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Mosayebi N, Khademi A, Bagherieh S, Abedi N, Kargarfard M, Tajmiri G, Kouhi M. The effect of micro-osteoperforation on root resorption, pulp vitality, and biological changes of teeth subjected to orthodontic tooth movement: A systematic review study. Dent Res J (Isfahan) 2023; 20:52. [PMID: 37304419 PMCID: PMC10247875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/28/2023] [Accepted: 02/25/2023] [Indexed: 06/13/2023] Open
Abstract
Background These days minimally invasive micro-osteoperforation (MOPs) has accelerated orthodontic tooth movement (OTM). However, there are some conflicting reports about their various impacts; hence, the present systematic review study aimed to evaluate the effect of MOP on root resorption, pulp vitality, and the biological changes of teeth subjected to OTM. Materials and Methods Search in electronic databases of English literature including PubMed, Scopus, Web of sciences, Cochrane, and Google scholar as well as a manual search was performed from 2013 to 2022. Most of the studies included in this article were randomized controlled trials. Results From the total number of 321 found articles, 31 duplicated and 268 irrelevant articles were excluded regarding the defined inclusion and exclusion criteria. Consequently, 22 articles were subjected to the quality assessment process, and finally, 18 articles were selected for the review phase. Root resorption during tooth movement using the MOP approach was reported only in one study. Besides, except for two animal studies, all of the relevant included articles showed that MOPs significantly increased the expression of some inflammatory biomarkers known to recruit osteoclast precursors and increase the number of osteoclast cells. On the other hand, two animal studies showed no differences in osteoclast counts by using MOPs in comparison to their control groups, which was consequently the result of biologic variability between animal and human and also probably the small sample sizes of these two studies. Conclusion In this systematic review, according to the adverse effects of MOP on root resorption, one study showed higher levels of root resorption among patients undergoing MOP. However, this outcome was due to the different methods used to evaluate the effect of MOPs on root resorption. Moreover, a high certainty of evidence supports that MOP causes biological changes and an elevation in cytokines, chemokines, and other biomarkers that stimulates osteoclasts differentiation which in turn accelerate OTM. There was no change in pulp vitality status based on available evidence.
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Affiliation(s)
- Neda Mosayebi
- Department of Orthodontics, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbasali Khademi
- Department of Endodontics, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shervin Bagherieh
- Department of Endodontics, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Niloufar Abedi
- Dental Materials Research Center, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mina Kargarfard
- Department of Orthodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Golnaz Tajmiri
- Dental Implants Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Monireh Kouhi
- Dental Materials Research Center, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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Eini E, Moradinejhad M, Chaharmahali R, Rahim F. The effect of micro-osteoperforations on the rate of orthodontic tooth movement in animal model: A systematic review and meta-analysis. J Oral Biol Craniofac Res 2022; 12:873-878. [PMID: 36212615 PMCID: PMC9535315 DOI: 10.1016/j.jobcr.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction The long passing time for tooth movement (TM) is one of the challenges in orthodontic. complications such as gingival recession, root resorption, and caries are common in orthodontic. To address this, there is an increased tendency to find safe and effective methods to accelerating tooth movement. A surgical method such as micro-osteoperforations (MOP) accelerating the TM. The current meta-analysis aims to investigate the outcome of MOP in accelerating TM in animal studies. Methods In the present meta-analysis, we evaluated 6 studies that focused on the effect of MOP on TM with the following keywords: (((MOP* OR micro-osteoperforations*) AND (("accelerating tooth movement " OR " tooth movement" AND " orthodontic tooth movement " OR " orthodontic ") until May 2021. Results The results have shown there is significant difference in TM after using MOP (MD: 0.31, 95%CI: 0.20, 0.42, P < 0.00001, I2 = 76%). Subgroup analysis revealed that though experimental duration in both less than 4-week and more than 4-week, the TM were significant difference between MOP and controls. Besides, in both force subgroups including less than 100 g and more than 100g, the TM was a significant difference between MOP and controls. Conclusion This meta-analysis found that generally MOP has a positive effect on TM.
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Affiliation(s)
- Ebrahim Eini
- Department of Orthodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehrnaz Moradinejhad
- Department of Orthodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Rayan Chaharmahali
- Department of Orthodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fakher Rahim
- Thalassemia and Hemoglobinopathy Research Center, Research Institute of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Corresponding author. Health Research Institute, Thalassemia and Hemoglobinopathies Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Micro-Osteoperforations Induce TNF-α Expression and Accelerate Orthodontic Tooth Movement via TNF-α-Responsive Stromal Cells. Int J Mol Sci 2022; 23:ijms23062968. [PMID: 35328385 PMCID: PMC8955966 DOI: 10.3390/ijms23062968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/08/2022] [Indexed: 02/04/2023] Open
Abstract
Micro-osteoperforations (MOPs) have been reported to accelerate orthodontic tooth movement (OTM), and tumor necrosis factor (TNF)-α has been reported to play a crucial role in OTM. In this report, the influence of MOPs during OTM was analyzed. We evaluated the expression of TNF-α with and without MOPs by RT-PCR analysis. A Ni-Ti closed coil spring was fixed between the maxillary left first molar and the incisors as an OTM mouse model to move the first molar in the mesial direction. MOPs were prepared on the lingual side and mesial side of the upper first molars. Furthermore, to investigate the target cell of TNF-α for osteoclast formation during OTM with MOPs in vivo, we created four types of chimeric mice in which bone marrow of wild-type (WT) or TNF receptor 1- and 2-deficient mice (KO) was transplanted into lethally irradiated WT or KO mice. The results showed that MOPs increased TNF-α expression, the distance of tooth movement and osteoclast formation significantly. Furthermore, mice with TNF-α-responsive stromal cells showed a significant increase in tooth movement and number of osteoclasts by MOPs. We conclude that MOPs increase TNF-α expression, and tooth movement is dependent on TNF-α-responsive stromal cells.
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Kim SG, Kook YA, Lim HJ, Park P, Lee W, Park JH, Bayome M, Kim Y. Comparison of the effects of horizontal and vertical micro-osteoperforations on the biological response and tooth movement in rabbits. Korean J Orthod 2021; 51:304-312. [PMID: 34556584 PMCID: PMC8461390 DOI: 10.4041/kjod.2021.51.5.304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/30/2020] [Accepted: 01/27/2021] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Seok-Gon Kim
- Department of Orthodontics, Graduate School of Clinical Dental Science, The Catholic University of Korea, Seoul, Korea
| | - Yoon-Ah Kook
- Department of Orthodontics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee Jin Lim
- Department of Orthodontics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Won Lee
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, AZ, USA.,International Scholar, Graduate School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Mohamed Bayome
- Department of Preventive Dental Sciences, College of Dentistry, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia.,Department of Postgraduate Studies, Universidad Autonoma del Paraguay, Asuncion, Paraguay
| | - Yoonji Kim
- Department of Orthodontics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Park JH, Kim KW, Lee NK, Ku JH, Kim J, Kook YA, Chou AHK, Kim Y. The effects of a corticotomy on space closure by molar protraction using TSADs in patients with missing mandibular first molars. Orthod Craniofac Res 2021; 25:159-167. [PMID: 34288403 DOI: 10.1111/ocr.12519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the effects of a triangular-shaped corticotomy on the protraction of second and third molars in patients with missing mandibular first molars. SUBJECTS AND METHODS The corticotomy and non-corticotomy groups consisted of sixteen first molars in fifteen patients (28.6 ± 9.4 years) and nineteen first molars in fifteen patients (26.6 ± 8.4 years), respectively. A triangular-shaped corticotomy was performed between the second premolar and molar. Temporary skeletal anchorage devices (TSADs) were placed between the first and second premolars in both groups. Mandibular dentition variables were measured on the pre and post-treatment panoramic radiographs and lateral cephalograms. Analysis of covariance was performed. RESULTS The corticotomy group exhibited 2.8 mm more inter-radicular correction between the second molar to second premolar roots (P < .001) and 1.6 mm more inter-radicular distance correction between the third molar to second premolar roots compared to the non-corticotomy group (P < .01). The corticotomy group required 5.5 months less treatment time for space closure (P < .05), but the total treatment time was the same for both groups. CONCLUSIONS The inter-radicular distance between the mandibular second premolar and molar and treatment times for space closure was significantly reduced in the corticotomy group.
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Affiliation(s)
- Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, AZ, USA.,Graduate School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Kyung Wook Kim
- Graduate School of Clinical Dental Science, The Catholic University of Korea, Seoul, Korea
| | - Nam-Ki Lee
- Department of Orthodontics, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ja Hyeong Ku
- Department of Orthodontics, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Jaehyun Kim
- Department of Orthodontics, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Yoon-Ah Kook
- Department of Orthodontics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | | | - Yoonji Kim
- Department of Orthodontics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Huang CY, Lu HP, Yu YF, Ding X, Zhang ZZ, Zhang JN. Comparison of tooth movement and biological response resulting from different force magnitudes combined with osteoperforation in rabbits. J Appl Oral Sci 2021; 29:e20200734. [PMID: 33825762 DOI: 10.1590/1678-7757-2020-0734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 12/23/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare tooth movement rate and histological responses with three different force magnitude designs under osteoperforation in rabbit models. METHODOLOGY 48 rabbits were divided into three groups: Group A, Group B, and Group C, with traction force of 50 g, 100 g, 150 g, respectively. Osteoperforation was performed at the mesial of the right mandibular first premolar, the left side was not affected. One mini-screw was inserted into bones between two central incisors. Coil springs were fixed to the first premolars and the mini-screw. Tooth movement distance was calculated, and immunohistochemical staining of PCNA, OCN, VEGF, and TGF-β1 was analyzed. RESULTS The tooth movement distance on the surgical side was larger than the control side in all groups (P<0.01). No significant intergroup difference was observed for the surgical side in tooth movement distance among the three groups (P>0.05). For the control side, tooth movement distance in Group A was significantly smaller than Groups B and C (P<0.001); no significant difference in tooth movement distance between Group B and Group C was observed (P>0.05). On the tension area of the moving premolar, labeling of PCNA, OCN, VEGF and TGF-β1 were confirmed in alveolar bone and periodontal ligament in all groups. PCNA, OCN, VEGF and TGF-β1 on the surgical side was larger than the control side in all groups (P<0.001). CONCLUSION Osteoperforation could accelerate orthodontic tooth movement rate in rabbits. Fast osteoperforation-assisted tooth movement in rabbits was achieve with light 50 g traction.
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Affiliation(s)
- Cheng-Yi Huang
- Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Department of Dentistry, Center of Orthodontics, Hangzhou, China
| | - Hai-Ping Lu
- Zhejiang Chinese Medical University, College of Stomatology, Department of Orthodontics, Hangzhou, China
| | - Yu-Feng Yu
- Hangzhou Cancer Hospital, Department of Radiotherapy, Hangzhou, China
| | - Xi Ding
- The First Affiliated Hospital of Wenzhou Medical University, Department of Stomatology, Wenzhou, China
| | - Zan-Zan Zhang
- Zhejiang Chinese Medical University, College of Stomatology, Department of Orthodontics, Hangzhou, China
| | - Jia-Nan Zhang
- Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Department of Dentistry, Center of Orthodontics, Hangzhou, China
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Wu YF, Guo HM. The effect of corticotomy on the compensatory remodeling of alveolar bone during orthodontic treatment. BMC Oral Health 2021; 21:134. [PMID: 33740958 PMCID: PMC7977253 DOI: 10.1186/s12903-021-01492-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/07/2021] [Indexed: 11/15/2022] Open
Abstract
Background This study aimed to explore whether compensatory remodeling of the alveolar bone surface occurred during the buccal palatal movement of orthodontic teeth. We preliminarily explored whether corticotomy could activate or accelerate osteogenesis in the alveolar bone surface by measuring the expression of TGF-β1 (transforming growth factor-β1), which can facilitate the proliferation and differentiation of osteoblasts and regulate the maturity and formation of bone. Methods Sixty 10-week-old male Wistar rats were selected. In the orthodontic group, 20 rats were implanted with a constriction device between the maxillary first molars under general anesthesia. In the corticotomy group, 20 rats were implanted with a constriction device, and a palatal incision was made to penetrate the cortical bone. In the control group, 20 rats underwent no experimental operation except general anesthesia. After 1, 3, 5 and 7 days, the maxillary first molars and the surrounding alveolar bone were harvested, and coronal sections containing the apical mesial buccal root were prepared and observed using tetracycline fluorescence, HE staining and immunohistochemical staining for TGF-β1. Image-Pro Plus software was used to assess the immunohistochemical results, and SPSS 22.0 statistical software was used to analyze variance and perform the LSD test. Results The tetracycline fluorescence results showed that in the periosteum near the apical region, an obvious fluorescence signal was observed in the orthodontic group and the corticotomy group compared with the control group. In the orthodontic group and corticotomy group, HE staining showed that the morphology was similar to cube-shaped. The immunohistochemical results showed that TGF-β1 was significantly increased in the periosteum near the apical region in the orthodontic group and corticotomy group, and there were significant differences among the three groups. In addition, the expression of TGF-β1 in the periosteum in the orthodontic group and the corticotomy group gradually increased over time, reaching a peak on day 5 and slightly decreasing on day 7. Conclusion Osteogenesis occurred on the alveolar bone surface during the buccal palatal movement of orthodontic teeth, and corticotomy had a positive effect, and TGF-β1 was involved in this process.
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Affiliation(s)
- Yi-Fei Wu
- Department of Orthodontics, Capital Medical University, School of Stomatology, Beijing, 100050, China
| | - Hong-Ming Guo
- Department of Orthodontics, Capital Medical University, School of Stomatology, Beijing, 100050, China.
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Mohaghegh S, Soleimani M, Kouhestani F, Motamedian SR. The effect of single/multiple micro-osteoperforation on the rate of orthodontic tooth movement and its possible complications: A systematic review and meta-analysis. Int Orthod 2021; 19:183-196. [PMID: 33678595 DOI: 10.1016/j.ortho.2021.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/06/2021] [Accepted: 02/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Different surgical and non-surgical approaches have been proposed to accelerate tooth movement and decrease the duration of orthodontic treatments. Recently, less invasive techniques such as micro-osteoperforation (MOP) are becoming more common. Several clinical trials have been performed to analyse the effect of MOP. This systematic review with meta-analyses was done to evaluate the effect of MOP on the rate of orthodontic tooth movement (OTM) and its complications. MATERIAL AND METHODS Electronic search was done in PubMed and Cochrane database for studies published until January 2021. Comparative randomized clinical trial studies with 10 or more participants per group were included. The risk of bias (ROB) of the studies was assessed according to the Cochrane Collaborations tool. Meta-analyses were performed to assess the mean difference in tooth movement rate and compare the level of pain between MOP and control groups. RESULTS Among a total of 15 included studies, eight studies were at low ROB, while others had unclear ROB. Ten studies evaluated the effect of MOP on OTM rate in canine retraction, and related meta-analysis showed a significant difference between the MOP and control group [SMD=0.42; 95% CI=0.20 to 0.63, P<0.01]. Besides, quantitative analysis showed MOP caused no significant higher anchorage loss [SMD=0.01; 95% CI=-0.15 to 0.13, P=0.89] and pain [SMD=0.54; 95% CI=-0.25 to 1.33, P=0.18]. CONCLUSIONS Overall, both single and multiple applications of MOP increased the rate of OTM. However, the meta-analysis results of the four studies with low risk of bias showed that there is no significant difference in the rate of tooth movement between MOP and control groups. Besides, it has been shown that MOP did not significantly increase the level of pain, anchorage loss, and periodontal complications.
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Affiliation(s)
- Sadra Mohaghegh
- Shahid Beheshti University of Medical Sciences, School of Dentistry, Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Tehran, Iran
| | - Milad Soleimani
- Alborz University of Medical Sciences, School of Dentistry, Department of Orthodontics, Karaj, Iran
| | - Farnaz Kouhestani
- Shahid Beheshti University of Medical Sciences, School of Dentistry, Department of Orthodontics, Tehran, Iran
| | - Saeed Reza Motamedian
- Shahid Beheshti University of Medical Sciences, School of Dentistry, Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Tehran, Iran.
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Al-Khalifa KS, Baeshen HA. Micro-osteoperforations and Its Effect on the Rate of Tooth Movement: A Systematic Review. Eur J Dent 2020; 15:158-167. [PMID: 32610360 PMCID: PMC7902111 DOI: 10.1055/s-0040-1713955] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Prolonged orthodontic treatments have inconvenienced patients and clinicians alike. Surgically assisted techniques for accelerating orthodontic tooth movement have shown promising results in the literature over the years. The minimally invasive nature of micro-osteoperforations (MOPs), however, for enhanced orthodontic tooth movement has recently gained momentum, with many clinical trials conducted on both animals and humans. An electronic search was performed to extract papers using PubMed, Google Scholar, Scopus, and Web of Science. The keywords that were used included “MOP,” “accelerating tooth movement,” “orthodontic tooth movement,” and “regional acceleratory phenomenon.” The studies that met our inclusion criteria were extracted and evaluated in this review. MOPs have been proven time and again, in animal and human studies alike, to increase the rate of orthodontic tooth movement. The application of perforations to cortical bone present in the pathway of teeth, which are specifically to be moved creates transient osteopenia. This reduces the density of the cortical bone, hence speeding up the rate of orthodontic tooth movement. Many techniques have been implemented and perfected to enhance orthodontic tooth movement and shorten the treatment time in the literature. MOPs have proven to be a universally applied, nontechnical, repeatable, and minimally invasive method of accelerating tooth movement, with extremely minimal consequences.
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Affiliation(s)
- Khalifa S Al-Khalifa
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hosam A Baeshen
- Department of Orthodontics, College of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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