Corticotomy-facilitated Orthodontics Research Articles

Analysis of Osteoclasts and Root Resorption in Corticotomy-Facilitated Orthodontics with Ibuprofen Administration-An Animal Study.

Following corticotomy surgery, patients experience moderate to severe post-operative pain that necessitates prescriptions of analgesics. The prostaglandin inhibitory effect of ibuprofen influences the mobility of teeth during orthodontic treatment. This study aimed to determine how ibuprofen affects histological reactions and dental root resorption during orthodontic tooth movement aided by corticotomy. Forty-two male Wistar rats were divided into three groups by random selection: (1) control group, (2) corticotomy group (CO), and (3) corticotomy with 0.6 mL of 15 mg/kg ibuprofen group (CI). On each buccal and palatal alveolar bone, two decortication points were made. Orthodontic tooth movement was induced on the maxillary first molar for 21 days utilizing a NiTi-closed coil spring with 10 g of force. Hematoxylin and eosin were used to prepare and stain the histological sections. The numbers of osteoclasts on days 0, 7, 14, and 21 were determined, and the root resorption area on days 0 and 21 was measured. Compared to the control group, the osteoclast counts in the CO and CI groups were considerably greater (p < 0.002). No significant differences were observed between the CO and CI groups in the numbers of osteoclasts or the percentages of root resorption (p > 0.05). The amounts of osteoclast activity and root resorption were unaffected by the administration of ibuprofen in corticotomy-facilitated tooth movement.

Root Length Changes in Orthodontically Displaced Teeth Treated with the Corticotomy Approach

The aim of the study: Corticotomy-facilitated orthodontics is a modern approach to resolve complicated orthodontic cases that may increase the pace of tooth movement. The study's goal was to assess the changes that occurred at the root level following orthodontic treatment when corticotomy was used. Material and methods: Based on Cone Beam Computer Tomography, measurements of the root length at T0 (before corticotomy) and T1 (after corticotomy) were taken after splitting the individuals into two groups (maxillary and mandibular corticotomy) (6 months after surgery). For statistical analysis of the data, many tests were utilized. Results: The root length values obtained at T1 showed minimal changes in length, with statistically insignificant values (for the maxillary arch, the values obtained were 13.36 ± 2.41 mm for women and 14.26 ± 2.06 mm for men; for the lower arch, the measured values were 12.38 ± 2.09 mm for women and 11.56 ± 2.29 mm for men). The canine on the left hemiarcade had the most significant change in root length following treatment, with a value assessed at T1 of 16.72 ± 1.78 mm, which was statistically significant, p 0.05. Conclusion: According to the data obtained in this study, when orthodontic therapy is associated with corticotomy, there is a decrease in root resorption that may occur in the case of conventional orthodontic treatments.

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.

Miniscrew Implant supported Maxillary Canine Retraction with and without Corticotomy Facilitated Orthodontics (CFO).

Introduction:The purpose of the study was to scientifically test maxillary canine retraction assisted by miniscrew implant with corticotomy-facilitated orthodontics.Materials and Methods:Fifteen patients (six males, nine females) who had Class II division malocclusion with enhanced overjet were included in the study. Maxillary first premolars were surgical displaced along with retraction of maxillary. In the canine-premolar region, corticotomy was performed on one side of the maxillary arch; the other side served as the control region. Over a 4-month follow-up span, the following variables were examined: plaque index, tooth movement intensity, attachment degree, gingival regression, molar anchorage failure, gingival index, and scope of testing.Results:After 2 months, the canine retraction rate on the corticotomy side was more significant than on the control side by twice. The tooth movement rate steadily decreased to 1.6 times faster at the end of the 3rd month and to 1.06 times faster at the end of the 4th month. No failure of molar anchorage occurred on either the controlled or nonoperated hand during canine retraction.Conclusions:For people requiring orthodontic care with shortened treatment periods, corticotomy-facilitated orthodontics may be a viable treatment modality.

Comparison of canine retraction by conventional and corticotomy-facilitated methods: A split mouth clinical study.

OBJECTIVE:The purpose of this split-mouth single-centered, parallel-group, randomized clinical trial was to evaluate the efficiency of corticotomy-facilitated orthodontics in rapid canine retraction.METHODS:The sample consisted of 10 patients (15–25 years old) requiring extraction of the maxillary first premolars with subsequent canine retraction. The patients’ right sides were randomly assigned to either the corticotomy (experimental) or control groups. Corticotomy cuts and perforations were performed and canine retraction was initiated bilaterally with closed-coil nickel-titanium springs that applied 150 g of force. The following variables were examined till the end of canine retraction on both sides: Rate of canine retraction, canine root resorption, and patient perception of the procedure. The rate of canine retraction was assessed every month using study models while root resorption was evaluated using CBCT. Patient`s perception was evaluated using a 100 mm VAS.RESULT:Mean time taken for full completion of canine retraction: 5.7 months (test) and 7.1 months (control). Mean root resorption: 0.53 ± 0.10 (control) and 0.24 mm ± 0.10 (test). Mean VAS scores: 16 ± 3.94 (24 hours) and 2 ± 2.58 (1 week) at control side and 46.50 ± 6.69 (24 hours) and 2 ± 2.58 (1 week) at test.CONCLUSION:There was an overall reduction in the time taken for canine retraction with corticotomy; however, an increase in the rate of canine retraction in the corticotomy-facilitated method was evident only for the first four months, compared to the conventional method. Less root resorption was observed in corticotomy-facilitated method than conventional method. Pain perception was more for corticotomy-facilitated method than conventional method at 24 hours, but similar after one week.

Surgically accelerated orthodontic techniques and periodontal response: a systematic review.

Reduction in orthodontic treatment time is gaining popularity due to patient demands. Several new techniques of acceleratory orthodontic treatment have been introduced to effectively treat the malocclusion in a shorter time period with minimal adverse effects. The objective of this systematic review is to critically evaluate the potential effect of accelerated surgically assisted orthodontic techniques on periodontal tissues. Electronic databases used to perform the search were Medline (Ovid), EMBASE, PubMed, Scopus, Cochrane, Google Scholar, and hand searching of the literature was also performed. Only randomized control trials (RCTs) that assessed the relationship between accelerated surgically assisted orthodontic techniques and its effects on periodontium were included. The Joanna Briggs Institute (JBI) critical appraisal checklist tool (2016) was used to assess the finally selected studies. Among these studies, five evaluated corticotomy-facilitated orthodontics, two tested accelerated tooth movement with piezocision, one compared corticotomy-facilitated orthodontics with piezocision, and one studied the effects of periodontally accelerated osteogenic orthodontics. The duration of these studies was relatively short and had moderate to high risk of bias. Literature search identified 225 records from 5 databases and 50 articles from the partial grey literature (Google scholar) search. Finally, nine eligible RCTs were included in the review. Most of the included studies were of a high risk of bias due to high experimental heterogeneity and small sample size. Long-term follow-up of the periodontal response to these interventions was also lacking. There is an absence of evidence considering the lack of long-term follow-up and small sample size therefore, the results of this review should be carefully interpreted. Due to the need for more studies with less risk of bias, these techniques should be implemented in dental practice with caution. With stronger evidence, the study may be confirmed to provide quicker desired results for orthodontic patients. This study protocol was not registered. No funding was obtained for this systematic review.

Biological events related to corticotomy-facilitated orthodontics.

Corticotomy-facilitated orthodontics is a clinical treatment modality comprising the application of conventional orthodontic forces combined with selective decortication of the alveolar process of the bone, which generates a localized process of bone remodeling (turnover) that enables accelerated orthodontic tooth movement. Compared with conventional orthodontic treatment, corticotomy-facilitated orthodontics is associated with reduced treatment time and reduces the frequency of apical external root resorption; however, this modality increases morbidity and financial costs. Although the clinical outcomes of corticotomy-facilitated orthodontics appear favorable, no results of evidence-based investigations of long-term outcomes are available in the literature, and the long-term effects of corticotomy-facilitated orthodontics on the teeth and periodontium are unclear. This narrative review discusses the biological events associated with corticotomy-facilitated orthodontics. Authoritative articles found in relevant databases were critically analyzed and the findings were integrated and incorporated in the text.

Comparison between the effect of low-level laser therapy and corticotomy-facilitated orthodontics on RANKL release during orthodontic tooth movement: a randomized controlled trial

Bone resorption is the cornerstone in bone remodeling affecting the rate of orthodontic tooth movement. RANKL has a direct effect on osteoclastogenesis. The aim of this study is to evaluate and compare the effect of low-level laser therapy (LLLT) and corticotomy-facilitated orthodontics (CFO) on RANKL release during orthodontic tooth movement. Twenty patients requiring orthodontic therapeutic extraction of the maxillary first premolar were randomly selected. A split-mouth study design was performed where corticotomy-facilitated orthodontics was randomly assigned to one side at the canine region (CG) before retraction, Laser group (LG) was assigned to the contralateral side using 940 nm diode laser irradiations (100 mW, 2.5 J, 3.9 J/cm2) at days 1, 3, 8, and 15. Canine retraction was done using nickel-titanium closed-coil spring applying a force of 150 g per side. Gingival crevicular fluid (GCF) samples were collected from distal surface of the canines on both sides, 1 day before the intervention treatment (T0), day 3 after the intervention (T1), and day 15 (T2). RANKL concentration levels were assessed using enzyme-linked immunosorbent assay. There was statistically significant increase in RANKL concentration levels in both groups (CG and LG) from T0 to T1, there was no statistically significant difference in concentration level from T1 o T2, but there was a statistically significant difference in RANKL concentration levels between T0 and T2 in both groups. CG and LG showed no statistically significant difference in RANKL concentration levels between them in T1 and T2. Low-level laser therapy and corticotomy-facilitated orthodontics can increase the RANKL release during orthodontic tooth movement which directly affects bone remodeling and the rate of orthodontic tooth movement.

A comparative evaluation of maxillary canine retraction using flap and flapless corticotomy: A clinical study

Objective: The objective of this study is to compare and evaluate the effectiveness of maxillary canine retraction using flap and flapless corticotomy. Materials and Methods: A sample of 10 adult patients undergoing orthodontic treatment requiring therapeutic extraction of maxillary first premolars bilaterally were selected, compliant with the inclusion criteria. By random allocation, one site was selected for flap corticotomy-facilitated orthodontics (CFO) and opposite site for flapless CFO. After corticotomy procedure, maxillary canine retractions were done on both the sides using sliding mechanics. A paired t-test was used to determine the statistical significance of the difference in the amount of tooth movement between the flap and flapless sides. Results: There were statistically significant differences (P ≤ 0.01) in the rates of anteroposterior movement of the canines between the flap and flapless sides at all measurement times, and the rates of canine retraction were consistently higher in the flap side than in the flapless side. Conclusions: Flap corticotomy technique is more effective as compared to that of flapless corticotomy technique. Clinical Relevance: Flap corticotomy will be more effective clinically; however, the histologic correlation in regard to the changes in both the technique would be more beneficial.

Evaluation on efficacy of corticotomy-facilitated treatment in skeletal class Ⅱ patients

Objective: To investigate the effect of corticotomy-facilitated orthodontics on the treatment time and final outcome in skeletal class Ⅱ division 1 patients. Methods: Twenty adult skeletal class Ⅱ division 1 patients treated with two maxillary first premolar extractions were included and randomly divided into two groups (the corticotomy group and the control group). The treatment time was recorded and the changes of soft and hard tissue were compared by using three-dimensional measurement and analysis of cone-beam CT images before and after treatment. Results: There was no significant difference in the alignment time between two groups, while the time of maxillary space closure and the total treatment time in corticotomy group ([5.8±1.3] and [24.9±5.1] months, respectively) were shorter than that in the control group ([9.9±1.1] and [30.8±4.6] months, respectively) and the differences were significant (P<0.01). In the corticotomy group, the retraction amount of the upper central in cisal margin, apical tip, supradentale, labrale superius and the increase of nasolabial angle were greater than those in the control group (P<0.05). Conclusions: In patients with mild to moderate skeletal class Ⅱ division 1 malocclusion, corticotomy-facilitated orthodontics can not only shorten the treatment time, but is more conductive to the retraction of upper anterior teeth and improvement of the profile.

Minimally invasive corticotomy in orthodontics using a three-dimensional printed CAD/CAM surgical guide

The aim of this prospective study was to evaluate the effectiveness of an innovative, minimally invasive, flapless corticotomy procedure in orthodontics. The STROBE guidelines were followed. Ten patients with severe dental crowding and a class I molar relationship were selected to receive orthodontic treatment with clear aligners and corticotomy-facilitated orthodontics. The mean age of these patients was 21 years (range 17–28, standard deviation 6.08 years); the male to female ratio was 2:1. The main outcome was a reduction in the total treatment time to correct dental crowding. The secondary outcomes were periodontal index changes, the degree of root resorption, and patient perceptions of the method used, assessed using the short-form Oral Health Impact Profile (OHIP-14). The occurrence of early surgical complications or unexpected events was also recorded. All patients completed the treatment to correct dental crowding. The average treatment time was reduced by two-thirds. The procedure did not significantly modify the periodontal indices or oral health-related quality of life. No early surgical complications or unexpected events were observed. In short, the results indicate that this new procedure is safe and accelerates tooth movement without periodontal complications or discomfort. However, the efficacy of this procedure must be confirmed in controlled clinical trials.

A quick fix for crooked teeth – recent advancements in corticotomy-facilitated orthodontics

A quick fix for crooked teeth – recent advancements in corticotomy-facilitated orthodontics

Accelerating orthodontic tooth movement with the aid of periodontal surgery – the practitioner viewpoint

Abstract Introduction: There has been a revival of interest in the acceleration of orthodontic tooth movement (OTM) by inducing injury to dentoalveolar cortical bone. Termed corticotomy, the procedure offers an advantage to adult patients whose bone metabolism is such that any reduction in treatment time would be welcomed. The procedure has been refined for over 100 years and recent research indicates treatment duration may be reduced often by as much as a third, but it is not clear how widely the method is applied in practice. For the procedure to be successful, careful interdisciplinary management by orthodontists and periodontists is required. However, information regarding the attitude and knowledge of practitioners and the frequency of the procedure performed in Australia and New Zealand is lacking. Methods: A questionnaire was formulated and tested in a pilot study on postgraduate orthodontic and periodontic students at The University of Adelaide. As a consequence of the responses, the wording of several questions was clarified and the sequence modified to produce the final format. Separate questionnaires were developed for specialist orthodontists and periodontists in keeping with their different backgrounds and were distributed at two relevant conferences. Results and conclusions: The number of practitioners who had been involved with at least one corticotomy per annum was low for orthodontists (12%) and periodontists (18%). The majority of those surveyed believed that more research was required on corticotomy-facilitated OTM and would not recommend the procedure to patients without greater investigation of the technique. More than half of the sampled orthodontists indicated that they would never recommend corticotomy-facilitated orthodontics to their patients. The minority who were willing to recommend the procedure would limit involvement to adult patients, the management of ankylosed teeth, impacted canines and patients susceptible to root resorption. Over 90% of the sampled periodontists believed that there were adverse side effects.

Treatment planning with corticotomy-facilitated orthodontics

Orthodontics combined with selective alveolar decortication and bone grafting may be an alternative treatment plan for borderline orthognathic/orthodontic surgical cases. Combining orthodontics with selective alveolar decortication and bone grafting can lead to a wider range of tooth movements while simultaneously reducing risk factors that may lead to periodontal breakdown. Indications for the application of this combined technique are derived from goal-oriented treatment planning and sequencing. Case selection, proposed direction and amount of tooth movement, and treatment timing must all be considered in order to achieve the most favorable outcomes with this combined surgical-orthodontic technique. The aim of this paper is to help identify the role of surgically facilitated orthodontics as a treatment modality for borderline orthognathic surgical cases.

Retraction of the upper maxillary incisors with corticotomy-facilitated orthodontics and mini-implants

Abstract This report describes a case of 21-year-old female with severe maxillary protrusion, and class ІІ/1 dental relationship. The treatment plan was extraction of upper first premolars and retraction of the anterior teeth. Mini-implants were used to provide maximum anchorage to maintain the extraction space. To shorten the retraction time selective alveolar corticotomy was combined with orthodontic therapy. The treatment time was reduced without any adverse effects on the periodontium and the vitality of the teeth.

Accelerating tooth movement: The case against corticotomy-induced orthodontics

We are pleased to participate in this Point/Counterpoint debate regarding corticotomy-facilitated orthodontics, also known as accelerated osteogenic orthodontics or periodontally accelerated osteogenic orthodontics. Drs Wilcko and Wilcko have presented their beliefs in the “Point” article. Our assignment is to present and justify an opposing viewpoint. Actually, there are some statements by Drs Wilcko and Wilcko with which we agree. We disagree with other statements. Finally, some issues regarding this procedure were not discussed, and we will raise these in our “Counterpoint” article.

Corticotomy Assisted Orthodontic Canine Retraction

Background: Surgical injury to alveolar bone can temporarily accelerate tooth movement by increasing the remodeling rate of alveolar bone. The purpose of this study was to clinically evaluate maxillary canine retraction acceleration with corticotomy-facilitated orthodontics, and its effect on vitality of pulp and gingival sulcus depth. Materials and method: The sample consisted of 12 adult patients (4 males, 8 females; mean age, 21.7 years) requiring the therapeutic extraction of the maxillary first premolars, with subsequent retraction of the maxillary canines. Surgical holes were done mesially and distally to the side with more space between canine and second premolar, and the other side served as the control. Canine retraction was done by power chain applying 200 g of force per side. Rate of canine movement and potential molar anchorage loss were measured after one month using study model and acrylic plug. Bleeding on probing, radiographical assessment, gingival sulcus depth, and vitality test have also been investigated throughout the study. Result: The surgical side showed a statistically higher retraction mean value as compared with the non-surgical side. In other words, the surgical side demonstrated 42.6% greater net canine distalization than the non-surgical side. Anchorage loss showed no significant difference between sides. There was no significant difference between the pre and post-surgery gingival sulcus depth and pulp vitality response values of surgical side. Conclusion: It has been concluded that surgical holes introduction is effective in accelerating orthodontic tooth movement, and has no harmful effects on surrounding vital structures and/or pulp vitality.

Endoscopically Assisted Tunnel Approach for Minimally Invasive Corticotomies: A Preliminary Report

The dental community has expressed low acceptance of traditional corticotomy techniques for corticotomy-facilitated orthodontics. These procedures are time consuming, entail substantial postoperative morbidity and periodontal risks, and are often perceived as highly invasive. A total of 114 interdental sites were treated in nine consecutive patients. Under local anesthesia, a tunnel approach requiring one to three vertical incisions per arch (depending on the targeted teeth) was used. Piezosurgical corticotomies and elective bone augmentation procedures were performed under endoscopic assistance. Postoperative cone-beam computerized tomography evaluation was used to confirm adequate corticotomy depth. Procedures were completed in a mean time of 26 minutes. Follow-up evaluations revealed no loss of tooth vitality, no changes in periodontal probing depth, good preservation of the papillae, and no gingival recession. No evidence of crestal bone height reduction or apical root resorption was detected. The tunnel approach minimizes soft-tissue debridement and permits effective cortical cuts. The combination of piezosurgery technique with endoscopic assistance provides a quick, reliable means to design and perform these corticotomies while maximizing root integrity preservation. Moreover, the sites needing bone augmentation are selected under direct vision. Compared to traditional corticotomies, this procedure has manifest advantages in surgical time, technical complexity, patient morbidity, and periodontium preservation.

THE INNOVATED LASER ASSISTED FLAPLESS CORTICOTOMY TO ENHANCE ORTHODONTIC TOOTH MOVEMENT

Introduction: Corticotomy-facilitated orthodontics provides a means for rapidly moving teeth purportedly with little damaging effects to the periodontium and with greatly reduced treatment time. The aim of this study was to enhance the orthodontic tooth movement by reducing the cortical bone layer (resistant to bone re-sorption relative to spongious bone) following Erbium, Chromium doped Yttrium Scandium Gallium Garnet (Er-Cr: YSGG)laser irradiation, without reflection of surgical soft tissue flap. Methods: In the present experimental study, 8 New Zealand Male rabbits were the samples for the research. The right first premolar of each rabbit (experiment group) underwent treatment for mesial movement with 75 gram of orthodontic force by using closed Ni-Ti coil spring (Dentaurum®). Coil spring was fixed in the cervical region of first premolars by means of ligature wire and No-Mix composite (Dentaurum®) and also activated to the cervical site of incisors. The left first premolars of the subjects were considered as the control group. Laser corticotomy was performed in anesthetized rabbits. Samples were sacrificed for determination of tooth movement after initiating premolar protraction on the 21 th day. The amount of orthodontic tooth movement was assessed by using a metal feeler gauge with the precision of 0.01 mm, between mesial surface of the second premolars and distal surfaces of the first premolars. The statistical package of SPSS (Kolmogorov - Smirnov and ANOVA test) was used for analytical evaluation of the measurements. Results: The amount of orthodontic tooth movement in the experimental group (mean=1.653±0.34 mm) was significantly (p<0.001) greater than that of the control group (mean=0.936 ±0.28 mm). The innovated laser assisted corticotomies enhanced the rate of orthodontic tooth movement on the intervention side, significantly (p<0.001). Conclusion: The innovated method of laser assisted flapless corticotomy is a useful procedure for reducing treatment time and damage to periodontium. It also eliminates the necessity of more invasive intervention of flap surgery.

Miniscrew implant-supported maxillary canine retraction with and without corticotomy-facilitated orthodontics

The purpose of this study was to clinically evaluate miniscrew implant-supported maxillary canine retraction with corticotomy-facilitated orthodontics. The sample consisted of 13 adult patients (5 men, 8 women; mean age, 19 years) exhibiting Class II Division 1 malocclusion with increased overjet requiring the therapeutic extraction of the maxillary first premolars, with subsequent retraction of the maxillary canines. Corticotomy-facilitated orthodontics was randomly assigned to 1 side of the maxillary arch at the canine-premolar region, and the other side served as the control. By using miniscrews as anchorage, canine retraction was initiated via closed nickel-titanium coil springs applying 150 g of force per side. The following variables were examined over a 4-month follow-up period: rate of tooth movement, molar anchorage loss, plaque index, gingival index, probing depth, attachment loss, and gingival recession. The average daily rate of canine retraction was significantly higher on the corticotomy than the control side by 2 times during the first 2 months after the corticotomy surgery. This rate of tooth movement declined to only 1.6 times higher in the third month and 1.06 times higher by the end of the fourth month. No molar anchorage loss occurred during canine retraction on either the operated or the nonoperated side. There was no statistically significant difference between preoperative and postoperative measurements of plaque index, probing depth, attachment loss, and gingival recession. Corticotomy-facilitated orthodontics can be a feasible treatment modality for adults seeking orthodontic treatment with reduced treatment times.