Bone Formation and Maintenance in Oral Surgery: The Decisive Role of the Immune System-A Narrative Review of Mechanisms and Solutions.

Based on the evidence of a significant communication and connection pathway between the bone and immune systems, a new science has emerged: osteoimmunology. Indeed, the immune system has a considerable impact on bone health and diseases, as well as on bone formation during grafts and its stability over time. Chronic inflammation induces the excessive production of oxidants. An imbalance between the levels of oxidants and antioxidants is called oxidative stress. This physio-pathological state causes both molecular and cellular damage, which leads to DNA alterations, genetic mutations and cell apoptosis, and thus, impaired immunity followed by delayed or compromised wound healing. Oxidative stress levels experienced by the body affect bone regeneration and maintenance around teeth and dental implants. As the immune system and bone remodeling are interconnected, bone loss is a consequence of immune dysregulation. Therefore, oral tissue deficiencies such as periodontitis and peri-implantitis should be regarded as immune diseases. Bone management strategies should include both biological and surgical solutions. These protocols tend to improve immunity through antioxidant production to enhance bone formation and prevent bone loss. This narrative review aims to highlight the relationship between inflammation, oxidation, immunity and bone health in the oral cavity. It intends to help clinicians to detect high-risk situations in oral surgery and to propose biological and clinical solutions that will enhance patients' immune responses and surgical treatment outcomes.

Tissue response during Piezocision-assisted tooth movement: a histological study in rats.

OBJECTIVES: Piezocision is a novel, minimally invasive technique combining micro-incisions and decortications made by a piezotome in order to enhance the rate of orthodontic tooth movement. The combined technique allows simultaneous hard and/or soft tissue grafting via selective tunnelling to correct gingival recessions or bone deficiencies. The present study was designed to evaluate the effects of Piezocision on bone with or without tooth movement on a rat model. MATERIALS AND METHODS: Ninety-four Sprague-Dawley rats were divided into four groups: no treatment (n = 3), TM (tooth movement alone; n = 21), PS (Piezocision alone; n = 35), and PS + TM (Piezocision and tooth movement; n = 35). In each group, seven time points were studied: 1, 3, 7, 14, 28, 42, and 56 days. After sacrifice, the maxillae were removed, defleshed, stained with haematoxylin and eosin for morphometric analyses and tartrate-resistant acid phosphatase for osteoclastic activity. RESULTS: Three days after the surgery, the bone content decreased significantly in the PS and PS + TM groups compared to baseline (P < 0.01) and the TM group (P < 0.05). This trend continued until Day 28 and was particularly evident in the PS + TM group. At Day 56, alveolar bone returned to its baseline levels in all groups. Osteoclastic activity followed similar change pattern found in the amount of bone, suggesting a strong role for the coupling of the resorptive and formative turnover of the bone. Osteoclastic activity increased as soon as Day 1 in the PS (29.0±3.0, P < 0.05) and PS + TM groups (39.0±6.0, P < 0.01) compared to baseline (22.0±4.0). The highest level of osteoclastic activity in TM group was observed at 3 days (64.3±8.0, P < 0.01) with a steady decrease thereafter. The Piezocision-induced osteoclastic activity showed a steady increase up to 7 days in both PS (39.0±7.0, P < 0.01) and PS + TM (51.8±7.0, P < 0.01) groups and decreased thereafter until Day 56. CONCLUSIONS: Within the limitations of our study (number of animals, duration in time, and limited data on the anabolic activity), our preliminary results suggest that Piezocision-facilitated orthodontic tooth movement increases the rate of movement of the teeth undergoing orthodontic treatment through the coupled remodelling of the alveolar bone. This process is initiated by the osteoclastic activity following surgery and extended via the synergistic relationship between Piezocision and tooth movement.

[Accelerated orthodontic treatment with piezocision: a mini-invasive alternative to conventional corticotomies]. / Traitements orthodontiques accélérés par piézocision : une alternative mini-invasive aux corticotomies alvéolaires.

An increasing number of adult patients are seeking orthodontic treatment and a short treatment time has become a recurring request. To meet their expectations, a number of surgical techniques have been developed to accelerate orthodontic tooth movement. However, these have been found to be quite invasive. We are introducing here a new, minimally invasive flapless procedure, combining micro incisions, piezoelectric incisions and selective tunneling that allows for hard- or soft-tissue grafting. Combined with a proper treatment planning and a good understanding of the biological events involved, this novel technique can locally manipulate alveolar bone metabolism in order to obtain rapid and stable orthodontic results. Piezocision allows for rapid correction of severe malocclusions without the drawbacks of traumatic conventional corticotomy procedures.

Rapid treatment of Class II malocclusion with piezocision: two case reports.

An increasing number of adult patients are seeking orthodontic treatment to enhance their smile or their masticatory function. In this fast-paced and self-conscious society, time and esthetics have become increasingly important. One of the biggest challenges an adult orthodontic patient faces is the time spent wearing brackets. Over the years, several surgical techniques have been developed to address this issue and reduce overall treatment time. Although very effective, these techniques have proven to be quite invasive. A new, minimally invasive procedure (piezocision) is presented that combines microincisions and localized piezoelectric surgery to achieve similar results rapidly and with minimal trauma.

Piezocision: a minimally invasive, periodontally accelerated orthodontic tooth movement procedure.

An increasing number of adult patients have been seeking orthodontic treatment, and a short treatment time has been a recurring request. To meet their expectations, a number of surgical techniques have been developed to accelerate orthodontic tooth movement. However, these have been found to be quite invasive, leading to low acceptance in patients and the dental community. The authors are introducing a new, minimally invasive procedure, combining microincisions with selective tunneling that allows for hard- or soft-tissue grafting and piezoelectric incisions. This novel approach is leading to short orthodontic treatment time, minimal discomfort, and great patient acceptance, as well as enhanced, or stronger, periodontium. Because of the added grafting (bone and/or soft tissue), the periodontium is much thicker buccally.