Leukocyte platelet-rich fibrin and orthodontic tooth movement

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We congratulate the authors for their notable work in the area of leukocyte- and platelet-rich fibrin (L-PRF) and orthodontic tooth movement (Pacheco AAR, Collins JR, Contreras N, Lantigua A, Pithon MM, Tanaka OM. Distalization rate of maxillary canines in an alveolus filled with leukocyte-platelet-rich fibrin in adults: a randomized controlled clinical split-mouth trial. Am J Orthod Dentofacial Orthop 2020;158:182-91). The study is significant because it takes the use of L-PRF a step ahead in orthodontics. However, there are a few concerns regarding the present study that, if clarified, might improve the clinical approach and outcome. In the third paragraph of the introduction, the authors wrote “After extraction, the alveolus begins the process of bone resorption, initially decreasing in width and subsequently in height, to achieve a 50% reduction in the width of the alveolar ridge during the first year.14” However, the cited reference (Hopewell) concerns Consolidated Standards of Reporting Trials reporting for randomized controlled trials, which is irrelevant to the sentence. Similarly, in the fifth paragraph of the introduction, the authors wrote that “The anti-inflammatory properties of L-PRF may reduce the rate of OTM because OTM relies on the inflammatory process.22” For this important evidence, the authors cited an article by Schulz et al, again dealing with the Consolidated Standards of Reporting Trials requirements. It is disturbing to note such irrelevant references for key statements. The sample consisted of young adult patients diagnosed with Class I or Class II Division 1 malocclusion, but nothing was mentioned about the facial pattern (hypodivergent, normodivergent, or hyperdivergent), which has a significant effect on the rate of orthodontic tooth movement and alveolar bone morphology.1Nahidh M. Al Azzawi A.M. Al-Badri S.C. Understanding anchorage in orthodontics-review article.J Dent Oral Disord. 2019; 5: 1117-1121Google Scholar In the third paragraph of the introduction, the authors mentioned “50% reduction in the width of the alveolar ridge during the first year.14” To avoid this, various biomaterials have been used. However, in orthodontia, forces are used to induce the tooth movement immediately after extraction and not after a year or so, which minimizes the side effects related to alveolar bone resorption. This concept of socket preservation is more relevant for other branches of dentistry rather than orthodontics. The authors claimed in the trial design section that the methodological quality of the trial was assessed by the Cochrane risk of bias tool. However, the result of the assessment was not mentioned or reported anywhere in the study. In the outcome measurements, the method used for measuring the rate of canine retraction was not valid. The reference considered in this study was the maxillary dental midline, which itself is not a stable landmark, and this would be highly influenced by forces acting on the entire arch. In the Material and Methods section, it has been mentioned that “the measurements were repeated 4 times…the measured distance was divided by the number of days (28), which yielded the amount of movement per month.” Dividing the measured distance by the number of days could only yield the amount of movement per day, not the month. In the statistical analysis, the Pearson correlation coefficient was used to calculate the measurement errors. In the Results section, the Pearson correlation coefficient was used as evidence of reliability to assess intrarater reliability, but Table III described the values of the intraclass correlation coefficient. It seems that the authors had mixed-up everything and tried to support the reliability of measurement method with values of the Pearson coefficient from the intraclass coefficient table because the Pearson coefficient is interclass not intraclass.2Koo T.K. Li M.Y. A Guideline of selecting and reporting intraclass correlation coefficients for reliability research.J Chiropr Med. 2016; 15: 155-163Crossref PubMed Scopus (5149) Google Scholar Distalization rate of maxillary canines in an alveolus filled with leukocyte-platelet–rich fibrin in adults: A randomized controlled clinical split-mouth trialAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 158Issue 2PreviewThe objective of this study was to evaluate the distalization rate and changes in inclination of the maxillary canines in alveoli preserved with leukocyte-platelet–rich fibrin (L-PRF) membranes in adult patients. The null hypothesis was that there are no differences in the canine distalization movement rate between the treated and the control sides. Full-Text PDF Authors' responseAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 158Issue 5PreviewThank you for your interest in our article and your comments. Full-Text PDF