Evaluation of the effectiveness of the platelet-rich plasma compared to the injectable platelet-rich fibrin on the rate of maxillary canine retraction: a three-arm randomized controlled trial.

BACKGROUND: Blood-derived materials have been used recently to accelerate orthodontic tooth movement, but there are conflicting reports on their effectiveness. OBJECTIVE: To evaluate the potential effect of local injection of platelet-rich plasma (PRP) and injectable platelet-rich fibrin (i-PRF) on the rate of orthodontic tooth movement. TRIAL DESIGN: A single-center, three-arm, parallel-group randomized controlled trial. MATERIALS AND METHODS: The sample consisted of 60 patients aged between 18 and 25 years (mean age: 21.1 ±â€…2.2 years) with Class II division 1 malocclusion requiring anterior retraction. Using a computer-generated list of random numbers, patients were assigned to three groups of canine retraction: (i) assisted with PRP injection (PRP group), (ii) assisted with i-PRF group, and (iii) conventional treatment with no injections (Cont. group). In the interventional groups, injections were done immediately and at 8 weeks after the onset of canine. Transpalatal arches (TPAs) were used to reinforce anchorage. The upper canines were distalized on 0.019 × 0.025-inch stainless archwires using coil springs with a force of 150 g. The primary outcome was the amount of canine retraction, whereas the secondary outcomes were canine rotation and anchoring loss. Assessment was done at five-time points: the beginning of tooth movement (T0) and at 4, 8, 12, and 16 weeks following T0 on three-dimensional superimposed digital models. RESULTS: Sixty patients were randomized and included in this study (20 patients in each group), there were no dropouts. The rate of canine retraction was faster in the experimental groups. The PRP group showed a significantly slower movement in the second and fourth months than the i-PRF group while in the first and third months, there were nonsignificant differences between the two experimental groups. LIMITATIONS: Blinding was not possible during the clinical stage of this trial. CONCLUSIONS: PRP and i-PRF were found to be effective in accelerating orthodontic tooth movement during canine retraction. However, the effect of i-PRF was longer than that of PRP. TRIAL REGISTRATION: ClinicalTrials.gov (ID: NCT05335824).

Effectiveness of Two Intensity Levels of Diode Laser in Debonding Metallic Brackets Regarding Enamel Surface Integrity and Pulpal Temperature: An Ex-Vivo Study.

INTRODUCTION: The traditional methods of deboning metal brackets exert excessive force, resulting in enamel scratches, fractures, and patient discomfort. The objective of this study was to evaluate the effectiveness of using two intensity levels of a diode laser for debonding metallic orthodontic brackets as an alternative to the conventional debonding method. MATERIALS AND METHODS: Sixty intact, extracted human premolar teeth were used in this study, and metal orthodontic brackets were bonded to the buccal surface of these teeth. The teeth were divided into three groups for the experiment: (1) the control group, where conventional bracket debonding was performed using a debonding plier, (2) the first experimental group, where a diode laser (2.5W, 980nm) was utilized for laser debonding, and (3) the second experimental group, where a diode laser (5W, 980nm) was used for laser debonding. The laser was applied using a sweeping movement for 5 seconds. After debonding, the adhesive remnant index (ARI), the lengths, and the frequency of enamel cracks were compared among the groups. Additionally, an increase in intra-pulpal temperature was measured. RESULTS: In all groups, there were no instances of enamel fractures. Laser debonding resulted in a significant reduction in both the frequency and length of newly formed enamel cracks compared to the conventional debonding method. The laser debonding group exhibited increases in intra-pulpal temperature of 2.37°C and 3.60°C in the second and third groups, respectively. These temperature increases were significantly lower than the threshold of 5.5°C. There were no significant differences observed in the ARI scores among the groups. CONCLUSION: With all debonding methods, an increase in the length and frequency of enamel cracks should be anticipated. However, laser-assisted debonding of metal brackets offers the advantage of reducing the risk of enamel damage while avoiding thermal damage to the pulp.

Evaluation of Patient-Centered Outcomes Associated With the Acceleration of en-Masse Retraction of Upper Anterior Teeth Assisted by Flapless Corticotomy Compared to Traditional Corticotomy: A Two-Arm Randomized Controlled Trial.

OBJECTIVE: This study aimed to assess the levels of pain, discomfort, and functional impairment associated with the en-masse retraction of the upper anterior teeth when treating Class II division 1 malocclusion patients using traditional corticotomy or flapless corticotomy. In addition, an assessment of patients' satisfaction with the selected surgical intervention was undertaken at one-month post-operatively. MATERIALS AND METHODS: The study sample comprised 40 patients with Class II division 1 malocclusion, randomly assigned to either the traditional corticotomy group (n=20) or the flapless corticotomy group (n=20). Patients underwent extraction of the maxillary first premolars, and orthodontic mini-screws were placed between the maxillary second premolars and the first molars for skeletal anchorage. An en-masse retraction was accomplished in both groups. Patients were asked to fill in a questionnaire at 24 hours (T1), four days (T2), seven days (T3), 14 days (T4), and 28 days (T5) after the surgical intervention using standardized questionnaires. Most questions were answered on a visual analog scale where zero scores meant the absence of pain, discomfort, or functional impairment, and 100 scores meant the worst feelings of these traits. RESULTS: All patients in both groups entered data analysis with no dropouts. All measured levels were significantly greater in the traditional corticotomy group during the first two weeks following the corticotomy intervention in terms of pain perception (P˂0.001), discomfort (P=0.004), and difficulty in chewing (P=0.015). Additionally, during the first week following corticotomy, levels of perception of discomfort (P˂0.001), difficulty in swallowing (P=0.001), and limitation of jaw movement (P˂0.001) were significantly greater in the traditional corticotomy group. Patient satisfaction, the recommendation to a friend, and acceptance of flapless corticotomy were significantly greater than traditional corticotomy (P=0.002, P=0.001, respectively). 78% of patients in the traditional corticotomy group considered it more discomfort than a tooth extraction, while 50% of patients in the flapless corticotomy group considered tooth extraction more discomfort, with a significant difference between the two groups (P=0.001). CONCLUSIONS: The levels of negative patients' reported outcomes were significantly smaller with flapless corticotomy than with traditional corticotomy. Traditional corticotomy was associated with mild to moderate levels of pain, swallowing difficulty, moderate levels of discomfort, chewing difficulty, and jaw movement limitation after 24 hours of the surgical procedure. In contrast, flapless corticotomy was less problematic and associated with mild pain, swelling, chewing difficulty, jaw movement limitation, and swallowing difficulty at the same assessment time. Patient satisfaction, acceptance, and recommendation to a friend were greater for flapless corticotomy than traditional intervention.