Corticotomy-assisted Orthodontic Treatment Research Articles

Corticotomy-Assisted Orthodontic Treatment: A Literature Review

The increased number of adults seeking orthodontic treatment has led to the need for faster results as social limitations arise with the use of fixed or even removable appliances. Corticotomy-assisted orthodontic treatment (CAOT) has been proposed as a technique that accelerates tooth movement and leads to a substantial reduction in treatment time. This review was conducted by searching four databases for original articles about CAOT, review articles and articles about alternative techniques and periodontal effects up to 31 December 2022. The aim of the review was to present the historical and biological background of CAOT, the description of the technique and some alternative and less invasive techniques that have been proposed. Indications, contraindications and periodontal side effects are also discussed.

The effectiveness of minimally-invasive corticotomy-assisted orthodontic treatment of palatally impacted canines compared to the traditional traction method in terms of treatment duration, velocity of traction movement and the associated dentoalveolar changes: A randomized controlled trial.

Objective: To evaluate the effectiveness of a minimally-invasive corticotomy-assisted treatment of palatally impacted canines (PICs) compared with the traditional method by evaluating treatment time, the velocity of movement, and the associated dentoalveolar changes. Materials and methods: Forty-six patients with palatally or mid-alveolar upper impacted canines were recruited and distributed into two groups: the corticotomy-assisted traction group (CAT group, mean age: 20.39±2.27 years) and the traditional treatment group (TT group, mean age: 20.26±2.17 years). The closed surgical approach was used in both study groups. The velocity of traction movement, traction duration and overall treatment duration were evaluated clinically. In addition, the bone support ratios and the amount of root resorption were assessed on cone-beam computed tomography (CBCT) images. Results: At the end of treatment, significant differences were found between the two groups regarding the velocity of traction movement, traction time, and overall treatment time (P<0.05). The mean velocity of traction movement in the CAT group was greater than the TT group ( x velocity=1.15±0.35 mm/month; 0.70±0.33 mm/month, P=0.027, respectively). The duration of the active traction and the overall orthodontic treatment in the CAT group were significantly shorter than the TT group by 36% and 29%, respectively. The mean bone support ratios of the aligned canines did not differ significantly between the two groups (88% vs. 89% in the CAT and TT groups, respectively). No significant differences were found between the two groups regarding the mean amount of root resorption on the adjacent laterals ( x resorption = 1.30±1.18 mm; 1.22±1.02 mm, P=0.612, in CAT and TT groups, respectively). Conclusions: The traction movement velocity of the palatally impacted canines can be increased using minimally-invasive corticotomy-assisted orthodontic treatment. The side effects of the acceleration procedure were minimal and almost similar to those of the traditional technique.

Assessment of Patient-Centered Outcomes When Treating Palatally Impacted Canines Using Conventional Versus Accelerated Minimally Invasive Corticotomy-Assisted Orthodontic Treatment: A Randomized Controlled Trial.

ObjectiveThis study aimed to investigate whether there were any differences in pain levels, discomfort, and functional impairments when treating palatally impacted canines (PICs) using the conventional treatment method compared to the accelerated minimally invasive corticotomy-assisted method.Materials and methodsFifty-two patients (11 males and 41 females) with unilateral PICs were included. The patients were randomly assigned to the conventional traction group (26 patients, mean age of 20.37 ± 2.15 years) or the minimally-invasive corticotomy-assisted group (26 patients, mean age of 20.18 ± 2.18 years). The levels of pain, discomfort, and functional difficulties were assessed using a visual analog scale (VAS) after 24 hours (T1), four days (T2), seven days (T3), 14 days (T4), and 28 days (T5) following the surgical exposure procedure.ResultsThere were no statistically significant differences between the two treatment groups for any patient-centered outcome at all assessment times (P>0.01). The levels of pain and discomfort were slightly greater in the conventional group than in the corticotomy-assisted group on the first day after surgical exposure, with no significant difference between the two groups (mean pain: 4.11, P=0.481; mean discomfort: 9.00, P=0.223). Pain and discomfort required seven days to reach low levels and four weeks to reach the lowest levels in both study groups. The levels of swelling, mastication difficulties, swallowing difficulties, limitation in jaw movements and speech changes were mild to moderate on the first postoperative day and the recovery time was four days postoperatively for swallowing difficulties and speech changes. In comparison, the recovery time was seven days for the other three outcomes in both study groups.ConclusionsAfter one day of the surgical intervention, either by conventional or corticotomy-assisted methods, the patients reported mild to moderate pain, discomfort, and functional impairments. These disabilities gradually reached low levels during the first and second weeks to reach their lowest levels four weeks postoperatively in both study groups. The similarity between the conventional and the acceleration methods in pain levels and other oral disabilities may make corticotomy-assisted treatment a comfortable and effective method when treating adult patients with PICs. In addition, patient satisfaction with the corticotomy-assisted procedure was high.

Influence of ibuprofen combined with corticotomy on tooth movement and alveolar bone remodeling in rats.

To investigate the effects of corticotomy-assisted orthodontic tooth movement and administration of ibuprofen on tooth movement rate and alveolar bone response. A total of 78 adult male Wistar rats were randomly assigned to five groups: one baseline group (no treatment) and four experimental groups including orthodontic tooth movement only (OTM), orthodontic tooth movement with ibuprofen (OTMI), corticotomy-assisted orthodontic tooth movement (COTM), and corticotomy-assisted orthodontic tooth movement with ibuprofen (COTMI). Corticotomy was performed on a maxillary molar unilaterally. Nickel-titanium closed-coil springs generated a 10-gram force for maxillary first molar movement. The experimental drug groups received 15 mg/kg of ibuprofen, and the other groups received reverse osmosis water. Tooth movement and bone volume fraction were evaluated by micro-computed tomography on days 0, 7, 14, and 21. The corticotomy groups had statistically significantly higher tooth movement and lower bone volume fraction than the orthodontic groups (P &lt; .05). The amount and rate of tooth movement were statistically significantly different between the OTM and OTMI groups, but not statistically significantly different in bone volume fraction. However, statistically significant differences were not observed in any measurements between the COTM and COTMI groups. Ibuprofen during orthodontic tooth movement inhibited tooth movement and alveolar bone remodeling but had no effect on corticotomy-assisted orthodontic treatment.

Morphologic Evaluation of Dentoalveolar Structures after Corticotomy-Assisted Orthodontic Treatment in Romanian Adult Patients.

Background and Objectives: Corticotomy-facilitated orthodontics is an approach that can be useful in treating complex orthodontic cases and that could enhance the rate of tooth movement. The aim of this study was to evaluate the changes that occurred in the buccal cortical bone and at the root level after an orthodontic treatment when corticotomy was used, in Romanian patients. Materials and Methods: After dividing the subjects into two groups (maxillary and mandibular corticotomy), based on CBCT, measurements were made of the thickness of the cortical buccal bone at the cervical, median and apical level, and of the root length at T0 (before corticotomy) and T1 (6 months after surgery). Several tests were used for statistical analysis of the data. Results: In the maxillary arch, the bone thickness measured after corticotomy in males was 0.64 mm at the cervical level, 0.53 mm at the medial level and 0.30 mm in the apical area. In females, the values were 0.46 mm (cervical), 0.37 mm (medial) and 0.36 mm (apical). In the lower arch, the values obtained for these three regions were 0.37 mm, 0.30 mm and 0.37 mm for males and 0.58 mm, 0.32 mm and 0.43 mm for female subjects. All values were statistically significant. The root length for the lower teeth at T0 was 11.98 ± 2.24 mm at T0 and 11.97 ± 2.24 mm at T1. For the upper teeth, the root length at T0 was 13.83 ± 2.28 mm and 13.81 ± 2.28 mm. Conclusions: Comparing the measurements, it was observed that the biggest changes in the cortical bone were at the cervical level. In the maxillary arch, the most significant modifications were registered at the canines and the level of the first premolars, and in the lower arch at the incisors level. The measured root resorption of the teeth was considered to be statistically insignificant.

Is the corticotomy assisted orthodontic treatment efficient in the expansion of narrow arches in adult patients?

Corticotomy assisted orthodontic treatment (CAOT) is a technique which, performing surgical cuts on the cortical alveolar bone around the teeth, induces a faster rate of orthodontic tooth movement. The development CAOT offers solutions to overcome many of limitations in adult orthodontic treatment, such as risk of hyalinization, root resorption, periodontal problems, lack of bone growth and a long therapy time due to slower tooth movement compared to adolescents. The purpose of this systematic review was to identify if CAOT is also useful for expanding narrow arches in adult orthodontic patients. An electronic research on PubMed until June 2020 was made with the combined search terms "corticotomy expansion," "corticotomy orthodontic expansion" and "corticotomy orthodontic." Six studies were included in this systematic review. The authors found discordant results in literature; however, it seems that CAOT can have better results than conventional expansion, but it cannot be considered as an alternative therapy for severe posterior cross-bite. CAOT have a greater predictability if done with bone grafting. The evidence of corticotomy as a help to palatal expansion in adult orthodontic treatment has not been well described in literature and only few published reports are available. Further testing in human beings are still necessary to confirm the validity of this technique.

Changes of alveolar bone dehiscence and fenestration after augmented corticotomy-assisted orthodontic treatment: a CBCT evaluation

BackgroundTo evaluate the changes of alveolar dehiscence and fenestration after augmented corticotomy-assisted orthodontic treatment on cone-beam computed tomography (CBCT) compared with traditional pre-surgical orthodontics, both quantitatively and qualitatively.MethodsTwo hundred and four anterior teeth from 17 skeletal class III malocclusions were divided into four groups. Groups G1 (upper teeth) and G3 (lower teeth), comprising 120 teeth, accepted traditional pre-surgical orthodontics; groups G2 (upper teeth) and G4(lower teeth), comprising 84 teeth, accepted augmented corticotomy-assisted pre-surgical orthodontics. The changes of alveolar bone dehiscence and fenestration of each tooth in all groups were evaluated with the help of CBCT.ResultsQuantitative analysis for comparing both groups: For the upper teeth, d1 − d0 was different between both groups while f1 − f0 was not statistically different. For the lower teeth, d1 − d0 was statistically different between both groups while f1 − f0 was not statistically different. Qualitative analysis: For the teeth that had no dehiscence before treatment, G2 and G4 had a better transition than did G1 and G3. For those having dehiscence before treatment, G4 had a better transition than did G3. For teeth having no fenestration before treatment, there was no statistically significant difference in transition between the control and treatment groups. For those having fenestration before treatment, G4 had a better transition than did G3.ConclusionsFor skeletal class III patients, augmented corticotomy-assisted orthodontic treatment is a promising method of improving alveolar bone dehiscence and fenestration for lower anterior teeth, and it also has the potential to protect both lower and upper anterior teeth against dehiscence.

Assessment of the effect of the corticotomy-assisted orthodontic treatment on the maxillary periodontal tissue in patients with malocclusions with transverse maxillary deficiency: a case series

BackgroundThe aim of the study was to assess the effect of corticotomy–assisted orthodontic treatment on soft tissue clinical parameters in patients with malocclusions with transverse maxillary deficiency.MethodsThe study included 20 generally healthy adult individuals with malocclusion, who underwent a corticotomy-assisted orthodontic treatment in maxilla. During the corticotomy performed after full-thickness flap elevation, only the buccal cortical plate was cut with the use of OTS-7, OTS7–4, OTS7-3 ultrasound tips of the piezosurgery device (Mectron s. p. a., Italy). A clinical examination was performed prior to the corticotomy procedure, then repeated – 3, 6, 9 and 12 months after the procedure. The following parameters were assessed: FMPI (full mouth plaque index), FMBOP (full mouth bleading on probing), PD (probing depth), CAL (clinical attachment level), GR (gingival recession height), RW (recession width), PH (papilla height), PW (papilla width), BS (bone sounding), biotype and KT.ResultsThere was a statistically significant reduction in PD (mean difference: 0.06; 95% Cl: − 0.33, − 0.18), CAL (mean difference: 0.07; 95% Cl: − 0.33, − 0.19), PH (mean difference: 0.26; 95% Cl: − 0.47, 0.05) and BS (mean difference: 0.13; 95% Cl: − 0.41, − 0.14) after the treatment. Statistically significant changes were also noted in relation to KT (mean difference: 0.17; 95% Cl: − 0.07, 0.27) and biotype (mean difference: 0.07; 95% Cl: 0.26, 0.39), which thickness increased significantly after the treatment. No statistically significant differences were observed in GR, RW and PW.ConclusionsThe corticotomy–assisted orthodontic treatment did not jeopardize the periodontal clinical status in maxilla. There is a need for further studies on a larger number of patient to compare the clinical findings with a control group as well as in patients with conventional orthodontic treatment in a longer follow-up time to find out more about the post-treatment periodontal tissue changes and stability.

Corticotomy-assisted orthodontic treatment. A systematic review of the biological basis and clinical effectiveness.

Objectives:To systematically review the literature to assess the quality of evidence related to corticotomy-assisted orthodontic treatment (CAOT) as adjunctive treatment in orthodontics.Methods:The study was conducted in the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia between 2013 and 2014. Various electronic databases were searched and abstracts were retrieved. Defined inclusion criteria were then applied to the obtained original articles for further evaluation by 2 examiners independently. The criteria of selection included human, or animal studies, which assessed some aspects of CAOT and/or the biological principles behind it. Case reports and series were excluded. The quality of the studies was evaluated by the methodological score for clinical trials developed.Results:Fourteen articles were retrieved initially, but only 12 articles were finally selected for the study. The CAOT was found to accelerate tooth movement by 2-2.5 folds when compared with conventional orthodontic tooth movement. The CAOT was found safe on periodontal health and exhibits no or little risk of root resorption. A localized turnover of alveolar spongiosa and the absence of a hyalinized zone was the acceptable biological explanation of CAOT. There is no evidence to support that CAOT enhances the movement of ankylosed teeth, closing old extraction sites, post-orthodontic stability, or transverse expansion.Conclusions:Corticotomy-assisted orthodontic treatment should be considered with caution. Long term randomized clinical trials are still needed.

Acceleration of Canine Movement by Laser Assisted Flapless Corticotomy : An Innovative Approach in Clinical Orthodontics

Background: Corticotomy-assisted orthodontic treatment is done to induce a state of increased tissue turnover and transient osteopenia, which is followed by a faster rate of orthodontic tooth movement. It considered as an adjunct treatment option for orthodontic treatment of adults. The aim of this Study was to elucidate the effectiveness of a new surgical approach for acceleration of maxillary canine retraction in human with laser assisted flapless corticotomy and evaluate its effect on vitality of pulp and gingival sulcus depth. Materials and methods: the sample comprised of 15 Iraqi patients (9 females and 6 males; mean age 21.7), who were required extraction for their maxillary first premolars followed by retraction of the canines as part of their orthodontic treatment plan. The study was designed as a split-mouth study. Decortications were done in the second stage of orthodontic treatment using Er:YAG laser to perform series of holes mesially and distally to the canine at the side with more space between the canine and second premolar without reflecting a surgical flap. The net canine movements and molar anchorage loss were calculated after six weeks. Vitality test, radiographical assessment and gingival sulcus depth were investigated. Results and Conclusions: The canines on the laser corticotomy side showed statisticaly higher mean value of retraction than their controls during six weeks period. Pulp vitality response and post surgery gingival sulcus depth showed no significant difference between the pre-laser and post-laser surgery. Based on the result of our study, flapless laser assisted corticotomy can be considered for acceleration of orthodontic tooth movement in humans.

Corticotomy-assisted orthodontic treatment: review.

Corticotomy-assisted orthodontic treatment is an established and efficient orthodontic technique that has recently been studied in a number of publications. It has gradually gained popularity as an adjunct treatment option for the orthodontic treatment of adults. 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. The aim of this article is to present a comprehensive review of the literature, including historical background, contemporary clinical techniques, indications, contraindications, complications and side effects.

Speedy Surgical Orthodontic Treatment With Skeletal Anchorage in Adults—Sagittal Correction and Open Bite Correction

The present report describes a new type of corticotomy-assisted orthodontic treatment called Speedy orthodontics, which allows faster movements of the dental segments using skeletal anchorage. To minimize the risk of necrosis, 2 procedures are performed. During the initial surgery, bilateral and horizontal corticotomies are performed in the palatal area with the patient under local anesthesia. After 2 to 3 weeks, a second buccal corticotomy is performed and 500 to 900 g of force per side is immediately applied to the corticotomized segment. Successful alveolar bone bending can be obtained in cases of adult protrusion or open bite. Speedy orthodontics allows for more precise control of anterior segment retraction in adult protrusion patients and can be used for posterior segment intrusion. This technology is powerful, easy to apply, and provides a significant advance in surgical orthodontics.

Speedy surgical-orthodontic treatment with temporary anchorage devices as an alternative to orthognathic surgery

We describe a new type of corticotomy-assisted orthodontic treatment called speedy orthodontics for treating severe anterior protrusion in adults. Once medullary bone is deformed after corticotomy, recovery to its original dimension is impossible if the greenstick fractured bone is ossified as it was deformed. Speedy orthodontics describes a protocol to allow movement of dental segments over a shorter time by using a corticotomy and an orthopedic force with temporary anchorage devices. After proper diagnosis and treatment planning, the maxillary first premolars are removed, and then a corticotomy is performed to outline a block of bone around the maxillary anterior teeth under local anesthesia. An interval of 2 weeks is optimal between the labial and lingual corticotomy for sufficient healing and less patient anxiety. The maxillary anterior teeth are fixated into a single unit with the specially designed lingual retractor. A retraction force of 500 to 900 g per side is applied to the lingual retractor and the C-palatal plate placed in the midpalatal area. After anterior bone segment retraction, finishing is performed with full fixed appliances. Correct overbite and overjet, facial balance, and improvement of lip protrusion were obtained in adults with protrusion treated by speedy orthodontics. This new type of treatment mechanics can be an effective alternative to orthognathic surgery in adults with protrusion.

Treatment Outcomes of Orthodontic Treatment, Corticotomy-Assisted Orthodontic Treatment, and Anterior Segmental Osteotomy for Bimaxillary Dentoalveolar Protrusion

The purpose of this study was to compare treatment outcomes of orthodontic treatment, anterior segmental osteotomy, and corticotomy-assisted orthodontic treatment for resolution of bimaxillary dentoalveolar protrusion. The samples consisted of 65 Korean adult female patients with bimaxillary dentoalveolar protrusion who had achieved a good treatment result and were divided into group 1 (orthodontic treatment), group 2 (corticotomy-assisted orthodontic treatment with skeletal anchorage in the maxilla and anterior segmental osteotomy in the mandible), or group 3 (anterior segmental osteotomy in the maxilla and mandible). The hard- and soft-tissue variables were measured from lateral cephalographic tracings at pretreatment and posttreatment stages. Statistic analyses were performed to compare differences in pretreatment and change from pretreatment to posttreatment. Group 3 showed the largest amount of basal bone retraction and the least amount of upper incisor inclination change and upper alveolar bone bending among the three groups. The amounts of change in the upper lip projection and angulation were greater in group 2 than in group 1. Group 3 showed a decrease of the upper incisal exposure, whereas group 1 showed an increase. Upper central incisor to Frankfurt horizontal plane, upper and lower alveolar ridge angle, Pog-N perpendicular, and anteroposterior discrepancy indicator were selected as significant variables for discriminating the three groups. The results of this study show that orthodontic treatment or corticotomy-assisted orthodontic treatment is indicated for those with severe incisor proclination with normal basal bone position, although corticotomy-assisted orthodontic treatment can be advantageous for adult patients concerned with treatment duration. Anterior segmental osteotomy is recommended for bimaxillary dentoalveolar protrusion patients with a gummy smile, basal bone prognathism, relatively normal incisor inclination, and relatively underdeveloped chin position.