Combined Periodontal-Orthodontic Treatment with Periodontal Corticotomy Regenerative Surgery in an Adult Patient Suffering from Periodontitis and Skeletal Class II Malocclusion: A Case Report with 5-Year Longitudinal Observation.

A thick periodontal phenotype with thick gingiva and alveolar bone volume is required for safe orthodontic tooth movement and long-term stability. A high incidence of dehiscence and fenestration in the labial aspect of mandibular anterior teeth may limit the correction of deformity and orthodontic treatment, especially when the lower anterior teeth are needed to have a large range of movement. This study reports a combination of periodontal therapy and orthodontic therapy with periodontal corticotomy regenerative surgery (PCRS) in a 25-year-old patient suffering from skeletal Class II malocclusion and periodontitis. The patient received periodontal therapy 5 years ago and commenced orthodontic treatment 4.5 years ago. During the 4 years of follow-up for PCRS, the clinical and radiographic evaluations revealed significant improvements in the periodontal phenotype of the mandibular anterior region. The periodontal phenotypes in the mandibular incisors region were all modified from thin to thick. Supplementing orthodontic treatment with labial PCRS could be a promising treatment strategy to maintain long-term periodontal health in adult patients with alveolar deficiency and thin gingiva tissue.

Determination of mandibular distraction osteogenesis most suitable parameters. An experimental study.

BACKGROUND: Distraction osteogenesis is a process of induced bone generation. Various protocols have been described for the management of the latency period, distraction speed and consolidation period, with greater or lesser success. OBJECTIVE: To better understand the process of mandibular distraction and establish the determining factors and their optimal times. MATERIAL AND METHODS: Twenty-seven dogs were studied, which had 54 distractors placed and that underwent unidirectional, bilateral mandibular distraction osteogenesis. The distraction processes were applied using six variants, two for each factor: latency period, distraction period and distraction speed. The changes were examined by means of bone biopsies and X-rays of the area at 0, 7, 14, 21, 45 and 55 days of the process. RESULTS: The most efficient osteogenic distraction parameters were a latency period of five days, a consolidation period of six weeks, distraction speed of 1 mm/day for distances of less than 20 mm, and 3 mm/day for longer distances. CONCLUSIONS: The sequential histological study allowed to observe the appearance of cellular elements (osteocytes, osteoclasts, osteoid matrix, trabeculate, etc.) and their participation in granulation tissue, newly-formed bone and compact mature bone.

ANTECEDENTES: Respecto a la distracción osteogénica (generación ósea inducida), con mayor o menor éxito han sido descritos diversos protocolos para el manejo del período de latencia, velocidad de distracción y período de consolidación. ­. OBJETIVO: Entender mejor el proceso de la distracción mandibular y establecer los factores determinantes y sus tiempos óptimos. MATERIAL Y MÉTODOS: Se estudiaron 27 perros sometidos a distracción osteogénica unidireccional, bilateral de la mandíbula. Los procesos de distracción se aplicaron con seis variantes, dos por cada factor (período de latencia, período de distracción y velocidad de distracción). Se estudiaron los cambios mediante biopsias del hueso y radiografías de la zona a los 0, 7, 14, 21, 45 y 55 días del proceso. RESULTADOS: Los parámetros de distracción osteogénica más eficientes fueron período de latencia de cinco días, período de consolidación de seis semanas, 1 mm diario de velocidad de distracción para distancias menores a 20 mm y 3 mm diarios para distancias mayores. CONCLUSIONES: El estudio histológico secuencial permitió observar la aparición de los elementos celulares (osteocitos, osteoclastos, matriz osteoide, trabeculado, etcétera) y su participación en el tejido de granulación, el hueso neoformado y el hueso maduro compacto.

Exploration of key factors in Gingival Crevicular fluids from patients undergoing Periodontally Accelerated Osteogenic Orthodontics (PAOO) using proteome analysis.

BACKGROUND: The aims of this study are to explore protein changes in gingival crevicular fluid at different time points after PAOO by proteomics method and to select significant bone metabolization-related biomarkers. METHODS: This study included 10 adult patients experiencing PAOO. After orthodontic alignment and leveling, the maxillary anterior teeth were treated with PAOO, which is classified as the experimental area. The traditional orthodontic treatment was performed in the mandibular dentition as the control. Gingival crevicular fluid samples were collected at the following time points: the day before the PAOO (T1) and at 1 week, 2 weeks, 1 month, 2 months and 6 months after PAOO (T2, T3, T4, T5 and T6, respectively). The label-free quantitative proteomic assay was used to evaluate the gingival crevicular fluid in PAOO and control areas at time point T1, T2, and T4. Bioinformatics analysis was carried out to categorize proteins based on biological processes, cellular component and molecular function, which is in compliance with gene ontology (GO) standards. The changes of proteins were confirmed by ELISA. RESULTS: A total of 134 proteins were selected by keywords (Osteoblast markers, Osteoclast markers, Osteoclastogenesis regulating genes and inflammatory marker). 33 of them were statistically different between groups, and 12 were related to bone metabolism. 5 proteins selected by label-free quantitative proteomics were KLF10, SYT7, APOA1, FBN1 and NOTCH1. KLF10 decreased after PAOO, hitting a trough at T4, and then leveled off. SYT7 increased after PAOO, reaching a peak at T3, and then stabilized until T6. APOA1 ascended to a peak at T4 after PAOO, and then remained stable until T6. The FBN1 rose after PAOO, reaching a peak at T4, and then went down slowly. NOTCH1 ascended rapidly in the first two weeks after PAOO and continued its slow growth trend. CONCLUSION: In this study, protein changes in gingival crevicular fluid were detected by proteomics method, and significant bone metabolization-related proteins were selected. It is speculated that APOA1, FBN1, NOTCH1, SYT7 and KLF10 played key roles in regulating bone metabolic balance and in reversible osteopenia after PAOO, which might be involved in the accelerated tooth movement. TRIAL REGISTRATION: This study was registered in the Chinese Clinical Trial Registry (Clinical trial registration number: ChiCTR-ONRC-13,004,129) (26/04/2013).

Harnessing the Power of PAOO and Invisalign: An Interdisciplinary Approach to Orthodontic Care.

The present article explores the benefits of combining periodontally accelerated osteogenic orthodontics (PAOO) with Invisalign for optimal orthodontic treatment outcomes. PAOO is an interdisciplinary dental technique that minimizes complications and accelerates tooth movement while enhancing various orthodontic treatments. In conjunction with Invisalign, PAOO provides a discreet and comfortable solution for patients seeking to improve their smile. The study presents two challenging cases successfully treated using this combined approach, emphasizing the technique's potential to reduce treatment times and improve orthodontic outcomes. The interdisciplinary approach of PAOO ensures long-term success and stability by preserving periodontal structures and addressing potential bony defects. By incorporating bone grafting materials, PAOO helps prevent common concerns in traditional orthodontic treatments, such as bony defects and gingival recession. Furthermore, the combination with Invisalign offers a more aesthetically pleasing and comfortable treatment experience, allowing patients to maintain their self-esteem and confidence throughout the treatment. Despite the potential advantages, dental professionals must manage patient expectations and address potential complications to ensure the best possible results. Overall, the integration of PAOO and Invisalign demonstrates a viable alternative for patients who do not want to proceed with orthognathic surgery, enhancing patient satisfaction and overall treatment outcomes.

A split-mouth randomized controlled trial to compare the rate of canine retraction after a soft tissue procedure compared against a corticotomy procedure for accelerated tooth movement.

Background and Aim: Various methods to accelerate the orthodontic tooth movement have been used, among which corticotomy is considered to be the most common one. The suggested reasoning for such acceleration was the regional acceleratory phenomenon (RAP). Since the RAP is a property of both the hard and soft tissues, we designed a soft tissue flap procedure to compare the effects with the conventional corticotomy procedure. A split-mouth study was conducted where the two procedures were assessed in a single participant. Patients and Methods: The total sample size was calculated to be 40 with 20 participants in each group. The rate of tooth movement was the primary outcome measure, and the secondary outcomes were dentoalveolar changes, which were studied in both the conventional corticotomy and the flap-only procedure based on a cone-beam computed tomography (CBCT) wherein the alveolar bone density (BD) around canines, tipping, and rotational changes in canines, premolars, and molars were assessed. Results: Corticotomy resulted in greater canine angulation, lesser canine rotation and premolar rotation, and greater molar rotation compared with flap elevation, but these differences were statistically insignificant. Conclusion: Though the corticotomy resulted in higher BD, the differences were statistically insignificant. There was no significant difference in the rate of space closure assessed by the two techniques compared.

The effects of a corticotomy on space closure by molar protraction using TSADs in patients with missing mandibular first molars.

INTRODUCTION: The purpose of this study was to evaluate the effects of a triangular-shaped corticotomy on the protraction of second and third molars in patients with missing mandibular first molars. SUBJECTS AND METHODS: The corticotomy and non-corticotomy groups consisted of sixteen first molars in fifteen patients (28.6 ± 9.4 years) and nineteen first molars in fifteen patients (26.6 ± 8.4 years), respectively. A triangular-shaped corticotomy was performed between the second premolar and molar. Temporary skeletal anchorage devices (TSADs) were placed between the first and second premolars in both groups. Mandibular dentition variables were measured on the pre and post-treatment panoramic radiographs and lateral cephalograms. Analysis of covariance was performed. RESULTS: The corticotomy group exhibited 2.8 mm more inter-radicular correction between the second molar to second premolar roots (P < .001) and 1.6 mm more inter-radicular distance correction between the third molar to second premolar roots compared to the non-corticotomy group (P < .01). The corticotomy group required 5.5 months less treatment time for space closure (P < .05), but the total treatment time was the same for both groups. CONCLUSIONS: The inter-radicular distance between the mandibular second premolar and molar and treatment times for space closure was significantly reduced in the corticotomy group.

Periodontal ligament cells under mechanical force regulate local immune homeostasis by modulating Th17/Treg cell differentiation.

OBJECTIVES: Improper orthodontic force often causes root resorption or destructive bone resorption. There is evidence that T helper 17 (Th17) cells and regulatory T (Treg) cells may be actively involved in bone remodeling during tooth movement. In a combination of in vitro and in vivo studies, we investigated the effect of human periodontal ligament cells (hPDLCs) on Th17/Treg cells under different orthodontic forces and corticotomy. MATERIAL AND METHODS: hPDLCs were cultured in vitro and subjected to different mechanical forces. The expression of interleukin (IL)-6 and transforming growth factor (TGF)-ß in the supernatant and the mRNA levels of hypoxia inducible factor (HIF)-1α, Notch1, and TGF-ß in hPDLCs were investigated. Supernatants were collected and co-cultured with activated CD4+T cells, and the differentiation of Th17/Treg cells was analyzed by flow cytometry. We also established an animal model of tooth movement with or without corticotomy. The tooth movement distance, alveolar bone height, and root resorption were analyzed using micro-computed tomography. Expression of interleukin (IL)-17A, forkhead Box P3 (Foxp3), and IL-6 were analyzed using immunohistochemistry, while osteoclasts were evaluated by tartrate-resistant acid phosphatase (TRAP) staining. The mRNA levels of IL-17A, IL-6, Foxp3, IL-10, HIF-1α, notch1, and C-X-C motif chemokine ligand 12 (CXCL12) in alveolar bone and gingiva were investigated. RESULTS: Heavy force repressed cell viability and increased the mortality rate of hPDLCs; it also improved the expression of IL-6, declined the expression of TGF-ß, and promoted the mRNA expression level of HIF-1α. The expression of TGF-ß and Notch1 mRNA decreased and then increased. The supernatant of hPDLCs under heavy force promotes the polarization of Th17 cells. The heavy force caused root resorption and decreased alveolar bone height and increased the positive area of IL-17A immunohistochemical staining and the expression of IL-17A, IL-6, HIF-1α, and Notch1 mRNA. Corticotomy accelerated tooth movement, increased the proportion of Foxp3-positive cells, and up-regulated the expression of Foxp3, IL-10, and CXCL12 mRNA. CONCLUSIONS: During orthodontic tooth movement, the heavy force causes root resorption and inflammatory bone destruction, which could be associated with increased expression of Th17 cells and IL-6. Corticotomy can accelerate tooth movement without causing root resorption and periodontal bone loss, which may be related to the increased expression of Treg cells. CLINICAL RELEVANCE: Altogether, this report provides a new perspective on the prevention of inflammatory injury via the regulation of Th17/Treg cells in orthodontics.

Accuracy evaluation of 3D-printed guide-assisted flapless micro-osteoperforations in the anterior mandible.

AIM: To evaluate the accuracy of tridimensional (3D)-printed guide-assisted flapless cortical bone micro-osteoperforations (MOPs) in the anterior mandible on a cadaver model. MATERIALS AND METHODS: Five human cadaver heads with complete dentition in the anterior mandible were used in the present study. Preplanning CBCT and intraoral surface scans were obtained. After alignment, drilling sites in the interradicular areas were planned from canine to canine, and a surgical guide was printed. The drilling was performed and a postprocedure CBCT scan was obtained to assess the accuracy of the procedure in relation to the virtual planning. RESULTS: The mean ± standard deviation (SD) mesiodistal interradicular space was 2.67 ± 0.84 mm. The mean ± SD error of the actual drilled hole compared with the planned position of the mesial drill site was 0.66 ± 0.33 mm, and to the distal drill site it was 0.56 ± 0.33 mm. There was a statistically significant difference between the number of times the teeth were hit mesially (10 out of 64 holes) and distally (none). CONCLUSIONS: The proposed technique, limited to an ex vivo scenario, provides a valid and reliable method for mandibular MOPs using a 3D-generated surgical guide. However, the risk of damaging adjacent radicular surfaces, particularly in areas with limited mesiodistal interradicular bone, needs to be considered. Further studies should focus on using thinner drills and adding other methods to stabilize the guide. Additionally, by selecting individuals and perforation sites with more mesiodistal interradicular bone, less damage is likely. (Int J Comput Dent 2022;25(4):387-0; doi: 10.3290/j.ijcd.b2599841).

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.

Augmented Corticotomy on the Lingual Side in Mandibular Anterior Region Assisting Orthodontics in Protrusive Malocclusion: A Case Report.

Adequate alveolar bone volume is a prerequisite condition for successful orthodontic tooth movement and posttreatment stability. Mandibular anterior teeth are more likely to exhibit dehiscence and fenestration in adult patients, which make orthodontic treatment in adults challenging, especially when the amount of retraction of the anterior teeth is large. Herein, we report the treatment of augmented corticotomy only on the lingual side in the mandibular anterior region to increase the volume of soft and hard tissue assisting orthodontics in a Class I bialveolar protrusive malocclusion and propose management strategies of mandibular incisor retractions. A 22-year-old female with a chief complaint of protrusive mouth presented to the Department of Orthodontics for orthodontic treatment, diagnosed with Class I bialveolar protrusive. The orthodontic treatment plan involved the extraction of four premolars and extensive retraction of the anterior teeth using microimplant anchorage. In consideration of the fenestration and dehiscence in the mandibular anterior alveolar bone and the pattern of tooth movement, augmented corticotomy was performed on the lingual side combined with bone grafting. Clinical and radiographic evaluation after treatment revealed significant improvements in the facial profile and in periodontal phenotype. Augmented corticotomy assisting orthodontic treatment could be a promising treatment strategy for adult patients with alveolar protrusion to maintain periodontal health.

[Algorithms for orthodontic treatment of patients with maxillary constriction based on the stages of formation of the palatal suture]. / Algoritmy ortodonticheskogo lecheniya patsientov s suzheniem verkhnei chelyusti na osnovanii stadii formirovaniya sredinnogo nebnogo shva.

THE AIM OF THE STUDY: Improving the effectiveness of complex orthodontic treatment of patients with constriction and deformation of the upper jaw during the period of replacement and permanent bite based on the analysis of cone-beam computed tomography (CBCT) data. MATERIALS AND METHODS: The results of complex treatment of 70 patients with constriction and deformation of the upper jaw during the period of temporary and permanent bite are presented. The patients were divided into groups according to the stage of formation of the midpalatal suture: 1st group - 40 patients with stage «A¼ and «B¼ (average age 11.5 years); 2nd group - 15 patients with stage «C¼ (average age 20.5 years); 3rd group - 15 patients with stage «D¼ and «E¼ (average age 24.5 years). Orthodontic treatment was carried out using palatine expanders with a dental and intraosseous type of fixation. The complex treatment consisted of: orthodontic treatment using a bracket system, transgingival laser corticotomy, piezocorticotomy, surgically assisted rapid palatal expansion, orthodontic appliances for the expansion of the upper jaw. After conducting a clinical X-ray examination of all patients and analyzing the data obtained, we developed algorithms for therapeutic measures. RESULTS: As a result of the diagnosis and treatment planning, the expansion of the upper jaw was achieved both at the dental alveolar and skeletal levels. Detailed algorithms of complex treatment were developed based on the analysis of CBCT data, the stage of formation of the midpalatal suture individually for each patient. CONCLUSION: It was found that the analysis of CBCT data makes it possible to choose the optimal treatment method for patients with skeletal deformities of the dentition complex, thereby increasing the effectiveness of orthodontic treatment.

The effect of corticotomy on the compensatory remodeling of alveolar bone during orthodontic treatment.

BACKGROUND: This study aimed to explore whether compensatory remodeling of the alveolar bone surface occurred during the buccal palatal movement of orthodontic teeth. We preliminarily explored whether corticotomy could activate or accelerate osteogenesis in the alveolar bone surface by measuring the expression of TGF-ß1 (transforming growth factor-ß1), which can facilitate the proliferation and differentiation of osteoblasts and regulate the maturity and formation of bone. METHODS: Sixty 10-week-old male Wistar rats were selected. In the orthodontic group, 20 rats were implanted with a constriction device between the maxillary first molars under general anesthesia. In the corticotomy group, 20 rats were implanted with a constriction device, and a palatal incision was made to penetrate the cortical bone. In the control group, 20 rats underwent no experimental operation except general anesthesia. After 1, 3, 5 and 7 days, the maxillary first molars and the surrounding alveolar bone were harvested, and coronal sections containing the apical mesial buccal root were prepared and observed using tetracycline fluorescence, HE staining and immunohistochemical staining for TGF-ß1. Image-Pro Plus software was used to assess the immunohistochemical results, and SPSS 22.0 statistical software was used to analyze variance and perform the LSD test. RESULTS: The tetracycline fluorescence results showed that in the periosteum near the apical region, an obvious fluorescence signal was observed in the orthodontic group and the corticotomy group compared with the control group. In the orthodontic group and corticotomy group, HE staining showed that the morphology was similar to cube-shaped. The immunohistochemical results showed that TGF-ß1 was significantly increased in the periosteum near the apical region in the orthodontic group and corticotomy group, and there were significant differences among the three groups. In addition, the expression of TGF-ß1 in the periosteum in the orthodontic group and the corticotomy group gradually increased over time, reaching a peak on day 5 and slightly decreasing on day 7. CONCLUSION: Osteogenesis occurred on the alveolar bone surface during the buccal palatal movement of orthodontic teeth, and corticotomy had a positive effect, and TGF-ß1 was involved in this process.

[Effect of corticotomy techniques accelerating orthodontic tooth movement on root resorption].

In recent years, developing new methods to accelerate orthodontic tooth movement (OTM) has attracted extensive attention in the field of orthodontic clinical and scientific research. It reduces orthodontic treatment time and risks. Over the past, various approaches have been done to accelerate orthodontic tooth movement. Several forms of corticotomy techniques have been effective in inducing rapid tooth movement. These techniques activate regional acceleratory phenomenon and create a favorable microenvironment for accelerating tooth movement. Root resorption is one of most common side effects of orthodontic treatment. It affects the long-term viability and health of teeth. However, the effect of corticotomy techniques accelerating orthodontic tooth movement on root resorption still remains unclear. Accelerating tooth movement may have two-side effects on root resorption. Through shortening the treatment period and removing the hyalinized tissues, the acceleration of orthodontic tooth movement could reduce root resorption. The increase of root resorption might be due to the local inflammation and function of cementoclasts/odontoclasts. In this paper, we reviewed the effects of different corticotomy techniques accelerating orthodontic tooth movement on root resorption. Corticotomy techniques deal with mucoperio-steal flaps and bone tissues differently and develop towards minimally invasive. Previous studies on root resorption use two-dimensional images, including apical films and panoramic tomography, to evaluate the degree of root resorption. In recent years, researches measure the volume of root resorption accurately using cone-beam computed tomography (CBCT) and micro-CT. Most studies suggest that the root resorption during acceleration of orthodontic tooth movement through corticotomy techniques is not statistically different from that of traditional orthodontic treatment. Some studies using micro-CT have shown that the root resorption in the groups of corticotomy techniques increases compared with the control group without surgery. Because of the short duration of these studies, the clinical significance is controversial on the overall impact of corticotomy techniques on orthodontic treatment. Accelerating orthodontic tooth movement is still at its emerging phase and need further research in the form of clinical trials to illustrate the effect of corticotomy techniques accelerating orthodontic tooth movement on root resorption.

The effectiveness of surgical adjunctive procedures in the acceleration of orthodontic tooth movement: A systematic review of systematic reviews and meta-analysis.

OBJECTIVE: To identify and evaluate the body of the evidence regarding the effectiveness of surgical adjunctive procedures (SAPs) in accelerating orthodontic tooth movement (OTM). DATA SOURCES: Unrestricted search of three electronic databases and manual search up to 12 June 2020 were undertaken. DATA SELECTION: All systematic reviews of randomised and non-randomised controlled trials that investigate the effectiveness of the SAPs in accelerating OTM were included. DATA EXTRACTION: Study selection and data extraction were undertaken independently and in duplicate by two reviewers. A random-effects model with a 95% confidence interval (CI) was generated for comparable outcomes. Two reviewers assessed the quality of the included studies using AMSTAR2 and GRADE. RESULTS: Fourteen systematic reviews were included; however, four systematic reviews were assessed quantitatively. Meta-analysis showed that mean difference (MD) of canine retraction rate, for the first month after SAPs, was mild (MD = 0.65 mm/month). Compared to control, micro-osteoperforations (MOPs) statistically but temporally accelerate lower canine retraction and en masse retraction by 0.25 mm/month and 0.31 mm/month, respectively. There was no significant effect (P>0.05) in terms of molar anchorage loss (MAL) between control and MOP groups. Piezocision non-significantly shortens the duration of en masse retraction (4.30 months, P>0.05), but significantly shortens incisors retraction (101.64 days, P<0.001). MAL is mild but significantly less in the piezocision group compared to the control group (MD = 0.53 mm, P=0.03). Low-level evidence showed that SAPs have no significant effect on root resorption or periodontal health; however, piezocision is associated with transient acute inflammation and noticeable scars. CONCLUSION: Low-level evidence concludes that SAPs accelerate OTMs and reduce treatment duration, but the acceleration is minor and transient. The effect on anchorage loss is variable and technique related. Side effects of SAPs are transient, but some might be aesthetically noticeable. A cost-benefit analysis of SAPs should be considered while making the treatment decision.

Surgical Orthodontic Treatment of Skeletal Mandibular Protrusion with Multiple Impacted Ankylosed Teeth Treated with Alveolar Corticotomy.

AIM: To present a case of skeletal mandibular protrusion with multiple impacted ankylosed teeth, which were treated with conventional orthognathic surgery and alveolar corticotomy, respectively. BACKGROUND: Tooth ankylosis is characterized by the fusion of a root surface with the surrounding alveolar bone. Various treatment modalities for tooth ankylosis have been developed and are used commonly in the clinic. Corticotomy is defined as the application of intentional surgical injury to the cortical bone to mobilize a tooth with the adjacent bone and soft tissues. The corticotomy technique has been improved in recent years to avoid possible risks such as periodontal damage, tooth devitalization, and osseous necrosis due to an inadequate blood supply. CASE DESCRIPTION: A female patient aged 16 years and 3 months was diagnosed with anterior crossbite and the impaction and ankylosis of multiple canines. After the confirmation of ankylosis, alveolar corticotomy was performed on the maxillary left and mandibular right canines. After 6 months of traction (patient age, 19 years and 7 months), both canines had extruded successfully. After the completion of preoperative treatment, bilateral intraoral vertical ramus osteotomy was performed to correct the anterior crossbite involving a skeletal mandibular protrusion. The amounts of mandibular setback on the right and left sides were approximately 7 and 5 mm, respectively. The total treatment period was 55 months. Acceptable occlusion with a balanced profile was maintained over a 5-year retention period, indicating the long-term stability and success of the treatment. CONCLUSION: Our results indicate that alveolar corticotomy should be considered to facilitate the treatment of multiple impacted ankylosed teeth. CLINICAL SIGNIFICANCE: This report proposes an efficacy of alveolar corticotomy for extrusion of impacted ankylosed teeth.

[Improving the effectiveness of treatment of the adult patients with dentoalveolar anomalies and deformities using Er,Cr:YSGG laser: a clinical study]. / Povyshenie effektivnosti lecheniya vzroslykh patsientov s zubochelyustnymi anomaliyami i deformatsiyami zubnykh ryadov s pomoshch'yu Er,Cr:YSGG lazera: klinicheskoe issledovanie.

THE AIM: Of the work is to develop and substantiate the method of minimally invasive complex orthodontic treatment of patients with constriction and deformation of the upper jaw in the period of permanent bite with the combined use of a bracket system, orthodontic devices for the expansion of the upper jaw and fractional photothermolysis to improve the effectiveness of complex treatment. MATERIALS AND METHODS: The results of complex treatment of patients with the deficiency of the upper jaw in the period of permanent bite are presented. Complex treatment consisted of orthodontic treatment using a bracket system, laser corticotomy, orthodontic devices for the expansion of the upper jaw. Ultrasound examination before and after the procedure was performed to obtain reliable results of laser impact on bone tissue. RESULTS: After conducting a clinical and radiological examination (using cone-beam computed tomography) of all patients and analyzing the data obtained, we have developed algorithms for therapeutic measures. As a result of orthodontic treatment aimed at the expansion of the upper jaw patients who underwent fractional photothermolysis procedure achieved the expansion of the upper jaw at both the dentoalveolar and skeletal levels. CONCLUSION: It was found that a comprehensive approach with minimally invasive effects can improve the effectiveness of treatment of patients with constriction and deformation of the upper jaw during the period of permanent bite and achieve stable treatment results.

The Effect of Partial Corticotomy on the Rate of Maxillary Canine Retraction: Clinical and Radiographic Study.

The study aimed to evaluate, clinically and radiographically, the effect of partial corticotomy of the buccal plate distal to the canine on the rate of maxillary canine retraction. A clinical trial with the split-mouth design was conducted among twenty orthodontic patients, recommended for first premolar extraction with an age range from 13 to 21 years, selected from patients seeking orthodontic treatment in private dental clinics in Jeddah, Kingdom of Saudi Arabia. After extraction of the maxillary right and left first premolar, partial corticotomy was performed distal to the canine on the right side. The canine retraction was carried out with a power chain on both sides extended between the canine and the maxillary first molar. The data collected from the current study were tabulated and statistically analyzed using an independent sample t-test with p < 0.05 considered statistically significant. The rate of canine retraction was significantly higher on the corticotomy side than the control side (p < 0.05). Under the limitations of the present study, it can be concluded that the technique of partial corticotomy of the buccal plate distal to the canine is a straightforward surgical procedure enhancing the rate of canine retraction significantly.

Effect of PTH and corticotomy on implant movement under mechanical force.

BACKGROUND: Osseointegrated implants are considered as clinically non-movable. Parathyroid hormone (PTH) is known to play a significant role in the regulation of bone remodeling and in intermittent, low doses, result in osteoanabolic effects. This study aimed to investigate the effects of PTH and corticotomy, both under traction force, on osseointegrated implants. METHODS: Four implants-two in each hemimandible-were placed in each of the three study mongrels. Each mongrels were designated as control, normal dose PTH (PTH-1), and high dose PTH (PTH-2) groups, with each groups further subdivided into non-surgery implant and surgery implant. After osseointegration, mechanical force with NiTi closed coil springs (500 g) was applied around each implants. Corticotomy was performed around one of four implants in each mongrels. Parathyroid hormone was administered locally on a weekly basis for 20 weeks. Clinical movement of the implants were evaluated with the superimposed 3D- scanned data, bone- microarchitectural and histologic examinations. RESULTS: Superimposition analysis showed continuous movement of the non-surgery implant of PTH-1 group. Movement was further justified with lowest bone implant contact (adjusted BIC; 44.77%) in histomorphometric analysis. Upregulation of bone remodeling around the implant was observed in the normal dose PTH group. In the surgery implants, the remarkably higher adjusted BIC compared to the non-surgery implants indicated increased bone formation around the implant surface. CONCLUSION: The results indicate that the catabolic and anabolic balance of osseointegrated implants in terms of bone remodeling can be shifted via various interventions including pharmacological, surgical and mechanical force. CLINICAL RELEVANCE: Upregulated bone remodeling by PTH and corticotomy under continuous mechanical force showed the possible implications for the movement of osseointegrated dental implant.

Comparison of Effectiveness of Corticotomy-assisted Accelerated Orthodontic Treatment and Conventional Orthodontic Treatment: A Systematic Review.

AIM: To systematically review the comparative differences in the performance and timeliness of conventional orthodontic treatment with that of corticotomy-assisted accelerated orthodontic treatment. DATA SOURCES: The electronic databases PubMed and Google Scholar were searched from January 2007 to January 2018 in English, with manual searches of reference lists and gray literature. Thirty-six articles were included in the study with inclusion criteria as prospective clinical studies of patients treated with fixed conventional appliance and the intervention was the corticotomy-assisted accelerated orthodontic treatment method. STUDY SELECTION: Two reviewers assessed independently the eligibility of the included articles. One investigator abstracted study design information, intervention details, and harms data from all included studies into a standardized evidence table. The accuracy of these data was checked by the second investigator. We resolved any disagreements through discussion with other authors. RESULTS: Different aspects of the corticotomy-assisted accelerated orthodontics treatment method were investigated including risk factors, advantages, and disadvantages as compared to that of conventional orthodontic treatment. CONCLUSION: There is limited available evidence about effectiveness of corticotomy-assisted accelerated orthodontics. Although the current review indicates that the corticotomy-assisted accelerated orthodontic treatment method can fasten the treatment duration by 2.2-3 folds compared to conventional orthodontic treatment, furthermore, the level of evidence needs well-conducted prospective research with big sample size to draw valid conclusions. CLINICAL SIGNIFICANCE: Orthodontic treatment is a time-consuming process and due to noncompliance of patients, research has found different methods to accelerate the treatment, thus reducing the total treatment duration. Use of accelerated orthodontic techniques is expected to help clinicians in better treatment decisions for noncompliant patients.

[Complex orthodontic-surgical rehabilitation of adults with malocclusions and deformations in dentition]. / Kombinirovannoe ortodonto-khirurgicheskoe lechenie vzroslykh patsientov s zubochelyustnymi anomaliyami i deformatsiyami zubnykh ryadov.

The aim of the study was the development and substantiation of the method of orthodontic treatment of patients with malocclusions and deformities of dentoalveolar arches with the combined use of braces, orthodontic miniscrew, piezo-surgical corticotomy or laser corticotomy to improve the efficiency and reduce the time of complex treatment. The results of complex rehabilitation of 80 adult patients with dentoalveolar anomalies and deformities of dentition are presented. As a result of the orthodontic treatment of patients who underwent piezo-surgical corticotomy the bodily movement of the posterior teeth in the area of the previously removed tooth was achieved. After piezo-surgical or laser corticotomy the rate of tooth protraction remained elevated for 3 to 5 months (on average 0.3±0.5 mm/month), then gradually decreased. Piezo-surgical corticotomy led to a decrease in bone density, which was measured on the Hounsfield scale. As a result of orthodontic treatment in patients who underwent laser corticotomy an expansion of the upper jaw and normalization of occlusion in the transversal and sagittal directions was achieved: in the region of the hard palate by 7.1±0.4 mm; in the region of the alveolar bone by 6.5±0.5 mm; in the region of the roots of molars by 6.4±0.9 mm; in the area of crowns of molars by 8.3±0.7 mm. It was found that the combined use of piezo-surgical corticotomy and orthodontic miniscrews improve the efficiency and reduce the duration of orthodontic treatment by 3 to 6 months.