The host in the machine

Dr. Jonathan Nicozisis waxes philosophical on Propel Orthodontics’ Excellerator technology

The machinery that is involved in orthodontic tooth movement is a complex milieu of cascading events and tissue reactions of the host periodontium. As the oldest specialized discipline in dentistry, we have researched and understood the periodontal response when forces are imparted on teeth better than anyone else. We fully understand the direct connection of the physical push and pull that elicits bone remodeling to satisfy the body’s mindful desire to return to homeostasis.

The “ghost in the machine” is a concept describing philosopher René Descartes’ mind-body dualism to explain mental activity carrying on in parallel to physical action, but where their means of interaction are unknown. To translate, it is the notion that the mind is distinct from the body, and that mental states are separable from physical states. Hence “the ghost in the machine” describes the fundamental distinction between mind and matter with the presumption that they act independently in parallel without a direct cause-and-effect relationship.

As orthodontists, we certainly know this is not the case in what we do. We appreciate that there is a direct cause and effect of our mental planning of mechanics to accomplish physical tooth movements given our initial diagnosis and planned treatment.

Our everyday routine actions, however, have created a mental complacency that has lulled us into repetitive activities, robbing us and our patients of novel processes to provide better outcomes in shortened treatment times. In a sense, unknowingly, a disconnect has developed between our thoughts in planning and how our physical mechanics are received by the host tissues of the periodontium.

This is our orthodontic ghost in the machine.

Simply put, we have forgotten the details involved in the physiology of tooth movement and thus do not even think of the possibility of enhancing the process to our advantage; for doctors in private practice, the host in the machine that is the periodontium reacting to orthodontic tooth movement has been overlooked for too long, thus resulting in this disconnect.


Postulate: (or axiom) is a statement accepted as true without proof Euclid had his postulates in Geometry. Nicozisis has his postulates of Propel:
1. Incorporation of Propel in a treatment plan and the corresponding decrease in number of visits to complete the case is congruent with an increase in profitability per visit.
2. If there is a space that exists between two teeth, then there exists one Propel procedure that will close the space faster than conversely without Propel.
3. A single office visit with a nominal increase in chair time of no more than 15 minutes for all four quadrants will substitute for a savings of two to three visits to produce the same movements.
4. The Fourth Order of Orthodontics is elicited with Propel allowing doctors to augment the host tissue response to their advantage preceding force application.
5. Doctor-controlled and targeting capabilities are characteristics inimitable to Excelleration with Propel.
6. If X is a variable, the one’s investment of $”X” thousand in Propel will translate in effecting 4.0-5.5 times “X” patients versus effecting 1 times “X” patients with other devices currently in the market place.

Prior to today’s technology, the connection between our mental thought processes to augment the physical reaction of the host tissues was to apply either a heavy or a light force. Heavy forces were reserved for skeletal movements (think cervical or high-pull headgear, protraction face masks, and palatal expanders), whereas light forces were applied for tooth movement to minimize tissue ischemia and promote frontal resorption as opposed to undermining resorption.

The basic science behind Propel Orthodontics’ proprietary Excellerator technology is the answer to the ghost in our own machine that is orthodontic tooth movement.

To that end, Propel allows us to connect the mental understanding of the physiology of tooth movement and physical actions to elicit the desired movement. More so, Propel now affords us the capability of enhancing this connection between our understanding and actual undertaking of tooth movement to our advantage and benefit to the patient.

Modestly put, an increase in local inflammation via transmucosal osteoperforations causes an increase in osteoclast recruitment and differentiation. This causes the bone to remodel faster, and therefore, teeth move faster through the bone. Doctors are in full control and can target where this facilitated phenomenon occurs without relying on patients for compliance.

The parallel knowledge of and physical stimulation of the host machinery involved in orthodontic tooth movement is now truly linked. Decades of academic research is crossing over into private practice and practical application in a non-disruptive way regardless of the modality of treatment chosen for our patients’ benefit.

Patients benefit from shortened treatment times, which means less time in orthodontic appliances or aligners. Furthermore, it means fewer visits to the office and taking less time away from work or school to complete treatment. Finally, there is no recovery from the procedure, and patients can go about their day without any downtime or discomfort.

Doctors benefit from better outcomes in less time. This means less chair time overall to finish each case with an increase in profitability per visit. Distinct marketing advantages of Propel accelerating orthodontic technology help attract new patients to the office as well as convert those who may have been reticent based on the length of time they were originally quoted. If the average case takes one to three devices, the modest increase in overhead, approximately $100-$300, is well worth the savings elsewhere.

The concept of mind-body dualism need not be reserved for philosophers waxing poetic on explaining the possible parallel nature of human being’s mental and physical activity. It can now be applied to bridge the fine gap between the basic science research behind Propel Orthodontics’ Excellerator technology and actual clinical application to the mutual benefit of both patients and doctors. The complacency of our mundane day-to-day office routines can now be filed in the history chapters of our orthodontic literature!

This information is sponsored and provided by Propel Orthodontics.

Jonathan Nicozisis, DMD, MS, has been in the specialty practice of orthodontics since 1999. He completed his dental education at the University of Pennsylvania before attending Temple University for his orthodontic residency. While at Temple University, Dr. Nicozisis received his specialty certificate in orthodontics and a master’s degree in oral biology. During his training, he also completed an externship at the Lancaster Cleft Palate Clinic in Lancaster, Pennsylvania, where he was involved with the care of patients with craniofacial syndromes. Dr. Nicozisis is a member of Invisalign® National Speaker’s Bureau and Clinical Research Network where he helps conduct research and development of new technologies and improvements to the Invisalign technique. Dr. Nicozisis is also the founding orthodontist and a 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. Dr. Nicozisis’ master’s research is the basis for BAS Medical innovative research. In February 2010, Corthera was acquired by Novartis. Dr. Nicozisis has been awarded membership to the Edward H. Angle Society of Orthodontists. He is a member of the American Association of Orthodontists, Middle Atlantic Society of Orthodontists, New Jersey Dental Association, Mercer County Dental Society, and the Greater Philadelphia Society of Orthodontists. Dr. Nicozisis is a paid lecturer, but not a consultant, for Propel Orthodontics.

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