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

Successful completion of orthodontic therapy in a patient with osteopetrosis: Case Report

INTRODUCTION

Orthodontic therapy in patients with osteopetrosis (OP) of the jaws has typically been contraindicated owing to the presence of poorly perfused and extremely compact bone, and the potential risk for infection and osteomyelitis. As such, completed orthodontic cases in association with OP have rarely been published.

PATIENT CONCERNS

A patient aged 14 years 6 months, with no known diagnosis of OP, sought orthodontic assessment for anterior crowding.

CLINICAL FINDINGS

The patient exhibited a straight facial profile and increased mandibular facial height, competent lips, shallow mentolabial sulcus with mild mentalis strain, flat/reverse smile arc and wide buccal corridors on smiling.

PRIMARY DIAGNOSIS

The patient had a Class I incisor relationship on Class I skeletal bases with bilateral Class I molars and Class II canine relationships. This was complicated by a crossbite involving the lateral incisors and a Bolton discrepancy due to small maxillary lateral incisors. A radiologic assessment revealed polyostotic OP of the oromaxillofacial complex.

INTERVENTIONS

Treatment consisted of maxillary and mandibular fixed orthodontic therapy, bite turbos and elastics to level and align the dentition. Extractions of permanent teeth were not needed.

OUTCOMES

At the conclusion of treatment, there was a slight left Class II malocclusion, with incomplete intercuspation on the left side due to tooth size discrepancy, possibly attributed to inadequate elastics compliance and the presence of osteopetrotic bone. The treatment was completed in 3 years, 1 year longer than anticipated.

CONCLUSION

This report represents the second published account of a patient with OP successfully managed with comprehensive orthodontic care and without osseous complications. Obtaining cephalometric measurements on OP-affected patients may be imprecise owing to the presence of extremely dense bone and difficulty to identify bony landmarks. To reduce osteopetrotic sequelae, attending clinicians should consider reduced exertional orthodontic forces and closely monitor patients for adverse alveolar events.

En masse retraction of anterior teeth through rapid periodontal distraction by a retraction screw: A randomized control trial

BACKGROUND

Rapid distraction of the periodontal ligament is an effective method to shorten the orthodontic treatment time. The objectives of the present study were to assess the effects of an HYCON device (Adenta GmbH, Germany) on the rate of en masse retraction of the anterior teeth, duration of retraction, anchorage loss, root resorption, and soft tissue changes.

METHODS

This study was conducted on 60 female patients aged >18 years, divided randomly into two equal groups: Group 1 comprised 30 patients with HYCON, and group 2 comprised 30 patients with nickel-titanium closed coil springs. Skeletal, dental, and soft tissue changes were evaluated on pre- and post-retraction lateral cephalograms, and the rates of anterior tooth movement and anchorage loss were assessed monthly on the dental casts of the patients. Root resorption was assessed using intraoral periapical radiograph. Student's t test was used for the analysis of parametric data, and the Mann-Whitney U test was used for nonparametric data.

RESULTS

HYCON significantly shortened the retraction duration by 3 months. The rate of anterior teeth retraction was two times faster in group 1, compared with group 2. There was a significant difference in the anchorage loss between the groups in only first 2 months of treatment. Group 2 showed significantly more root resorption and soft tissue changes than group 1 (P < 0.05).

CONCLUSIONS

HYCON is an effective device for significantly shortening the duration of retraction with anchorage loss of 2 to 2.5 mm. However, careful monitoring for possible root resorption should be performed.

Unveiling an Uncommon Scenario of Co-occurrence of Multiple Odontomes With Impacted Maxillary Lateral Incisor and Canine in a 17-Year-Old Girl: A Unique and Rare Case Report

This case report presents the enigma of multiple odontomes with overretained deciduous teeth leading to the impaction of permanent successors (22, 23) in an abnormal position in a 17-year-old female patient who reported the chief complaint of maligned teeth. Permanent maxillary canines and lateral incisors are the most common teeth to face the brunt of impaction due to a wide range of etiological factors. It is imperative for a clinician to diagnose cases at an early stage to accelerate the rate of eruption of such teeth. This is especially important in cases where initially the etiology seems to be simple but on careful and judicious evaluation of the case, numerous other etiologies are found to map together for the underlying pathology. This case discusses how the presence of multiple odontomes with delayed exfoliation of deciduous teeth leads to the impaction of a permanent successor. Understanding the underlying pathology is seemingly important to devise intricate treatment mechanics for traction of impacted teeth without taxing anchorage from dental units and taking cognizance of the amount of alveolar bone loss post-removal of multiple odontomes. The appropriate thickness of alveolar bone scaffolding is required for the canine to extrude down, with an adequate band of marginal gingiva encircling the cement-enamel junction of the impacted canine, preventing any kind of fenestration and dehiscence. Hence, meticulous care was taken during surgical exposure and removal of odontomes to preserve an adequate labial cortical plate intact for traction. These excavated tooth-like structures were later subjected to histopathological evaluation, which confirmed the diagnosis of compound odontomes.

Protraction of Mandibular Second Molar for Substitution of Adjacent Missing First Molar With a Mini-Implant-Anchored Albert Loop Appliance

Protraction of mandibular posterior teeth into edentulous regions is challenging in clinical practice. This case demonstrated a minor tooth movement of a mandibular second molar to substitute its adjacent missing first molar in a 15-year-old female. An efficient bodily movement of the mandibular second molar was achieved through a mini-implant-anchored protraction loop appliance. With this carefully designed biomechanical system, over 10-mm molar protraction was accomplished within 14 months without mesial or lingual tipping. The adjacent third molar erupted spontaneously during the protraction process and drafted mesially. Through brackets and segmented archwire after the protraction, the second and third molars were successfully protracted and good buccal interdigitation was achieved. The combination of the Albert protraction loop and mini-implant allows for more efficient protraction of the mandibular molars, avoiding mesial tipping and lingual rotation of the molars.

The efficacy and safety of corticotomy and periodontally accelerated osteogenic orthodontic interventions in tooth movement: an updated meta-analysis

BACKGROUND

The surgically facilitated orthodontic strategy has been a promising strategy for orthodontic treatment recently. Therefore, the present meta-analysis was conducted to assess the available scientific evidence regarding the clinical outcomes, including the potential detrimental effects associated with these surgical procedures, with the aim of providing much more evidence-based information for clinical practice.

METHODS

An electronic search of three databases (PubMed, Cochrane, and Embase) and a manual search of relevant articles published up to May 2023 were carried out. Clinical trials (≥ 10 subjects) that utilized surgically facilitated orthodontic strategies with clinical and/or radiographic outcomes were included. Meta-analyses and sub-group analyses were performed to analyze the standardized mean difference (SMD) or weighted mean difference (WMD), and confidence interval (CI) for the recorded variables.

RESULTS

Nineteen studies published from Oct 2012 to May 2023 met the inclusion criteria. Based on the analysis outcomes, corticotomy treatment significantly decreased the alignment duration (WMD: -1.08 months; 95% CI = -1.65, -0.51 months, P = 0.0002), and accelerated the canine movement (WMD: 0.72 mm; 95% CI = 0.63, 0.81 mm, P < 0.00001) compared to the traditional orthodontic group. The periodontally accelerated osteogenic orthodontic (PAOO) strategy markedly reduced the total treatment duration (SMD: -1.98; 95% CI = -2.59, -1.37, P < 0.00001) and increased the bone thickness (SMD:1.07; 95% CI = 0.74, 1.41, P < 0.00001) compared to traditional orthodontic treatment.

CONCLUSION

The present study suggests that facilitated orthodontic treatment in terms of corticotomy and PAOO strategy may represent attractive and effective therapeutic strategy for orthodontic patients.

The Skeletal Stability of Combined Surgery First Approach and Clear Aligners in Skeletal Class III Malocclusion Correction: A Randomized Controlled Trial

The surgery first approach (SFA) and clear aligners technique can address traditional treatment defects, such as prolonged waiting times for surgery and a less desirable facial appearance due to wire aligners. However, the curative effect of the combination remains uncertain. The randomized controlled study aimed to evaluate the skeletal stability of the SFA compared to the conventional orthodontic first approach (OFA), both of which were applied with clear aligners. A total of 74 participants were randomly allocated to two groups: the SFA group (experimental) and the OFA group (control). The skeletal deviation was calculated using reconstruction models from computed tomography scans taken immediately and 6 months after surgery. The largest median deviations were detected in the y-axis of the mandible for both two groups, separately 1.36 mm in the experimental group and 1.19 mm in the control group. Apart from the maxillary yaw dimension (p = 0.005), there were no significant differences between the two groups in terms of linear and angular deviation. The experimental group had an overall treatment time of 18.05 ± 2.53 months, while the control group took 22.83 ± 3.60 months (p < 0.05). Therefore, the combined surgery-first and clear aligners treatment can achieve comparable skeletal stability to the conventional approach, while also saving significant time.

Evaluation of Micro-Osteoperforations in Expediting Orthodontic Tooth Movement in Adult Patients

Background

Orthodontic tooth movement, the process of aligning teeth, can often be time-consuming, particularly in adult patients. Micro-osteoperforations (MOPs) have emerged as a potential technique to accelerate this process.

Materials and Methods

A sample of 30 adult patients undergoing orthodontic treatment was selected. The patients were divided into two groups: an experimental group (EG) receiving MOPs and a control group (CG) without MOPs. Standard orthodontic treatment was administered to both groups. The rate of tooth movement was measured using digital models and recorded in millimeters per month. Pain levels reported by patients were also noted. The data were analyzed using basic statistical methods.

Results

The EG demonstrated a significantly higher rate of orthodontic tooth movement compared to the CG. The average rate of tooth movement in the EG was 1.5 millimeters per month, while the CG exhibited an average rate of 0.8 millimeters per month. Additionally, pain levels reported by patients in the EG were slightly elevated immediately after MOPs but subsided within a few days.

Conclusion

The findings of this study suggest that MOPs can effectively expedite orthodontic tooth movement in adult patients.

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.

Volumetric changes in temporomandibular joint space following trans-oral vertical ramus osteotomy in patients with mandibular prognathism: a one-year follow-up study

This study measured and analyzed chronological changes in temporomandibular joint space volume by compartment following transoral vertical ramus osteotomy (TOVRO) using reconstructed 3-dimensional (3D) images of patients with mandibular prognathism. It included 70 joints of 35 patients who underwent TOVRO between January 2018 and December 2021. Computed tomography (CT) or cone-beam CT (CBCT) was performed before surgery (T0) and at 3 days (T1), 6 months (T2), and 12 months postoperatively (T3). These scans were then analyzed using 3D software. The volumes of the overall (Vjs), anterior (Vajs), posterior (Vpjs), medial (Vmjs), and lateral (Vljs) joint spaces were calculated at each time point. A linear mixed model and repeated-measures covariance pattern with unstructured covariance were used to evaluate significant changes in joint space volume over time. Vjs significantly increased to 134.54 ± 34.28 mm3 at T3 compared to T0 (p < 0.001). Vpjas and Vljs increased by 130.72 ± 10.07 mm3 and 109.98 ± 7.52 mm3 at T3 compared to T0, respectively (p < 0.001). However, no significant difference was observed between T0 and T2 in Vajs and Vmjs (p = 0.9999). The observed volume increases in Vpjs and Vljs appeared to contribute to the overall Vjs increase.

Comparison of the effectiveness of piezocision-aided canine retraction augmented with micro-osteoperforation: a randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of micro-osteoperforation (MOP) on the rate of piezocision-aided canine retraction (CR).

MATERIALS AND METHODS

The split-mouth study included 25 participants at the stage of commencing CR. The participants received flapless piezocision bilaterally at T0 (0 months) and MOP only on one side at T3 (3 months). The quadrant that received MOP at T3 served as the intervention, whereas the other quadrant served as the control. The primary outcome was the rate of CR, assessed using digital models. The angular change (AC) of the canine and the change in the buccal cortical bone thickness (BCBT) from before to after CR were also assessed using cone beam computed tomography.

RESULTS

The rate of CR was 0.82 ± 0.39 mm/month in the control quadrant vs 0.75 ± 0.44 mm/month in the intervention quadrant (P > .05). The AC of the canine was 2.00° ± 0.88° in the control quadrant vs 1.98° ± 0.86° in the intervention quadrant (P > .05). The crestal bone gain was 0.50 mm in the control quadrant vs 0.28 mm of bone loss in the intervention quadrant. The bone thickness at a 3-mm height was increased by 0.11 mm in the control quadrant vs a 0.29-mm decrease in the intervention quadrant. The bone thickness at a 6-mm height was decreased by 0.12 mm in the control quadrant vs a 0.15-mm decrease in the intervention quadrant. However, none of the changes or group differences in bone height or thickness were statistically significant (P > .05).

CONCLUSIONS

The periodic activation of a piezocision-aided CR site using MOP had no significant positive effect on the rate of CR, angulation of the canine, or changes in BCBT.

MicroRNA-155 targets SOCS1 to inhibit osteoclast differentiation during orthodontic tooth movement

BACKGROUND

MicroRNA-155 (miR-155) is a multifunctional miRNA whose expression is known to be involved in a range of physiological and pathological processes. Its association with several oral diseases has been established. However, the specific role of miR-155 in orthodontic tooth movement remains unclear. In this study, we investigated the impact of miR-155 on osteoclast differentiation and orthodontic tooth movement models, aiming to explore the underlying mechanisms.

METHODS

In this experiment, we utilized various agents including miR-155 mimic, miR-155 inhibitor, as well as non-specific sequences (NC mimic & NC inhibitor) to treat murine BMMNCs. Subsequently, osteoclast induction (OC) was carried out to examine the changes in the differentiation ability of monocytes under different conditions. To assess these changes, we employed RT-PCR, Western blotting, and TRAP staining techniques. For the orthodontic tooth movement model in mice, the subjects were divided into two groups: the NaCl group (injected with saline solution) and the miR-155 inhibitor group (injected with AntagomiR-155). We observed the impact of orthodontic tooth movement using stereoscopic microscopy, micro-CT, and HE staining. Furthermore, we performed RT-PCR and Western blotting analyses on the tissues surrounding the moving teeth. Additionally, we employed TargetScan to predict potential target genes of miR-155.

RESULTS

During osteoclast induction of BMMNCs, the expression of miR-155 exhibited an inverse correlation with osteoclast-related markers. Overexpression of miR-155 led to a decrease in osteoclast-related indexes, whereas underexpression of miR-155 increased those indexes. In the mouse orthodontic tooth movement model, the rate of tooth movement was enhanced following injection of the miR-155 inhibitor, leading to heightened osteoclast activity. TargetScan analysis identified SOCS1 as a target gene of miR-155.

CONCLUSIONS

Our results suggest that miR-155 functions as an inhibitor of osteoclast differentiation, and it appears to regulate osteoclasts during orthodontic tooth movement. The regulatory mechanism of miR-155 in this process involves the targeting of SOCS1.

Mandibular Posterior Anatomic Limit for Distalization in Patients With Various Patterns of Third Molar Impactions: A Three-Dimensional Cone Beam CT (CBCT) Study

AIM

The aim was to compare and evaluate the variation in the mandible's posterior anatomic limits (MPAL) stratified by different third molar impaction patterns utilizing cone-beam CT (CBCT) in individuals with skeletal Class III malocclusion.

METHODOLOGY

The sample consisted of CBCT records of 80 samples of Class III patients categorized based on the pattern of their third molar impaction. The shortest linear distances from the distal root of the second mandibular molar to the inner cortex of the mandibular body were measured at the crown level, at the cementoenamel junction (CEJ), and at the depths of 4, 6, and 8mm from the CEJ, all parallel to the posterior occlusal line. The MPAL of the four groups were compared. The Shapiro-Wilk test for normality was performed. The Kruskal-Wallis test was performed to compare the MPAL distances between the groups.

RESULTS

Significant differences were noted between the four groups at every level. MPAL distances decreased towards apex in all the groups and was least at the 8mm root level. The greatest MPAL distances were noted in the no-impaction group followed by the horizontal. At 8mm, the MPAL were 4.2+/-1.3 in Group 3 (Control), 3.3+/-0.9 in Group 1 and 2.7+/-0.05 mm in Group 2. Though the amount of space available for distalization was greatest for the mesioangular group at the crown level, it was least at the 8mm level compared to other groups.

CONCLUSION

MPAL distances were shortest at the root level in Class III patients who had mesioangularly impacted third molars and care should be taken before attempting distalization in them.

The transparency of reporting 'harms' encountered with the surgically assisted acceleration of orthodontic tooth movement in the published randomized controlled trials: a meta-epidemiological study

BACKGROUND

Surgical-assisted accelerated orthodontics (SAAO) has become very popular recently. Therefore, this study aimed to investigate the extent to which researchers adhere to Item 19 (harms) of the Consolidated Standards of Reporting Trials (CONSORT) in the published studies in the field of SAAO. In addition, the study evaluated the possible association between harm reporting and the human development index (HDI) of the recruited research sample country, CiteScore-based quartile (CSBQ) of the publishing journal, invasiveness of the surgical intervention (ISI), and the type of orthodontic tooth movement (TOTM). Moreover, it aimed to summarize the different possible harms and complications that maybe encountered in the course of SAAO.

MATERIALS AND METHODS

Electronic searching of six databases was conducted for SAAO-related English RCTs published between January 2000 and April 2022. For the RCTs that did not report harms, information was sought by contacting the corresponding authors. Descriptive statistics of the evaluated variables were performed. The association between 'harm reporting' and the HDI of the research team, the BDRQ of the publication journal, the ISI, and the TOTM were investigated. Binary logistic regression was used, and the odds ratios (ORs) with 95% confidence interval (CIs) of the evaluated variables were obtained. Moreover, the risk of bias of the included RCTs was assessed using the RoB2 tool.

RESULTS

Among the 91 included RCTs, 54 RCTs (59.3%) did not adhere to reporting harm associated with the SAAO. The non-adherence was significantly associated with the ISI (OR 0.16; CI 0.03-0.73; p < 0.018) for invasive methods compared with minimally invasive ones). There was a significant positive correlation between harm reporting and both the CSBQ of the publishing journal and the HDI of the recruited research sample country (p = 0.001, p = 0.003, respectively). On the contrary, a non-significant association was found between harm reporting and the type of OTM (p = 0.695). The incidence of harms associated with SAAO was approximately 17.5%.

LIMITATIONS

Assessment was restricted to English RCTs related to SAAO.

CONCLUSION AND IMPLICATIONS

The adherence to reporting harms in the field of SAAO was deficient. Efforts should be made by authors, peer reviewers, and editors to improve compliance with the CONSORT guidelines regarding harms reporting. Additionally, there is a wide spectrum of harms that could be associated with SAAO that the practitioner should pay attention to and alert the patient to the possibility of their occurrence.

A review on accelerated orthodontics

When the duration of orthodontic treatment is shortened, the patient may have a number of benefits, including an increase in the number of dental cavities, root resorption, and gingival irritation, all of which are associated to a higher degree of decalcification. In addition to drugs, magnets, and other therapies, they include surgical methods (corticotomies, piezosurgery), mechanical/physical stimulation techniques (vibration, lasers), and other forms of therapy. These methods, each of which has been validated by extensive research, have been shown to reduce treatment times.

Effects of autologous leukocyte-platelet rich fibrin (L-PRF) on the rate of maxillary canine retraction and various biomarkers in gingival crevicular fluid (GCF): A split mouth randomized controlled trial

OBJECTIVES

Primary objective: To evaluate the effect of L-PRF on the rate of maxillary canine retraction.

SECONDARY OBJECTIVE

To validate the rate of maxillary canine retraction by identifying the levels of Interleukin-1β (IL-1β) and Tumour Necrosis Factor-α (TNF-α) in the Gingival Crevicular Fluid (GCF).

MATERIALS AND METHOD

Fifteen females (age range, 18-25 years) with Class I bimaxillary dentoalveolar protrusion malocclusions were included. After levelling and alignment of maxillary arches, 1st premolars were extracted from both sides. Canines were retracted immediately after the extraction of 1st premolars in control sides and placement of L-PRF plugs in the experimental sides. The amount of canine retraction was evaluated from study models recorded before the extraction of 1st premolars (T₀) and at 1-week (T₁), 2-weeks (T₂), 4-weeks (T₃), and 8-weeks (T₄) after the beginning of canine retraction by using digital model superimpositions. The concentrations of IL-1β and TNF-α were evaluated from the GCF collected at T₀, T₁, T₂, T₃, and T₄ by using commercially available human IL-1β and TNF-α ELISA kits.

RESULTS

The amount of canine retraction in the experimental sides was statistically greater during T₀-T₁ (P=0.038),T₁-T₂ (P=0.002), and T₂-T₃ (P=0.011) periods. Total canine retraction during T₀-T₄ was statistically greater in experimental sides (2.43±0.46mm) than control sides (2.08±0.28mm) (P=0.001). The concentration of IL-1β increased significantly in the experimental sides at T₁ (P=0.000),T₂ (P=0.000), and T₃ (P=0.032). The concentration of TNF-α increased both in the control and experimental sides, but it was statistically greater in the experimental sides compared to control sides at T₁ (P=0.000) and T₂ (P=0.006). A positive but not statistically significant correlation was noted between the rate of canine retraction and the concentrations of cytokines such as IL-1β and TNF-α in GCF.

CONCLUSION

Over an 8-week period, autologous L-PRF statistically accelerated the rate of maxillary canine retraction, but only by 0.35mm. This small acceleration occurred mainly in the first 4 weeks. During the following 4 weeks, the amount of canine retraction was comparable on the experimental and control sides.