Evaluation of the effectiveness of piezocision-assisted flapless corticotomy in the retraction of four upper incisors: A randomized controlled clinical trial

BACKGROUND

Comprehensive orthodontic treatment may last for 20-24 months. Reducing the treatment time has become a common demand from both patients and orthodontists. Minimally invasive piezocision is one of the suggested approaches to accelerate the orthodontic tooth movement.

OBJECTIVES

The aim of this randomized controlled clinical trial was to assess the effectiveness of the flapless piezocision procedure in accelerating the retraction of upper incisors.

MATERIAL AND METHODS

A single-blinded, parallel-group randomized controlled clinical trial was conducted at the Department of Orthodontics at the University of Damascus Dental School, Syria. The study involved 42 patients (11 males, 31 females) at the age of 16-31 years (mean age: 19.15 years). The patients had class II division I malocclusion and were treated with fixed appliances using the two-step retraction technique. With an allocation ratio of 1:1, the participants were randomly assigned to either the experimental group (n = 21) or the control group (n = 21) using a computer-generated list of random numbers. Allocation was concealed due to the use of sequentially numbered, opaque, sealed envelopes. The primary outcomes were the rate of incisor retraction (RIR) and the time required for retraction. The outcome assessor was blinded.

RESULTS

The data analysis included 20 patients in each group. The rate of incisor retraction significantly increased in the experimental group by 53%, with a significant shortening of the retraction time in the experimental group by 27% (p < 0.001). The rate of anchorage loss was significantly lesser in the experimental group (p < 0.001). Regarding the cephalometric assessment, incisor tipping was significantly greater in the control group than in the experimental group. Skeletal measurements showed insignificant changes following retraction between the 2 groups.

CONCLUSIONS

The piezocision procedure was found to be effective in accelerating the retraction of 4 upper incisors, reducing the retraction time, preserving anchorage and enhancing root torque control during retraction.

Pain, Discomfort, and Functional Impairments When Retracting Upper Anterior Teeth Using Two-Step Retraction With Transpalatal Arches Versus En-Masse Retraction With Mini-implants: A Randomized Controlled Trial

Background This study aimed to evaluate the levels of pain and discomfort associated with employing mini-implants as a temporary skeletal anchorage device compared to the traditional transpalatal arches (TPAs) during upper anterior teeth retraction in patients with upper dentoalveolar protrusion and to determine the level of acceptance of both techniques among patients. Methodology The study sample consisted of 38 patients (29 women and nine men) with an average age of 21.7 years. The patients were randomly and equally distributed into two groups. In the first group: upper anterior teeth were en-masse retracted using mini-implants (the TAD group), whereas, in the second group, TPAs were used during the two-step retraction of upper anterior teeth (the TPA group). Standardized questionnaires were distributed to all patients after 24 hours of mini-implant application. The questionnaire asked the patients to rate their pain perception, swelling sensation, eating difficulties, talking impairments, and cleansing difficulties on a four-point Likert scale on the third-day, one-week, two-week, and one-month follow-ups after the anchorage application. Wilcoxon matched-pairs signed-rank tests were used to evaluate intragroup changes, whereas Mann-Whitney U tests were employed to examine intergroup differences. Results Patients in the TAD group had higher pain and swelling levels than those in the TPA group, and differences were statistically significant at the first three assessment time points. The differences between the two groups were statistically insignificant regarding eating and talking difficulties, whereas differences were statistically significant for brushing difficulties. These impairments decreased to almost normal levels after one month of treatment initiation. Conclusions TPAs, when used for anchorage in the two-step retraction technique, were less problematic compared to mini-implants with en-masse retraction, where the sensation of pain or swelling around the mini-implants did not last for more than a week. The difficulties of cleaning, chewing, and speaking in the presence of mini-implants were temporary and mostly disappeared within two weeks of mini-implant application.

An Innovative Approach to Accelerate Maxillary Canine Retraction With Low-Amperage Direct Electric Current: A Preliminary Clinical Study

Background and objective Accelerating orthodontic tooth movement is a significant goal for clinicians and patients. This study aimed to investigate the effectiveness of a low-ampere, electrically inducible tooth movement accelerator device. The study focuses on an innovative intraoral removable device designed to expedite the retraction of maxillary canines. Methods This research was conducted in the Orthodontics Department at Damascus University, Syria, between September 2022 and March 2023, and involved seven patients (five females and two males; mean age: 20.85 ± 1.34 years) initially diagnosed with class II, division I malocclusion. The treatment plan included retraction of the upper anterior teeth in two stages following the extraction of the first premolars on each side. Electrical stimulation was applied during the retraction of the maxillary canines using a removable, custom-manufactured device developed by the researchers. Patients were instructed to wear the device for five hours daily. The variables investigated included the rate of canine retraction, safety, and patient acceptance of the device. Results The average rate of canine retraction was consistent, averaging 1.25 ± 0.13 mm/month. No side effects, such as irritation or discomfort, were observed. Patients reported no adverse effects and stated that they would recommend the technique to others. Five out of seven patients found it easy to adapt to the device, while two found it moderately challenging. Conclusions Our findings showed that low-amperage direct current electrical stimulation effectively accelerated orthodontic movement. The maxillary canine retraction was significantly sped up without any adverse effects. Patients responded positively, indicating feasibility and acceptability. This technique could reduce treatment duration, which is pending further validation.