Effectiveness of autologous leukocyte-platelet-rich fibrin on the rate of maxillary canine retraction, rotation, pain, and soft tissue healing: A split-mouth randomized controlled trial.

Objective: To assess the effectiveness of leukocyte-platelet-rich fibrin (L-PRF) compared with conventional treatment on canine retraction, rotation, pain, and soft tissue healing. Methods: Sixteen adult patients aged 18-25 years (10 females, and 6 males; mean age 22.25 ± 2.26 years) with Class I bimaxillary protrusion and Class II div 1 malocclusion participated in this single-center, split-mouth randomized controlled trial at the Orthodontics Department of a single hospital in SCB Dental College and Hospital, Cuttack, India. Randomization was performed using a computer-assisted function with a 1:1 allocation ratio. The intervention included the placement of L-PRF on the experimental side and follow-up for 90 days. The primary outcome measures were canine retraction, rotation, pain, and soft tissue healing. The range of tooth movement was evaluated at 15-day intervals: 0th day (T0), 15th day (T1), 30th day (T2), 45th day (T3), 60th day (T4), 75th day (T5), and 90th day (T6). Canine rotation was assessed at T0 and T6, and pain and soft tissue healing were evaluated on the 3rd, 7th, and 15th days of the treatment. Results: Cumulatively, the L-PRF group demonstrated a significantly greater tooth movement as compared to conventional treatment group (P < 0.001). Overall, canine retraction was 1.5 times greater on the L-PRF side than on the control side. Canine rotation showed no significant relationship, whereas pain and soft tissue healing were significantly better on the L-PRF side than on the control side. Conclusions: Local administration of L-PRF amplifies canine retraction while improving pain and soft tissue repair.

Enhancing root coverage and esthetic outcomes in isolated gingival recession using orthodontic intervention and lateral closed tunnel technique: An interdisciplinary prospective case series.

BACKGROUND: Gingival recession (GR) in malposed tooth in association with bone dehiscence and/or fenestration poses a challenge for successful root coverage treatment. Lateral closed tunnel (LCT) technique is particularly useful in isolated GR in mandibular anterior region, where the shallow vestibular depth prevents tension-free coronal mobilization of tissues. METHODS: Twenty patients with GR associated with tooth malposition were treated using a combined orthodontic-periodontic approach with a torquing auxiliary spring followed by LCT technique. RESULTS: The two techniques resulted in a combined recession depth reduction from 3.75 ± 1.14 mm to 0.40 ± 0.50 mm at the end of 6-month study period. The orthodontic intervention led to an increase in labial marginal bone levels, as assessed through cone beam computed tomography (CBCT), while the LCT achieved closure of residual recession defect. Also, an increase of keratinized tissue width from 0.81 ± 0.88 mm at baseline to 3.30 ± 0.67 mm at 6 months was achieved. Mean root coverage percentage (MRC%) of 91.40% + 10.25% was seen, with 11 out of 20 sites (55%) showing complete root coverage (CRC). CONCLUSIONS: Single tooth orthodontic repositioning followed by LCT technique proved effective in successfully managing isolated recession defects in the mandibular anterior gingival region, which often presents challenging mucogingival conditions. The precise single tooth repositioning resulted in labial marginal bone augmentation, while the LCT surgical approach allowed residual defect closure. KEY FINDINGS: Why are these cases new information? Correction of single tooth malposition is achieved before recession coverage treatment to achieve a favorable environment for graft uptake. The reduction in denuded root surface along with the bone remodeling results in increasing the ratio of vascular to avascular region, thus improving the overall prognosis of the treatment. What are the keys to successful management of these cases? The lateral closed tunnel technique involves creating a mucoperiosteal tunnel to close the recession site. Precision is crucial to avoid damage to surrounding tissues. The recipient site should be wider than the width of recession to improve graft vascularity. What are the primary limitations to success in these cases? Limitations may arise when dealing with complex cases, such as multiple teeth involvement or teeth with significant vertical or horizontal bone loss.

Evaluation of dentoalveolar changes following maxillary incisor intrusion with one vs two anterior miniscrews in subjects with gummy smile: a randomized clinical trial.

OBJECTIVES: To examine dentoalveolar changes following intrusion of maxillary incisors with one or two anterior miniscrews in subjects with gummy smile and deep bite. MATERIALS AND METHODS: Forty-three subjects were selected and divided into two groups: group I (22 subjects: 15 women, 7 men; mean age 30 ± 10 years) received one miniscrew between the upper central incisors, and group II (21 subjects: 16 women, 5 men; mean age 30 ± 10 years) received two miniscrews between the canines and lateral incisors. Dentoalveolar parameters, including amount of intrusion, root resorption, incisor inclination, alveolar bone thickness, and buccal alveolar crest height (cementoenamel junction to labial alveolar crest), were evaluated using cone-beam computed tomography scans obtained before and after intrusion. The intergroup comparison was analyzed using a paired t-test and unpaired t-test to determine significant changes within and between groups. RESULTS: The amount of intrusion was significantly greater in group II than in group I (P < .05). No statistically significant differences were found between groups I and II for changes in incisor inclination, labial bone thickness, and buccal alveolar crest height (P > .05). CONCLUSIONS: Maxillary central and lateral incisor intrusion was significantly greater in subjects treated with two miniscrews. Root resorption of the maxillary central incisors was notably greater in subjects with one miniscrew, while maxillary lateral incisor resorption was greater in subjects treated with two miniscrews.

Success rate of infrazygomatic crest mini-implants used for en-masse retraction of maxillary anterior teeth in first premolar extraction cases: A three-dimensional comparative prospective clinical trial between adolescents and young adults.

BACKGROUND: The purpose of this study was to compare the success rate of infrazygomatic mini-implants between adolescents and young adults. METHODS: A total of 60 subjects of different age groups ie, (group I [adolescents]: 12-18 years, mean age: 14.9 ± 2.9 years; group II [young adults]: 19-25 years, mean age = 21.9 ± 3.1 years) were assessed in the study. En-masse retraction of maxillary anterior teeth was carried out with extraction of upper first premolars with infrazygomatic crest (IZC) mini-implants as anchorage units. Clinical parameters such as success rate, soft tissue thickness, maximum insertion torque, maximum removal torque, pain response, soft tissue response, and cone-beam computed tomography parameters such as embedded angulation, penetration depth, thickness of bone on buccal and palatal aspect of mini-implant, and peri-implant bone density were evaluated. RESULTS: The success rate of IZC mini-implants in adolescents was found to be 96.6% and 98.3% in young adults respectively. There was no significant difference in success rate between the two groups. Intergroup comparison showed a significant difference (P < 0.05) in terms of maximum insertion torque, maximum removal torque, soft tissue thickness, cortical bone thickness, and peri-implant bone density values. Comparison between right and left side revealed a significant difference (P < 0.05) with regards to soft tissue response, soft tissue thickness, total bone thickness, cortical bone thickness, and peri-implant bone density. CONCLUSIONS: There was no significant difference in the success rate of IZC mini-implants between adolescents and young adults. Thus, the use of IZC mini-implants can be recommended in adolescents for successful orthodontic treatment.

Evaluation of physiodispenser assisted micro-osteoperforation on the rate of tooth movement and associated periodontal tissue status during individual canine retraction in first premolar extraction cases: A split-mouth randomized controlled clinical trial.

OBJECTIVE: To assess the rate of tooth movement and the periodontal tissue status over a period of 90 days with and without micro-osteoperforation (MOP). METHOD: Thirty-three adults of the 19 to 25 age group undergoing labial fixed orthodontic treatment with bilateral maxillary first premolar extraction, requiring individual canine retraction as a part of the treatment plan, were recruited for this split-mouth randomized clinical trial. While performing micro-implant-assisted canine retraction in the maxillary arch, the experimental side received three MOPs each on the mesial and distal aspects of the canine root. The amount of tooth movement was measured clinically at every 15 days interval for 90 days; the periodontal status was assessed clinically (probing depth, relative attachment level) and tomographically (canine root length, alveolar bone level) at the 1st day and 90th day of retraction. The data were subjected to appropriate statistical analyses. RESULTS: A statistically significant difference in tooth movement on the MOP side was observed in the first 45 days, amounting to 1.5 times more than that of the control side. However, during 45 to 90 days, the difference in the rate of tooth movement between the sides was not statistically significant. Changes in periodontal variables were also insignificant between the sides except for the distal alveolar bone level. CONCLUSION: An increase in the rate of tooth movement can be achieved without any periodontal adverse effects in the first 45 days of the MOP procedure. The effectiveness of the MOP procedure on the rate of tooth movement gradually declined thereafter. TRIAL REGISTRATION: CTRI/2019/07/020403.