The Significance of Utilizing A Corticotomy on Periodontal and Orthodontic Outcomes: A Systematic Review and Meta-Analysis.

Abstract

Simple SummaryThe collaboration between periodontics and orthodontics has the potential to allow safer orthodontic tooth movement and improve vulnerable oral conditions especially for patients with very thin bone and soft tissue. By providing this interdisciplinary surgical approach where thin bone and soft tissue are surgically augmented to convert a fragile-thin to a robust-thick tissue phenotype, this permits orthodontic treatment in these previously thin tissue cases to proceed without iatrogenically induced adverse effects. This is an infrequently performed procedure with few clinical recommendations. This review paper provides the rationale and the currently available evidence on the benefits of this novel surgical approach.Purpose: This systematic review compares the clinical and radiographic outcomes for patients who received only a corticotomy or periodontal accelerated osteogenic orthodontics (PAOO) with those who received a conventional orthodontic treatment. Methods: An electronic search of four databases and a hand search of peer-reviewed journals for relevant articles published in English between January 1980 and June 2021 were performed. Human clinical trials of ≥10 patients treated with a corticotomy or PAOO with radiographic and/or clinical outcomes were included. Meta-analyses were performed to analyze the weighted mean difference (WMD) and confidence interval (CI) for the recorded variables. Results: Twelve articles were included in the quantitative analysis. The meta-analysis revealed a localized corticotomy distal to the canine can significantly increase canine distalization (WMD = 1.15 mm, 95% CI = 0.18–2.12 mm, p = 0.02) compared to a conventional orthodontic treatment. In addition, PAOO also showed a significant gain of buccal bone thickness (WMD = 0.43 mm, 95% CI = 0.09–0.78 mm, p = 0.01) and an improvement of bone density (WMD = 32.86, 95% CI = 11.83–53.89, p = 0.002) compared to the corticotomy group. Conclusion: Based on the findings of the meta-analyses, the localized use of a corticotomy can significantly increase the amount of canine distalization during orthodontic treatment. Additionally, the use of a corticotomy as a part of a PAOO procedure significantly increases the rate of orthodontic tooth movement and it is accompanied by an increased buccal bone thickness and bone density compared to patients undergoing a conventional orthodontic treatment.