Effect of piezocision corticotomy on en-masse retraction

The biological effects of Piezocision™ on bone for accelerated tooth movement: A systematic review of animal studies

OBJECTIVES

This systematic review aimed to assess the biological response at tissue, cellular, and molecular levels following Piezocision™ surgery, and its efficacy in accelerating orthodontic tooth movement.

MATERIAL AND METHODS

A systematic review of the literature was conducted across 4 databases following the PRISMA guidelines up to May 2022. Prospective controlled animal studies involving healthy animals under active orthodontic treatment assisted by corticotomy performed with a piezotome (Piezocision™) published in the English language without time restrictions were included. The article selection, data extraction and risk of bias assessment (SYRCLE tool) were performed by two independent blinded review authors.

RESULTS

Out of 738 articles screened, 10 studies were included with various level of bias. Biological responses were categorized into tissue, cellular, and molecular levels. Tissue-level changes included a global decrease in bone mineral content post-Piezocision™. At the cellular level, increased bone turnover activity was noted. Molecularly, elevated RANKL and OPG expression, along with increased TRAP+ and cytokines, were observed after Piezocision™. Studies confirmed Piezocision's efficacy, reporting 1.35 to 3.26 times faster tooth movements, peaking between the 3rd and 50th day post-surgery. Biological responses were transient, reversible, and proportional to surgical insult, with reactivation possible through a second Piezocision™.

CONCLUSIONS

After Piezocision™ surgery, a transient and reversible biological response was described at the tissue, cellular and molecular levels, which induced faster orthodontic tooth movements. This biological response could be re-activated by an additional Piezocision™ and is proportional to the surgical injury.

SYSTEMATIC REVIEW REGISTRATION

Prospero CRD42022303237.

Automated artificial intelligence-based three-dimensional comparison of orthodontic treatment outcomes with and without piezocision surgery

OBJECTIVE(S)

This study aims to evaluate the influence of the piezocision surgery in the orthodontic biomechanics, as well as in the magnitude and direction of tooth movement in the mandibular arch using novel artificial intelligence (AI)-automated tools.

MATERIALS AND METHODS

Nineteen patients, who had piezocision performed in the lower arch at the beginning of treatment with the goal of accelerating tooth movement, were compared to 19 patients who did not receive piezocision. Cone beam computed tomography (CBCT) and intraoral scans (IOS) were acquired before and after orthodontic treatment. AI-automated dental tools were used to segment and locate landmarks in dental crowns from IOS and root canals from CBCT scans to quantify 3D tooth movement. Differences in mesial-distal, buccolingual, intrusion and extrusion linear movements, as well as tooth long axis angulation and rotation were compared.

RESULTS

The treatment time for the control and experimental groups were 13.2 ± 5.06 and 13 ± 5.52 months respectively (P = .176). Overall, anterior and posterior tooth movement presented similar 3D linear and angular changes in the groups. The piezocision group demonstrated greater (P = .01) mesial long axis angulation of lower right first premolar (4.4 ± 6°) compared with control group (0.02 ± 4.9°), while the mesial rotation was significantly smaller (P = .008) in the experimental group (0.5 ± 7.8°) than in the control (8.5 ± 9.8°) considering the same tooth.

CONCLUSION

The open source-automated dental tools facilitated the clinicians' assessment of piezocision treatment outcomes. The piezocision surgery prior to the orthodontic treatment did not decrease the treatment time and did not influence in the orthodontic biomechanics, leading to similar tooth movements compared to conventional treatment.

Patient-Reported Outcome Measures of Flapless Corticotomy with Low-Level Laser Therapy in En Masse Retraction of Upper Anterior Teeth: A Three-Arm Randomized Controlled Trial

(1) Background: This study aimed to compare patient-reported outcome measures when accelerating en masse retraction between the piezocision procedure and the subsequent application of low-level laser therapy (FC+LLLT), with the piezocision alone (FC), and in a control group. (2) Methods: A three-arm randomized controlled trial (RCT) was conducted involving 60 patients (41 females and 19 males) with Class II division I malocclusion. The en masse retraction was performed using NiTi closed coil springs attached to miniscrews. The LLLT was performed using an 808 nm Ga-Al-As diode laser. Patient responses regarding pain, discomfort, swelling, and chewing difficulties were reported at ten assessment points. (3) Results: The greatest pain levels were observed 24 h after the application of force during the first and third months of retraction. The mean pain, discomfort, swelling, and chewing difficulties were significantly smaller in the control group than in the FC and FC+LLLT groups. High satisfaction levels were reported in all three groups (p < 0.05). (4) Conclusions: The accelerated en masse retraction via piezocision, followed by a small course of LLLT, was accompanied by significantly fewer pain, discomfort, and chewing difficulties than the control group. LLLT is a valuable addition to piezocision, with an improved patient experience.

Impact of micro-osteoperforations on root resorption and alveolar bone in en-masse retraction in young adults: A CBCT randomized controlled clinical trial

BACKGROUND

Micro-osteoperforations (MOPs) as a surgical technique is increasingly being used as a method to enhance orthodontic tooth movement. However, its iatrogenic effects on root and alveolar bone morphology have been less studied.

OBJECTIVE

This parallel-groups single-centered trial aimed to assess the impact of micro-osteoperforations (MOPs) on orthodontically induced inflammatory root resorption (OIIRR) and alveolar bone during en-masse retraction stage of maxillary and mandibular anterior teeth.

METHODS

Fifty-two patients (mean age 21.35±2.2 years) with Class I bi-dentoalveolar protrusion, requiring all 1st premolar extractions and miniscrews for anchorage, were randomly distributed into two groups (n=26 each): MOP group treated using single application of MOP's and control group treated with routine sliding mechanics, for en-masse retraction. The primary outcomes were assessed using CBCT-based measurements.

RESULTS

Anterior teeth in MOP group showed increased mean OIIRR than control group, though the difference was statistically non-significant [maxillary anteriors, MOP group - OIIRR=0.78±0.29mm and control group OIIRR=0.73±0.36mm; mandibular anteriors, MOP group - OIIRR=0.733±0.20mm and control group OIIRR=0.70±0.24mm]. Levander and Malmgren's Index for objective scoring of OIIRR revealed only mild resorption with most teeth in both the groups (47% and 51%, respectively). Lateral incisors showed highest OIIRR followed by central incisors and canines in both groups. Lingual side bone thickness and height decreased significantly, however, the differences between the two groups were non-significant (P>0.05).

CONCLUSION

Within the settings of the current RCT, en-masse retraction when combined with single application of micro-osteoperforations did not pose an increased risk of root resorption or alveolar bone changes compared to routine sliding mechanics.

One-stage versus two-stage piezocision-assisted orthodontic tooth movement: A preclinical study based on Nano-CT and RT-PCR analyses

OBJECTIVE

To evaluate the effect of a second-stage piezocision on the biological response.

MATERIALS AND METHODS

60 rats were randomly allocated to 6 experimental groups of 10 rats. Rats undergoing a one-stage piezocision were sacrified on day 7, 28 and 42 (groups 1-3) while rats undergoing a two-satge piezocision were sacrified on day 42, 63 and 90 (groups 4-6), respectively. The biological response was investigated in 3D at the tissue level using Nano-computed tomography (Nano-CT) and, at the molecular level using the qRT-PCR technique. Bone Volume Fraction (BVF) loss was the primary endpoint.

RESULTS

Similar loss of BVF were observed both after the first and second piezocisions. The change in BVF loss between 7 and 28 days after each piezocision were 25.1 ± 13.0 (SE)% and 11.2 ± 11.6 (SE)% respectively and did not differ from each other (p = 0.43). Changes in BVF loss from 7 to 42 days were also comparable in one-stage and two-stage piezocision (4.9 ± 12.3 (SE) vs. -19.9 ± 13.4 (SE), p = 0.19). At the molecular level, all parameters except Translating Ribosome Affinity Purification (TRAP) protein had identical patterns.

CONCLUSION

Within the limits of the present study, a second piezocision allowed to re-induce the Regional Acceleratory Phenomenon (RAP) effect. Nevertheless, the relevance of the findings to the clinical effect has not been tested.

Evaluation of patient-reported outcome measures (PROMs) during surgically-assisted acceleration of orthodontic treatment: a systematic review and meta-analysis

BACKGROUND

With the widespread of surgically-assisted orthodontic acceleration, the analysis of patient-reported outcome measures (PROMs) has become very important to assure patient acceptance and satisfaction before adopting any acceleration procedure.

OBJECTIVE

This review aimed to critically appraise the available evidence regarding the levels of pain, discomfort, functional impairments, and other patient-reported outcome measures during surgically-assisted acceleration of orthodontic treatment compared with the traditional non-accelerated treatment.

SEARCH METHODS

Eight electronic bibliographic databases were searched from January 1990 till May 2022. A manual search of the selected orthodontic journals was also undertaken.

SELECTION CRITERIA

Randomized controlled trials (RCTs) were included in this systematic review on patients undergoing orthodontic treatment with one group subjected to an acceleration procedure.

DATA COLLECTION AND ANALYSIS

Cochrane's risk of bias tool (RoB2 tool) was used to assess the risk of bias of the included RCTs. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines were used to assess the overall quality of the evidence.

RESULTS

Thirteen RCTs were included in this review (333 patients), and only minimally invasive surgically-assisted acceleration studies were included. Two RCTs were included in the quantitative synthesis of data. After the first day of surgical intervention, the levels of pain and discomfort ranged from mild to moderate in the surgical groups (mean values ranged from 0.8 to 6.8), while it was mild in the control groups. However, on the seventh day after the surgical intervention, the levels of pain, discomfort, swelling, and functional impairments were almost similar between groups. According to the GRADE, the quality of evidence supporting these findings ranged from low to very low.

CONCLUSIONS

All surgical interventions were minimally invasive. There was very low to low evidence that acceleration caused mild to moderate pain and discomfort on the first day after the surgical intervention and disappeared completely at one week following surgery. Functional impairments were found within acceptable limits immediately and in the short-term follow-up. More high-quality randomized controlled clinical trials are needed to establish good evidence in this field.

REGISTRATION

The protocol of this systematic review was registered in PROSPERO database (CRD42021274481) during the first stages of this review.

Efficacy and safety of piezocision in accelerating maxillary anterior teeth en-masse retraction: study protocol for a randomized controlled trial

BACKGROUND

Orthodontic treatment is commonly more time-consuming in adults than in teenagers, especially when it comes to the maxillary en-masse retraction, which may take 9 months or even longer. As to solve this concern, orthodontists have been striving to seek new methods for shortening orthodontic treatment time. Piezocision, as a popular alternative treatment, has been widely used in different types of tooth movement. However, its effect on en-masse retraction of maxillary anterior teeth remains unclear. This randomized controlled trial intends to figure out the role piezocision plays in accelerating en-masse retraction.

METHODS

This protocol is designed for a prospective, single-center, assessor-blinded and parallel-group randomized controlled trial. Twenty adult patients aged from 18 to 40 whose orthodontic treatment required bilateral maxillary first premolars extraction will be randomly assigned to the piezocision group and the control group at a ratio of 1:1. The piezocision group will undergo en-masse retraction immediately after the piezo surgery, while the control group will start en-masse retraction directly. Both groups will be followed up every 2 weeks to maintain the retraction force until the end of space closure. The space closing time is set as the primary endpoint. Meanwhile, the secondary endpoints include the change of root length, labial and palatal alveolar bone thickness, vertical bone height, probing depth of maxillary anterior teeth, cephalometric measurements, visual analogue scale, and postoperative satisfaction questionnaire.

DISCUSSION

This study will attempt to provide more convincing evidence to verify whether piezocision will shorten the time of en-masse retraction or not. Distinguished with previous studies, our study has made some innovations in orthodontic procedure and primary outcome measurement, aiming to clarify the efficacy and safety of piezocision-assisted en-masse retraction in Chinese population.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR 1900024297 . Registered on 5 July 2019.

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.

Comparison of canine retraction by conventional and corticotomy-facilitated methods: A split mouth clinical study

OBJECTIVE:

The purpose of this split-mouth single-centered, parallel-group, randomized clinical trial was to evaluate the efficiency of corticotomy-facilitated orthodontics in rapid canine retraction.

METHODS:

The sample consisted of 10 patients (15–25 years old) requiring extraction of the maxillary first premolars with subsequent canine retraction. The patients’ right sides were randomly assigned to either the corticotomy (experimental) or control groups. Corticotomy cuts and perforations were performed and canine retraction was initiated bilaterally with closed-coil nickel-titanium springs that applied 150 g of force. The following variables were examined till the end of canine retraction on both sides: Rate of canine retraction, canine root resorption, and patient perception of the procedure. The rate of canine retraction was assessed every month using study models while root resorption was evaluated using CBCT. Patient`s perception was evaluated using a 100 mm VAS.

RESULT:

Mean time taken for full completion of canine retraction: 5.7 months (test) and 7.1 months (control). Mean root resorption: 0.53 ± 0.10 (control) and 0.24 mm ± 0.10 (test). Mean VAS scores: 16 ± 3.94 (24 hours) and 2 ± 2.58 (1 week) at control side and 46.50 ± 6.69 (24 hours) and 2 ± 2.58 (1 week) at test.

CONCLUSION:

There was an overall reduction in the time taken for canine retraction with corticotomy; however, an increase in the rate of canine retraction in the corticotomy-facilitated method was evident only for the first four months, compared to the conventional method. Less root resorption was observed in corticotomy-facilitated method than conventional method. Pain perception was more for corticotomy-facilitated method than conventional method at 24 hours, but similar after one week.

Comparison of the effects of horizontal and vertical micro-osteoperforations on the biological response and tooth movement in rabbits

Objective

This study aimed to compare the amount of tooth movement after multiple horizontal (MH) and single vertical (SV) micro-osteoperforations (MOPs), and evaluate the histological changes after orthodontic force application in rabbits.

Methods

The mandibles of 24 white rabbits were subjected to two experimental interventions: MH and SV MOPs. Defect volume of the MOPs between the two groups was kept similar. A force of 100 cN was applied via a coil spring between the incisor teeth and the first premolars. The amount of tooth movement was measured. Differences in the amount of tooth movement and bone variables at three time points and between the two groups were evaluated using repeated-measures analysis of variance.

Results

The first premolar showed a mesial movement of 1.47 mm in the MH group and 1.84 mm in the SV group, which was significantly different at Week 3 (p < 0.05). No significant difference was observed in bone volume and bone fraction between the groups. Tartrate-resistant acidic phosphatase-positive cell count was also significantly greater at Week 3 than at Week 1 in both the SV and MH groups.

Conclusions

The amount of tooth movement showed significant differences between Weeks 1 and 3 in the SV and MH MOP groups, but showed no differences between the two groups. Therefore, SV MOP could be considered an effective tool for enhancing tooth movement, especially for molar distalization, uprighting, and protraction to an edentulous area.

Biomechanical and biological responses of periodontium in orthodontic tooth movement: up-date in a new decade

Nowadays, orthodontic treatment has become increasingly popular. However, the biological mechanisms of orthodontic tooth movement (OTM) have not been fully elucidated. We were aiming to summarize the evidences regarding the mechanisms of OTM. Firstly, we introduced the research models as a basis for further discussion of mechanisms. Secondly, we proposed a new hypothesis regarding the primary roles of periodontal ligament cells (PDLCs) and osteocytes involved in OTM mechanisms and summarized the biomechanical and biological responses of the periodontium in OTM through four steps, basically in OTM temporal sequences, as follows: (1) Extracellular mechanobiology of periodontium: biological, mechanical, and material changes of acellular components in periodontium under orthodontic forces were introduced. (2) Cell strain: the sensing, transduction, and regulation of mechanical stimuli in PDLCs and osteocytes. (3) Cell activation and differentiation: the activation and differentiation mechanisms of osteoblast and osteoclast, the force-induced sterile inflammation, and the communication networks consisting of sensors and effectors. (4) Tissue remodeling: the remodeling of bone and periodontal ligament (PDL) in the compression side and tension side responding to mechanical stimuli and root resorption. Lastly, we talked about the clinical implications of the updated OTM mechanisms, regarding optimal orthodontic force (OOF), acceleration of OTM, and prevention of root resorption.

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

Background

Orthodontic treatment may result in undesirable side effects, such as root resorption and a decrease in the size of the pulp tissue which could be associated with the duration of the orthodontic treatment. Piezocision-assisted tooth movement was introduced as a minimally invasive surgical procedure to shorten orthodontic treatment time. This prospective randomized clinical trial was aimed to compare the pulp volume changes of maxillary anterior teeth after en-masse retraction with or without piezocision-assisted orthodontics.

Methods

Patients who required orthodontic treatment with bilateral maxillary first premolar extractions and en-masse retraction were recruited. Patients were randomly divided into extraction with piezocision, or only extraction, serving as controls. Pulp volume and root length changes of the maxillary six anterior teeth were measured and compared between the two groups using a 3-Dimensional analytical software. Paired and independent sample t-tests were used to compare within and between groups. Bivariate correlation was done between the mean change in pulp volume and its corresponding root length. The significance level was set at α = 0.05.

Results

A total of 23 patients were included, 12 in the piezocision, and 11 in the control group. At the end of the en-masse retraction phase, (mean = 122.74 ± 3.06 days) pulp volume was significantly decreased in all six anterior teeth in both groups (P < 0.01). The decrease in pulp volume was not statistically different between both groups, (P > 0.05). There was a statistically significant but moderate correlation only between the pulp volume change of the right canine and its root length, r = 0.44, P = 0.034.

Conclusions

The effect of piezocision-assisted orthodontic tooth movement on the pulp volume was comparable to the conventional orthodontic treatment. The degree of change in pulp volume does not appear to be related to the amount of root resorption.

Trial registration NCT03180151. Registered December 25, 2016, retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT03180151.

Young Adults' Preferences and Willingness to Pay for Invasive and Non-invasive Accelerated Orthodontic Treatment: A Comparative Study

To evaluate the preference of young adult patients and their willingness to pay for the different approaches accessible to accelerate orthodontic tooth movement. A cross-sectional survey was conducted in Jeddah, Saudi Arabia from September to December 2019. Young adult orthodontic patients from 18 to 45 years old were interviewed via online survey regarding their perception to the extent of treatment, acceptability of non-invasive (customized appliances and medications) and invasive (surgery) approaches accessible to accelerate orthodontic treatment and increase in fees they were willing to pay. Statistical analyses were performed, and gender difference was calculated at P < .05. There are 100 respondents: 70% aged between 18 to 25, 50% male, and 56% with annual income <10 000 SR. About 72% of the respondents decided that treatment takes longer period and 51% wished it would last for less than 6 months. Customized appliances were reported to be the most convenient to use (58%) and to pay (44%), followed by medications (48%). On the other hand, surgery was reported to be the most inconvenient to use (58%) and to pay for (55%). About 70% of the respondents were unwilling to pay more than 10% to 20% for all procedures assessed; considerable variation was not observed in responses between gender at 95% confidence level. Majority of the respondents believed that orthodontic treatment is taking lengthy duration. Less invasive, nonsurgical techniques and procedures were more preferred. Likewise, financial factors play vital role in the selection of their preferred approach. Most of them agrees to provide up to 20% increment of the fee for additional procedures.