“Patients that are stuck, I do [MOPs®]. Patients that are burned out, I do it. Non-responsive teeth, I do it. Patients in relapse, I do it. Issues with root resorption, I do it.” – Dr. Neil Warshawsky on micro-osteoperforation™, AAO 2019.
The process of orthodontic tooth movement centers around bone remodeling. When a constant force is applied to a tooth, for example via braces or aligners, the body responds by breaking down alveolar bone to allow the tooth to move more easily through it. At the same time, the alveolar bone is rebuilding itself to fill in the gaps left behind by that displaced tooth. This process of breaking down bone and rebuilding bone is known as bone remodeling.
Cells that break down bone are called osteoclasts, and cells that build up bone are called osteoblasts. In the figure below, you can see how osteoclasts are activated and make way for tooth movement, while osteoblasts follow in the tooth’s path.
Micro Osteo Perforation (aka MOPs, Propel®)
Micro-osteoperforation (MOPs) is a University developed technique, used to accelerate the rate of orthodontic tooth movement. MOPs has demonstrated to accelerate bone remodeling by as much as 62%. It works by placing small dimples along a patient’s gum-line, in accordance with an orthodontic treatment plan. Those dimples cause micro fractures within the bone that in turn accelerate the body’s local osteoclastic and osteoblastic responses.
This inflammatory response was first described as the Regional Acceleratory Phenomenon (or RAP) by Harold Frost in 1983. He determined that an injury to the cortical bone accelerated ordinary wound healing processes. In other words, the activation of cells necessary for repair are given a boost, concentrated around the site of the injury.
As a result of this increased cellular activity, the alveolar bone becomes temporarily less dense, and teeth can move more easily and predictability through it. It is important to note that the micro-osteoperforation technique utilizes the body’s own biological responses to accelerate orthodontic tooth movement.
MOPs can be performed in-office within a matter of minutes, as only topical anesthetic is required. If necessary, MOPs can be administered more than once on the same patient. MOPs can be performed on patients with brackets or clear aligners, just before treatment begins, or at any time during active treatment. The placement of MOPs varies from patient to patient and is best determined by a treating clinician. Due to its concentrated localized effect, MOPs is most commonly administered around rate-limiting teeth.
The benefits of MOPs reach far beyond clinical solutions; there are considerable practice solutions too. Not only does MOPs accelerate bone remodeling and orthodontic tooth movement, it increases predictability and reduces treatment time, allowing for reduced chair time, greater practice efficiency, and ultimately a greater patient experience.
Propel® Excellerator® Series Drivers are used in conjunction with Propel Excellerator Series Tips in order to perform micro-osteoperforations. The Propel device is the only product on the market cleared by the FDA for use in micro-osteoperforation. The patented Excellerator Series devices are purposefully designed and manufactured with specially treated high-grade surgical steel to ensure safety and to help prevent shearing, breakage or dulling and minimize soft tissue injury.
MOPs at a Glance [1,4]
Clinical Benefits [1,3,4]
Practice Benefits