini-screws were originally introduced in orthodontia as a tool for absolute anchorage, often to treat complex orthodontic malocclusions, i.e. misaligned upper and lower teeth.
In MARPE, these mini-screws assist in expansion, and as Mehta’s published research has shown, the location where the mini-screws are inserted is extremely important and can affect the success rate.
Compared to traditional expansion appliances, the MARPE appliance is anchored to the bone, which could potentially result in a greater expansion of the maxillary arch.
Perhaps even more important to patients is MARPE’s potential to cut down on some of the side effects of other expansion techniques.
“Our research has shown for the first time the long-term effects of MARPE and confirmed that MARPE appliances are advantageous in that they lead to reduced dental side effects such as root resorption and loss of alveolar bone.”
Mini-screws are a kind of technology in and of themselves, but more relevant to the discussion of the relationship between orthodontia and tech are some of the advanced tools that Mehta uses to study MARPE.
Just one of the many pieces of advanced tech that Mehta uses in his research is known as Cone-Beam Computer Tomography.
At a basic level, CBCT is a way to accomplish three-dimensional imaging of head and neck structures, which of course are crucial for a researcher or an orthodontist’s understanding of a patient’s needs and the effects that current treatments are having.
“Combining CBCT with my long background of research on rapid palatal expansion, I have accomplished multiple state-of-the-art research projects regarding the long-term treatment outcomes after conventional and mini-screw assisted rapid palatal expansion.”
Making use of tech that simply didn’t exist previously, CBCT offers major advantages when compared to other imaging options, such as X-Ray.
With more accurate information on how a patient is faring with any given treatment method over time, Mehta can properly assess the efficacy of each technique.
Orthodontia has lifelong effects, and in Mehta’s opinion, other contemporary research studies of expansion appliances have only examined the short-term effects of these appliances.
Mehta finds this to be problematic and has been attempting to remedy this with his own research.
“The important clinically relevant question is whether these effects with expansion appliances can lead to a difference in the treatment outcomes in the long term. One of our pivotal studies on airway and orthodontics was published recently in The Angle Orthodontist to identify the long-term effects of MARPE on airway and skeletal expansion.”
To summarize the results of this research, while both MARPE and RPE both caused an increase in maxillary skeletal width after expansion, only MARPE’s changes were stable. MARPE led to increased skeletal width of the maxilla (the upper jaw) after two years and eight months compared to RPE and controls.
“This is an important breakthrough missing from the current literature regarding the long-term effects of MARPE and how MARPE can be useful in increased skeletal expansion of the maxilla, even in older patients where conventional RPE can’t be used.”
This longer-term aspect of expansion just isn’t being covered elsewhere, and Mehta is confident that this information is of great value not only to other researchers and orthodontists but also to the many patients who could benefit from the use of MARPE.
This is an important point to return to: despite all the technical details that we’ve been sharing here, this isn’t theory. This is real, hands-on research that’s meant to lead to advances in orthodontia.
Both cutting-edge technology and researchers willing to make use of this technology are key to these advances, and this leads us to a challenging but essential question about the orthodontia industry: are practicing orthodontists, researchers, and academics often supportive of change?
We put this question to Mehta, hoping to better understand the relationship between research and orthodontic practice.
Though it’s difficult to speak on any industry in generalizations, Mehta feels that positive change in orthodontia is often slow but also steady and significant.
He pointed out that new techniques have already changed orthodontic biomechanics substantially. Mini-screws alone, both within and outside of the application of MARPE, have opened new doors in orthodontic practice.
As for whether practicing orthodontists are typically willing to explore and offer new treatment methods and techniques, Mehta maintains a positive perception.
“Orthodontists accept new techniques provided there is reliable, quality research on these techniques. By undertaking research projects on the long-term effects of MARPE, my goal has been to provide more information and evidence to orthodontists that can help them make informed decisions in their clinical practice.”
As we’ve already touched on briefly, MARPE holds great significance for certain types of patients. It’s not meant to become the new universal standard for palatal expansion but rather a highly useful option for specific cases.
“Especially in adult patients who need maxillary expansion and cannot be treated well with conventional expansion, MARPE can be a very effective alternative as the conventional rapid maxillary expansion doesn’t lead to predictable results. MARPE is a non-surgical option that can lead to higher stability.”
With proven advantages like these, orthodontists really can’t ignore MARPE, but again, all this information has been thoroughly vetted and tested by researchers like Mehta, and this research takes time.
It could be a while longer before MARPE becomes a common treatment, but in the meantime, Mehta continues his work in earnest, and a big part of that work is presenting his ideas to the orthodontic community.
In addition to his ongoing research work, Mehta has been invited to present on MARPE at an international orthodontic conference in Brazil, as well as at a major conference in the US.
Mehta will also present lectures on MARPE throughout numerous orthodontic programs both in the US and abroad.
“I’m excited to share an evidence-based perspective on the long-term effects of conventional expansion and MARPE and disseminate the results to a broader audience.”
The work never really ends, but Mehta is clearly dedicated to sharing evidence with as many people as possible. It’s a long process, but this is how an industry moves forward, and it’s certainly worth acknowledging the role that researchers and their technological tools play in improving the options and outcomes for patients. And this is something we can all smile about.