Alveolar Decortication Research Articles

Corticotomy–An Accelerated Orthodontic Procedure

Corticotomy found to be effective in accelerating orthodontic treatment. It involves selective alveolar decortication in the form of decortication lines and dots performed around the teeth that are to be moved. It is done to induce a state of increased tissue turnover and a transient osteopenia, which is followed by a faster rate of orthodontic tooth movement. This technique has several advantages, including faster tooth movement, shorter treatment time, safer expansion of constricted arches, enhanced post-orthodontic treatment stability and extended envelope of tooth movement.

Relationship between the polymorphism in the interleukin 1-β and the treatment time of patients subjected to a modified piezocision technique.

Aim: We aimed to evaluate the correlation between the polymorphism of the interleukin 1-Beta (IL1-β, +3954 C>T) and tooth movement, in a group of Colombian patients undergoing surgically accelerated orthodontic tooth movement. Methods: The study was nested to a controlled clinical trial. Blood samples were taken from 11 women and 29 healthy Colombian male volunteers between 18 and 40 years old, after 1 year of starting orthodontic treatment. The patients presented malocclusion class I, with grade II or III. To detect the genetic polymorphism of the nucleotide +3954 C to T in the IL-1β gene, we used a real-time PCR assay. Results: Eleven individuals presented the allele 2 (T) heterozygous with the allele 1 (T/C) and 19 individuals were homozygous for the allele 1 (C/C). When analyzing the presence of the SNP, no significant differences were found in any of the variables. The best treatment was reflected in Group 3 (selective upper and lower alveolar decortication and 3D collagen matrix) and Group 4 (only selective alveolar decortication in the upper arch, with 3D collagen matrix), with 27% and 35% more speed respectively than in the control group. Conclusions: Our analyses indicated that a reduction in the total treatment time can be mostly potentiated by using decortication and collagen matrices and not for the presence of the allele 2 in the IL-1β. Nevertheless, it is important that further studies investigate if the polymorphism could be associated with the speed of tooth movement and analyze the baseline protein levels.

The effect of alveolar decortication on orthodontically induced root resorption.

To determine the effect of alveolar decortication on orthodontically induced root resorption. A total of 24 male Wistar rats (14 week old) were used. The rats were randomly divided into one of the following three groups: group 1 (control group), orthodontic tooth movement (OTM) for 2 weeks; group 2, OTM for 2 weeks + two alveolar decortications (2AD); group 3, OTM for 2 weeks + four alveolar decortications (4AD). The first molar was moved mesially for 2 weeks. Micro computed tomography was used to analyze root volume. In addition, histological sections were stained with Tartrate Resistant Acid Phosphatase (TRAP) to quantify the osteoclast number. The buccal root volume in OTM + 4AD group was decreased by 8.92% and 6.11% when compared with the OTM-only group and OTM + 2AD group, respectively. Similarly, the other four root volumes in the OTM + 4AD group was decreased by 8.99% and 5.24% when compared with the OTM-only group and OTM + 2AD group, respectively. There was a decrease in buccal root density in the OTM + 4AD group by 4.66% and 3.56% when compared with the OTM-only group and the OTM + 2AD group, respectively. In addition, there was an increase in the number of osteoclasts by 195.73% and 98.74% in OTM + 4AD group in comparison with the OTM and OTM + 2AD group. The amount of orthodontically induced root resorption was positively correlated with the extent of surgical injury used to accelerate orthodontic tooth movement.

Comparison of the efficiency of alveolar decortication and low level laser therapy on orthodontic tooth movement and alveolar metabolism in rats

Background/purposeReducing orthodontic treatment duration has many advantages for both clinicians and patients. This study was designed to compare the effects of alveolar decortication and low level laser therapy methods on tooth movement rate and alveolar bone metabolism. Materials and methodsA total of 42 Wistar albino rats were divided into three main groups as: Alveolar decortication (AD), low level laser therapy (LLLT) and only orthodontic force (F). The groups were evaluated at 7 and 14 day time points. Tooth movement rates were calculated by measuring the space between the contact points of the first and second molars. Comparisons regarding the alveolar bone metabolism were accomplished by evaluating osteoclast counts and RANKL - OPG expressions. ResultsThe rate of tooth movement, at all time points, was significantly higher for the AD group than the other groups and was significantly higher in the LLLT group than the F group. At both time points, the RANKL and OPG expression in the AD group was significantly higher than the other groups and these parameters in the LLLT group was significantly higher than the F group. The osteoclast count values in the AD and LLLT groups were significantly higher than the F group and there were no significant differences between these two groups at all time points. ConclusionThis study shows that, to be more effective at AD, both AD and LLLT therapy significantly increases the level of tooth movement in the early period through their stimulating effects on the alveolar bone metabolism.

Localized Piezoelectric Alveolar Decortication for Orthodontic Treatment in Adults: A Randomized Controlled Trial

Localized Piezoelectric Alveolar Decortication for Orthodontic Treatment in Adults: A Randomized Controlled Trial

Multilevel biological responses following piezocision to accelerate orthodontic tooth movement: A study in rats

AimThe objective of the present study was to explore the alveolar bone tissue response and its dynamic at the tissue, cellular, and molecular levels following a piezocision procedure in a rat model. MethodsSixty rats were randomly allocated to either a control group (conventional orthodontic tooth movement) (TM) or a test group (piezocision-assisted orthodontic tooth movement) (TM+PS). Tissue, cellular, and molecular analyses were performed at 7, 28, and 42 days after the procedures. Orthodontic Tooth Movement (OTM) and Bone Volume Fraction (BVF) were evaluated using Nano-computed tomography. Moreover, histological parameters such as the number of osteoclasts were assessed, and the expression of cytokines involved in the bone turnover was investigated using quantitative reverse transcriptase polymerase chain reaction analysis. ResultsThe OTM was 1.8 times faster in the TM+PS compared with the TM at day 42. A significant decrease in BVF was found in the TM+PS group compared with the TM group at day 7 and day 28, whereas no difference was observed at day 42. The number of osteoclasts was significantly higher in the TM+PS group compared with the TM group at day 7. No difference between the two groups was found in the number of osteoclasts involved in root resorption. RANKL and osteoprotegerin were significantly higher in the piezocision group than in the control group at day 7. ConclusionsIn these conditions, the efficacy of piezocision-assisted alveolar decortication to accelerate tooth movement was demonstrated, and the underlying biological responses at the tissue, cellular and molecular levels were emphasized.

Study of bone remodeling in corticotomy-assisted orthodontic tooth movement in rats.

The goal of this study was to determine the structure change of the alveolar bone and the expression of a group of bone remodeling-related factors. Sixty healthy male Wistar rats were randomly divided into three groups. Selective alveolar decortication (SAD), tooth movement (TM), and "combined therapy" (SAD+TM) was performed in group I, II, and III, respectively. On days 0, 7, 14, 21, and 42, a Micro-CT scan was performed on the maxillary alveolar bone and tooth. In addition, on days 0, 7, 14, 21, 28, and 42, some of the rats were killed by cervical dislocation and tissues were harvested. Analysis of scan data revealed a significant decrease in bone density of the alveolar bone at 14 days post-surgery, and increased at 42 days post-surgery to a level higher than that before the surgery. Microarray and bioinformatics analysis were performed to explore gene expression profile in three groups (SAD, TM, and SAD+TM),and a large number of differentially expressed genes were identified. In addition, real-time polymerase chain reaction was performed to determine the expression of bone remodeling-related factors. The expression of osteoblast-related cytokines, including osteopontin, bone sialoprotein, and osteocalcin,and osteoclast regulators macrophage-colony stimulating factor (M-CSF) and RANKL (activator of nuclear factor KB receptor ligand) were increased in group III, suggesting that there was increased bone synthesis and activation of bone absorption. Moreover, group III had a unique alveolar bone remodeling pattern: RANKL and osteoprotegerin-promoted alveolar remodeling. In conclusion, during the early stage of orthodontic tooth movement, corticotomy can accelerate the movement of teeth, modulate the state of bone metabolism, and activate osteogenesis and osteoclast, which support the theory of regional acceleratory phenomenon.

Three-dimensional finite element analysis to evaluate biomechanical effects of different alveolar decortication approaches on rate of canine retraction

The aim of this study was to compare different corticotomy approaches and determine their biomechanical effects on rate of canine displacement when compared to conventional orthodontics. Three-dimensional Finite Element Models with conventional non-corticotomy approach (model 1) and three corticotomy approaches ensuing buccal and palatal vertical cuts (model 2), interseptal bone reduction (model 3), buccal vertical cuts (model 4) were fabricated. Displacement of the canine and von Mises stresses in the canine and trabecular bone were calculated and compared under a distal retraction force of 1.5N. The maximum displacement of canine with minimum anchorage loss was seen in model 3 followed by model 2, model 4 and model 1. The maximum equivalent (von Mises) stress was concentrated mainly on the distal side of canine in model 3 and had a uniform distribution of stresses on entire root surface. Corticotomy approaches effectively accelerated maxillary canine retraction, exhibiting twice the rate of canine movement with minimum anchorage loss when compared to non-corticotomy approach. Corticotomy with interseptal bone reduction was most effective in terms of canine displacement and stress distribution.

The effect of the extent of surgical insult on orthodontic tooth movement.

The primary objective of this study was to investigate how the extent of surgical insult affects the orthodontic tooth movement (OTM) and the alveolar bone modelling and remodelling in a rodent model. 15-week-old male Wistar rats were used in the research and they were randomly divided into three treatment groups: (1) OTM only (N = 8); (2) OTM + 2 alveolar decortication (AD) (less surgical insult) (N = 8); and (3) OTM + 4 AD (more surgical insult) (N = 8). A nickel-titanium spring delivering 5-8 g of force was used to protract the molar mesially using maxillary incisors as an anchorage. AD was done using a hand piece and a round bur, adjacent to the left first maxillary molar on the palatal alveolar bone. After 14 days of OTM Wistar rats were killed and microfocus computed tomography and histological analysis were performed. The OTM + 4AD group presented with a significant increase (P < 0.05) in the rate of tooth movement when compared to OTM + 2AD group and OTM only group. In addition, the OTM + 4AD group had a significant decrease in bone volume and tissue density (P < 0.05) and a significant increase (P < 0.05) in the trabecular spacing and trabecular thickness when compared to OTM only. Histological quantification of tartrate-resistant acid phosphatase indicated a significant percent increase (P < 0.05) in OTM + 4AD group, when compared to OTM + 2AD and OTM only group. Increased surgical insult increases the rate of OTM. Additionally, increased surgical insult decreases the bone volume and the tissue density.

Selective piezocision-assisted orthodontic treatment combined with minimally invasive alveolar bone regeneration: A proof-of-concept

Piezocision is a localised piezoelectric alveolar decortication involving minimally invasive corticotomies to accelerate orthodontic treatments. The objective of this proof-of-concept was to describe an innovative protocol combining selective piezocision with minimally invasive bone regeneration to reduce the risk of buccal tissue dehiscences often observed in orthodontic treatments. This proof-of-concept initial report aimed at investigating whether this new surgical concept is relevant. A patient presenting an asymmetrical dental class II, overcrowdings, midline deviations and buccal bone dehiscences in the lower incisor region was treated with this new treatment approach. From an orthodontic point of view, the dental class II, the overcrowdings and the midlines were completely corrected. From a periodontal perspective, no gingival recession was observed; however, scars related to the piezocision were slightly visible at the mandible. The post-imaging demonstrated the absence of bone dehiscences. Up to 3 years after the completion of the treatment, no relapse was observed. This novel approach suggested several advantages and may be further investigated at a larger scale in order to validate the benefits and to define the scope of intervention.

Effects on Alveolar Bone Changes Following Corticotomy-assisted Molar Mesialization

Objectives: The aim was to evaluate alveolar bone changes that occur following decortication-facilitated orthodontics for mandibular molar protraction and to evaluate the rate of mandibular molar mesialization after decortication. Materials and Methods: The sample comprised 24 patients with a mean initial age of 29.04 years. Patients had their mandibular first molar extracted due to carious lesions. Alveolar decortication at the edentulous site was performed on all patients 2 weeks before protraction of the second molar. Cone-beam computed tomogram was used to evaluate alveolar bone changes following decortication-assisted mandibular molar protraction. Changes in buccolingual alveolar bone thickness, buccal and lingual marginal bone levels, and crestal bone height were assessed at preprotraction (T0) and 6-month postprotraction (T1). A lateral cephalometric radiograph was used to evaluate the rate of mandibular second molar protraction at T0 and T1. Results: The mean mandibular second molar movement was 5.98 mm and ranged from 3.5–10.5 mm. The mean treatment time was 4.85 months with a range of 3–9.5 months. The buccolingual alveolar bone thickness of the edentulous ridge was significantly increased; the marginal bone level did not change significantly, and the crestal bone height was significantly decreased after the edentulous space had been closed for 6 months. Conclusions: Decortication-facilitated orthodontics for mandibular molar protraction can help move the mandibular second molar forward through the atrophic edentulous area and improve alveolar bone thickness in the buccolingual dimension.

The effects of alveolar decortications on orthodontic tooth movement and bone remodelling in rats.

Alveolar decortication (AD) is a minimally invasive procedure that can be performed in the orthodontic office as an intervention to accelerate tooth movement. There is a gap in the literature evaluating the earlier and delayed responses after AD using lighter orthodontic forces in a rat model. Therefore, the aim of this study was to determine the effects of AD in the amount of orthodontic tooth movement and on alveolar bone remodelling in a rodent model, after 7 or 14 days. A total of 32 15-week-old male Wistar rats were used in four treatment groups: (1) orthodontic spring only (7 days), (2) orthodontic spring only + AD (7 days), (3) orthodontic spring only (14 days), and (4) orthodontic spring only + AD (14 days). A closed coil nickel-titanium spring delivering 8-10 g of force was used to move the molar mesially. Alveolar decortication was done using a high speed, quarter round bur adjacent to the left first maxillary molar, on the palatal alveolar bone. At each endpoint, rats were sacrificed and microfocus computed tomography and histological analysis were performed. The spring + AD group presented with a significant increase in the rate of tooth movement when compared with spring only group, 7 and 14 days after the beginning of the experiments. In addition, the spring + AD group had a significant decrease in bone volume and tissue density and a significant increase in the trabecular spacing and the number of osteoclasts at 7 and 14 days. Furthermore, a fibrous tissue was found to replace the alveolar bone in the spring + AD group at day 14. Alveolar decortications enhanced bone remodelling around the tooth movement region and could be used as an adjunct surgical procedure to accelerate the rate of tooth movement.

Mandibular Incisor Position Changes do not Explain Increase in Keratinized Gingiva Height after Periodontally Accelerated Osteogenic Orthodontics

Purpose This study aimed to reexamine the relationship between mandibular incisor inclination, prominence and vertical changes in position, and keratinized gingival tissue (KT) height changes labial to the mandibular incisors after orthodontic treatment with and without augmented corticotomy (Cort). Materials and Methods Two orthodontically treated groups of 35 individuals each, with (Cort) and without (conventional [Conv]) alveolar decortication and augmentation bone grafting (periodontally accelerated osteogenic orthodontics [PAOO]), were matched for sample size, gender, mandibular premolar extractions, pretreatment age, posttreatment observation period, and pretreatment KT height in this case–controlled retrospective study. Pre- and post-treatment lateral cephalometric radiographs were evaluated for mandibular incisor vertical, inclination, and prominence changes. Results As reported previously (Wilcko 2015), KT height had significantly increased by 0.78 mm (P = 0.001) in the Cort group and decreased by 0.38 mm (P = 0.002) in Conv on an average of 1.5 years after completion of active orthodontic therapy. In this study, Cort mandibular incisors proclined and protruded significantly during therapy while Conv incisors did not. Changes in mandibular incisor inclination and prominence explained neither the decrease in keratinized gingiva height in Conv nor the KT height gain in Cort. Conclusions In spite of mandibular incisor proclination and protrusion, orthodontic therapy combined with alveolar decortication and augmentation bone grafting resulted in a clinically significant increase in keratinized gingiva height 1.5 years’ posttreatment.

Three-dimensional alteration of constricted alveolar ridge affected by root thrusting with and without open-flap decortication.

To investigate the morphometric and histological alterations of the constricted alveolar ridge when affected by root thrusting with and without open-flap decortication. Eight beagles were divided into three groups: C, control without root thrusting; R, root thrusting only; RD, root thrusting with alveolar decortication. The ridge constriction model was prepared in 16 mandibular quadrants after extraction of the third premolars. Reciprocal root thrusting of the second and fourth premolars was performed toward the constricted ridge for 10 weeks, having a moment of 900 g-mm. Open-flap decortication was conducted on the constricted bone surface in group RD. Micro-CT-based histomorphometric analysis and trichrome-staining-based tissue fractional analysis were performed to evaluate morphometric and microstructural changes on the ridge. Group R revealed a higher percentage of bone volume (P < .001), lower bone mineral density (P < .01), and higher trabecular number (P < .001) than did group C, which was supported by a higher bone fraction woven to lamellar bone (P < .05) resulting from histologic fractional analysis. However, group RD showed no significant difference from group C. Root thrusting toward the constricted ridge induced hypertrophic bone modeling with a high trabecular fraction on the ridge. However, combined open-flap decortication with root thrusting did not improve the volume or quality of the constricted ridge.

Expediting the Irksome - the Cortical Approach: A Case report

Corticotomy assisted orthodontic treatment is a promising interdisciplinary approach, which has offered solution to many limitations in the orthodontic therapy. The procedure involves the alveolar decortication in the form of cortical grooves and perforations performed around the teeth that are to be moved. In this case report, a 17 year old male under fixed orthodontic therapy with a complaint of delayed protraction of mandibular second molars underwent corticotomy procedure. The decortication was done followed by elevation of buccal and lingual flaps. After 2 weeks of the surgical procedure, orthodontic tooth movement was initiated.

Instability of the mandibular dental arch? Look again!

Changes in mandibular dental arch parameters have been thoroughly investigated as a function of time after removal of orthodontic appliances and instability tenets have emerged. To date, only permanent fixed retention as a posttreatment strategy has been demonstrated effective against changes in mandibular anterior alignment. No active orthodontic therapy has been shown to improve mandibular arch outcome stability except augmented corticotomy significantly reduced 5- and 10-year rate of change in mandibular irregularity index. The purposes of this study were as follows: (1) to evaluate efficacy of augmented corticotomy in stabilizing posttreatment mandibular arch widths and length and (2) to review mandibular dental arch instability data from the scholarly literature. Results demonstrated augmented corticotomy effective in the 5-year short term for stabilizing intercanine width and arch length but not 10-year long term. Data extracted from 76 separate publications representing 4250 subjects reaffirmed the consensus view that irregularity index will increase and there will be decreases in arch width and length as a function of time. It was concluded that alveolar decortication + augmentation bone grafting (PAOO) is the only active orthodontic treatment strategy that will stabilize mandibular irregularity index for at least a decade, and permanent fixed canine-to-canine retention is the only posttreatment orthodontic strategy that will preclude recrowding and intercanine width decrease in the mandibular anterior segment.

Localized Piezoelectric Alveolar Decortication for Orthodontic Treatment in Adults

This randomized controlled trial aimed to evaluate the benefits and clinical outcomes of piezocision, which is a minimally invasive approach to corticotomy that is used in orthodontic treatments. Twenty-four adult patients presenting with mild overcrowdings were randomly allocated to either a control group that was treated with conventional orthodontics or a test group that received piezo-assisted orthodontics. The piezocisions were performed 1 wk week after the placement of the orthodontic appliances. Neither grafting material nor sutures were used. All patients were followed every 2 wk, and archwires were changed only when they were no longer active. The periods required for the completion of the overall orthodontic treatments were calculated, and the periodontal parameters were evaluated at baseline and at the end of the orthodontic treatment. Patient-centered outcomes were assessed with a visual analog scale; analgesic use following the procedures was also recorded. The patient characteristics were similar between the 2 groups. The overall treatment time was significantly reduced by 43% in the piezocision group as compared with the control group. In both groups, periodontal parameters (i.e., recession depth, pocket depth, plaque index, and papilla bleeding index) remained unchanged between the baseline and treatment completion time points. No increase in root resorption was observed in either group. Scars were observed in 50% of the patients in the piezocision group. Analgesic consumption was similar following orthodontic appliance placement and piezocision surgery. Patient satisfaction was significantly better in the piezocision group than in the control group. In these conditions, the piezocision technique seemed to be effective in accelerating orthodontic tooth movement. No gingival recessions were observed. The risk of residual scars might limit the indications for piezocision in patients with a high smile line (ClinicalTrials.gov NCT02590835).

Osteoclastogenesis in Local Alveolar Bone in Early Decortication-Facilitated Orthodontic Tooth Movement.

ObjectiveIn the current study, we aimed to investigate the effects of alveolar decortication on local bone remodeling, and to explore the possible mechanism by which decortication facilitates tooth movement.Materials and MethodsForty rabbits were included in the experiment. The left mandible was subjected to decortication-facilitated orthodontics, and the right mandible underwent traditional orthodontics as a control. The animals were sacrificed on the days 1, 3, 5, 7 and 14, after undergoing orthodontic procedures. Tooth movement was measured by Micro-CT, and the local periodontal tissues were investigated using H&E, Masson's trichrome and tartrate-resistant acid phosphatase (TRAP) staining. The mRNA levels of genes related to bone remodeling in the alveolar bone were analyzed using real-time PCR.ResultOn days 3, 5, 7 and 14, tooth movement was statistically accelerated by decortication (P < 0.05) and was accompanied by increased hyperemia. Despite the lack of new bone formation in both groups, more osteoclasts were noted in the decorticated group, with two peak counts (P < 0.05). The first peak count was consistent with the maximum values of ctsk and TRAP expression, and the second peak counts accompanied the maximum nfatc1 and jdp2 expression. The increased fra2 expression and the ratio of rankl/opg also accompanied the second peak counts.ConclusionsFollowing alveolar decortication, osteoclastogenesis was initially induced to a greater degree than the new bone formation which was thought to have caused a regional acceleratory phenomenon (RAP). The amount of steoclastogenesis in the decorticated alveolar bone was found to have two peaks, perhaps due to attenuated local resistance. The first peak count in osteoclasts may have been due to previously existing osteoclast precursors, whereas the second may represent the differentiation of peripheral blood mononuclear cells which came from circulation as the result of hyperemia.

Posttreatment and retention outcomes with and without periodontally accelerated osteogenic orthodontics assessed using ABO objective grading system

Background: The posttreatment and retention outcomes following nonextraction orthodontic therapy, with and without corticotomy, were assessed using the American Board of Orthodontists objective grading system (OGS). Purpose: The purpose was to determine if the course of retention was any different following alveolar decortication and augmentation bone grafting, i.e., periodontally accelerated osteogenic orthodontics (PAOO). Materials and Methods: Study casts and panoramic radiographs of patients with and without PAOO (28 subjects each) were selected on the basis of the following: (1) comprehensive nonextraction orthodontic treatment using straight wire edgewise appliances for Class I crowding, (2) availability of immediate posttreatment records and retention records at least 1 year post de-bracketing, and (3) use of Hawley removable retainers with similar wearing instructions. Results: Independent and paired t -test statistical testing revealed the following: (1) Posttreatment orthodontic outcomes were the same, with or without corticotomy. (2) During retention, 5 of 8 ABO grading criteria improved for the sample without corticotomy, and 6 of 8 ABO grading criteria improved for the group with corticotomy. (3) Retention outcome scores were lower (better) for alignment and marginal ridges in the corticotomy-facilitated group. (4) The total score was significantly lower (better) for the corticotomy group at retention and the increment of total score change decreased (improved) significantly more during retention following corticotomy. Conclusions: The retention phase was more favorable following corticotomy because the amount of OGS total score change demonstrated a significantly improved retention outcome following PAOO therapy.

Surgical Methods for the Acceleration of the Orthodontic Tooth Movement.

Surgical techniques for the acceleration of the orthodontic tooth movement have been tested for more than 100 years in clinical practice. Since original methods have been extremely invasive and have been associated with increased tooth morbidity and various other gaps, the research in this field has always followed an episodic trend. Modern approaches represent a well-refined strategy where the concept of the bony block has been abandoned and only a cortical plate around the orthodontic tooth movement has been desired. Selective alveolar decortication has been a reproducible gold standard to this end. Its proposed mechanism has been the induction of rapid orthodontic tooth movement through the involvement of the periodontal ligament. More recent techniques included further refinement of this procedure through less invasive techniques such as the use of piezoelectricity and corticision. This chapter focuses on the evolution of the surgical approaches and the mechanistic concepts underlying the biological process during the surgically accelerated orthodontic tooth movement.