Pulp volume changes after piezocision-assisted tooth movement: a randomized clinical trial

A potential novel technique for measurement of pulp volume on periapical radiography: A pilot study

Pulp volume can be assessed during dental treatment. Three-dimensional imaging techniques are not routinely used for this purpose because of high radiation doses. This study aimed to develop a novel method to measure pulp volume using periapical radiography. In this study, cone-beam computed tomography (CBCT) was used as a reference method. Periapical radiography and CBCTs obtained from the same patients (n = 32) were recorded. Pulp volume was determined by observing the density differences between the pulp and peripheral structures using ImageJ. A method of graph and volume calculation was developed for each tooth. The Shapiro-Wilk test and Mann-Whitney U test were used to show normality and non-normal distributions. The Bland-Altman plot was used to show the scattering of the mean versus difference values of the measurements of the two methods used to calculate the pulp volume. Normality was evaluated using the Shapiro-Wilk test. CBCT measurements are normally distributed (p = 0.307), while ImageJ is not normally distributed (p = 0.027). Therefore, the mean difference between the two groups was analyzed using the nonparametric Mann-Whitney U test. There was a statistically significant difference between the CBCT and ImageJ measurements (p = 0.01). According to Spearman's correlation analysis, the results obtained from the novel method were moderately correlated with those obtained from the reference method (r = 0.444). The results of this study indicated that a novel method-based Java software can be used to calculate pulp volume using low-dose radiation containing periapical radiography.

Convalescing Mandibular Anterior Crowding through Piezocision and the Micro-Osteoperforation Surgical Procedure-A Clinical Comparative Study

BACKGROUND

Minimally invasive periodontic (perio) surgical procedures, piezocision, and micro-osteoperforation are useful techniques for accelerating tooth movement. These techniques also offer advantages in the orthodontic (ortho) and aesthetic domains. This study aimed to evaluate and compare the rates of lower anterior decrowding with piezocision and micro-osteoperforation.

METHODS

This clinical study included 24 patients requiring fixed orthodontic treatments. Two periodontic techniques (piezocision (PZ) and micro-osteoperforation (MOP)) were considered for the orthodontic treatments. Each patient was randomly allocated to either the piezocision (PZ) group or the micro-osteoperforation (MOP) group. The piezocision group received five radiographically guided incisions on the labial surface of the alveolar bone, whereas the micro-osteoperforation group received one to three MOPs each using a mini-implant drill between the six lower anterior teeth, and later, an initial arch wire was ligated to each bracket. Little's irregularity index (LII) was calculated using a digital vernier caliper on study models every four weeks until decrowding was achieved. The difference in the rates of lower anterior crowding between the piezocision and micro-osteoperforation groups was analyzed to determine the statistical significance.

RESULTS

The rates of irregularity index change during decrowding were 4.38 ± 0.61 in the piezocision group and 3.82 ± 0.47 in the micro-osteoperforation group. Piezocision was found to be 1.2 times faster than micro-osteoperforation in terms of the rate of decrowding.

CONCLUSION

The advanced perio-ortho combination technique was advantageous in accelerated decrowding. In comparison to MOP, there was an increase in the rate of decrowding with PZ. Decrowding can be completed quickly with PZ, and it can thus be used to treat crowding effectively in a limited time frame.

Pulp Changes Secondary to Orthodontic Forces: A Review of Literature

This review article encompasses the literature pertaining to changes in the dental pulp subsequent to forces exerted secondary to orthodontic treatment. The review was conducted at the College of Dentistry, Qassim University, Saudi Arabia, from October 2022 to February 2023. A literature search was conducted on PubMed, Embase, The Cochrane Library and Google Scholar for articles from 2000 to 2023. Keywords and MeSH terms used were 'orthodontic forces', 'pulp changes', 'dental pulpal changes', and 'pulp volume'. Two reviewers went through the titles. After removing irrelevant and duplicate articles, abstracts were assessed for relevant articles. Finally, the reviewers analyzed full-text articles, and a total of five articles including four randomized controlled trials and one retrospective study were selected. It was concluded that managing and minimizing injury to the pulp or supporting tissues is important when using orthodontic mechanics. In order to do so, clinicians must thoroughly understand any change in the pulpal tissue following the orthodontic treatment. Orthodontic tooth movements cause inflammatory changes in the tooth pulp and periodontal ligament which are directly related to the amount, direction, and time duration of force used. Long-term pulp blood flow analysis shows that even though there is a transient uptrend in the flow of blood after the removal of the orthodontic force, it reverts to normal levels three months later. However, pulp volume has been reported to decrease, more prominently in anterior teeth, as orthodontic forces stimulate the pulp to produce tertiary dentin.

The clinical efficacy of periodontally accelerated osteogenic orthodontics in patients with bone fenestration and dehiscence: a retrospective study

PURPOSE

The objective of the study was to explore the effect of periodontally accelerated osteogenic orthodontics (PAOO) in orthodontic patients with bone dehiscence and fenestration in the anterior alveolar region of the mandible.

METHODS

A retrospective study was performed in 42 patients with bone dehiscence and fenestrations in the anterior alveolar region of the mandible who underwent the PAOO technique. The bleeding index (BI), probing depth (PD), keratinized gingiva width (KGW), gingival recession level (GRL), and gingival phenotype were recorded and assessed at baseline and 6 and 12 months postoperatively. Cone-beam computerized tomography was used to measure bone volume in terms of root length (RL), horizontal bone thickness at different levels, and vertical bone height at baseline and 6 months and 12 months after surgery.

RESULTS

The sample was composed of 42 patients (22 males and 20 females; mean age, aged 25.6 ± 4.8 years) with 81 teeth showing dehiscence/fenestrations and 36 sites presenting gingival recessions. There was no significant difference in BI, PD, or KGW (between baseline and 6 or 12 months postoperatively) based on the clinical evaluations (P > 0.05). Gingival recession sites demonstrated a significant reduction in the GRL after surgery (P < 0.05). Furthermore, the proportion of teeth with a thick gingival phenotype increased from 33.61% at baseline to 53.13% at the end of the follow-up. In addition, the bone thickness measurements at the mid-root and crestal levels were markedly increased compared with the baseline values (P < 0.05), although the increase in thickness at the apical level was not statistically significant (P > 0.05).

CONCLUSIONS

Within the limitations of the study, the results show that the PAOO technique is beneficial to periodontal conditions in terms of soft and hard tissue augmentation. The PAOO procedure may represent a safe and efficient treatment for orthodontic patients with bone dehiscence and fenestration.

TRIAL REGISTRATION

This study was approved by the ethics committee of the stomatological hospital affiliated with Xi'an Jiaotong University (xjkqll [2019] No. 016) and registered in the Chinese Clinical Trial Registry (ChiCTR2100053092).

Adverse Effects of Surgically Accelerated Orthodontic Techniques: A Systematic Review

Evidence on the potential adverse effects of surgically accelerated orthodontic techniques is scarce. The aim of this review was to evaluate the available scientific evidence regarding the adverse effects on periodontium, tooth vitality, and root resorption, associated with these surgical procedures in children, adolescents, and adults. The reporting of this review was based on the PRISMA2020 guidelines. Seven databases and three registers were searched for randomized clinical trials (RCTs) and controlled clinical trials (CCTs) published up to 22 June 2022. Hand searching of the reference lists of the included studies was also performed. The quality of the evidence was assessed with the Cochrane risk of bias and ROBINS-I tools. A total of 887 records were initially screened. Finally, 33 RCTs (713 patients), six CCTs (103 patients), and six ongoing protocols were eligible for this systematic review. The current review indicated that there are no significant adverse effects of surgically accelerated orthodontic techniques on periodontium, root length, or tooth vitality. High-quality clinical trials with less risk of bias should be conducted to allow reliable conclusions regarding the adverse effects of the surgical procedures associated with the acceleration of orthodontic treatment on children, adolescents, and adults.

Adverse effects of orthodontic forces on dental pulp. Appearance and character. A systematic review

OBJECTIVE

To comprehensively assess recent data on the effects of orthodontic forces on the dental pulp and to critically evaluate, whether any of the changes are permanent.

MATERIALS AND METHODS

Articles published between 2/2009 and 2/2022 were searched electronically on the PubMed, EMBASE and SCOPUS databases. The initial search retrieved 780 publications and, applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 33 relevant articles were identified. Twenty articles fulfilled the requirements for high (n = 1) or moderate (n = 19) methodological quality and were included. All assessments were made independently by three researchers.

RESULTS

Orthodontic forces appeared to cause a reduction in pulpal blood flow and a reduction in tooth sensibility, as indicated by increased response thresholds and increased amounts of negative responses to tooth sensibility tests. In addition, there were increases in the expression or activity levels of enzymes and neuropeptides associated with hypoxia and inflammation. Fibrotic tissue formation in the pulp was also reported.

CONCLUSIONS

Except for some histological and morphological alterations, the observed pulpal changes were in most cases only temporary, appearing within days of initiating the treatment and usually lasting for weeks. There were no clear signs of permanent damage.

Accelerated orthodontic tooth movement: surgical techniques and the regional acceleratory phenomenon

BACKGROUND

Techniques to accelerate tooth movement have been a topic of interest in orthodontics over the past decade. As orthodontic treatment time is linked to potential detrimental effects, such as increased decalcification, dental caries, root resorption, and gingival inflammation, the possibility of reducing treatment time in orthodontics may provide multiple benefits to the patient. Another reason for the surge in interest in accelerated tooth movement has been the increased interest in adult orthodontics.

REVIEW

This review summarizes the different methods for surgical acceleration of orthodontic tooth movement. It also describes the advantages and limitations of these techniques, including guidance for future investigations.

CONCLUSIONS

Optimization of the described techniques is still required, but some of the techniques appear to offer the potential for accelerating orthodontic tooth movement and improving outcomes in well-selected cases.