Effect of piezocision corticotomy on en-masse retraction.
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ABSTRACT: Objectives
To compare the amount of en-masse retraction with or without piezocision corticotomy, to assess the type of tooth movement, to evaluate root integrity after retraction, and to record reported pain levels.Materials and methods
This randomized, controlled clinical trial included 26 orthodontic patients requiring premolar extraction. The patients were divided into two groups: (1) an extraction with piezocision corticotomy group (PCG) and (2) an extraction-only group, which served as the control group (CG). Cone-beam computed tomography images were acquired before and 4 months after the initiation of en-masse retraction utilizing miniscrews. The following variables were assessed: the amount of en-masse retraction, incisor inclination, incisor and canine root resorption, and patient-reported pain.Results
Twelve and 11 participants completed the entire study in the PCG and CG, respectively. The amount of en-masse retraction was significantly greater in the PCG compared to the CG (mean = 4.8 ± 0.57 mm vs 2.4 ± 0.33 mm, respectively [P < .001]). There was also significantly less tipping and root resorption of incisors in the PCG (P < .05). The reported pain was significantly higher on the first day in the PCG compared to the CG (P < .001); however, it became similar between the groups after 24 hours.Conclusions
Piezocision corticotomy enhanced the amount of en-masse retraction two times more with less root resorption. However, future studies are required to assess the long-term effects of this technique.
SUBMITTER: Hatrom AA
PROVIDER: S-EPMC8032268 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The aim of this systematic review was to evaluate the effectiveness and complications of corticotomy and piezocision in canine retraction. Five electronic databases (PubMed, SCOPUS, Web of Science, Embase, and CENTRAL) were searched for articles published up to July 2017. The databases were searched for randomized control trials (RCTs), with a split-mouth design, using either corticotomy or piezocision. The primary outcome reported for canine retraction was either the amount of tooth movement, rate of tooth movement, or treatment time. The secondary outcome was complications. The selection process was based on the PRISMA guidelines. A risk of bias assessment was also performed. Our search retrieved 530 abstracts. However, only five RCTs were finally included. Corticotomy showed a more significant (i.e., 2 to 4 times faster) increase in the rate of tooth movement than did the conventional method. For piezocision, both accumulative tooth movement and rate of tooth movement were twice faster than those of the conventional method. Corticotomy (with a flap design avoiding marginal bone incision) or flapless piezocision procedures were not detrimental to periodontal health. Nevertheless, piezocision resulted in higher levels of patient satisfaction. The main limitation of this study was the limited number of primary research publications on both techniques. For canine retraction into the immediate premolar extraction site, the rate of canine movement after piezocision was almost comparable to that of corticotomy with only buccal flap elevation.
| S-EPMC5932322 | biostudies-literature
Project description:BackgroundThe aims of this study were to evaluate the efficacy of alveolar corticotomy (AC) and piezocision (PZ) in accelerating maxillary canine retraction, and their effects on multiple bone remodeling expression in gingival crevicular fluid (GCF). A split-mouth, randomized controlled clinical trial was performed at the Department of Orthodontics of Pontifical Catholic University of Minas Gerais, Brazil. Eligibility criteria included orthodontic need for first maxillary premolars extractions, followed by canine retraction. Fifty-one adult patients were recruited and randomly assigned to 3 groups (allocation ratio 1:1:1). Random allocation of surgical or control interventions to each side of the maxillary arch was also conducted: G1 - AC × Control, G2 - PZ × Control, and G3 - AC × PZ. Both the definition of the group and the decision of the experimental or control sides were randomized by the software. Intraoral digital scans were performed before, 7 and 14 days after the beginning of canine retraction, and subsequently, at every 14 days until a maximum period of 6 months. GCF samples were collected before, and 1, 2, 4, 8, and 12 weeks. The primary outcome consisted in the cumulative distal movement of the canines and was measured by digital model superimposition. The secondary outcome consisted in GCF bone remodeling samples that were quantified in a multiplex immunoassay. The measurements examinator was properly blinded.ResultsForty-seven patients, 19 males and 28 females, were analyzed (mean age 20.72, SD = 6.66, range 15 to 38). Statistically significant differences in canine distal movement between AC and control in G1 were not observed (p > 0.05). In G2, PZ showed lower cumulative incisal and cervical measurements than control from the 2nd to the 24th week (p < 0.05). In G3, PZ showed a lower cumulative incisal and cervical measurements than AC from the16th to the 24th week (p < 0.05). In all groups, differences on biomarkers expression occurred at specific timepoints (p < 0.05), but a distinct pattern was not observed.ConclusionsAC and PZ were not effective to accelerate maxillary canine retraction and did not induce a distinct pattern of biomarker expression.Trial registrationNCT03089996 . Registered 24 March 2017 - Registered.
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Project description:ObjectiveThis study aimed to assess the levels of pain, discomfort, and functional impairment associated with the en-masse retraction of the upper anterior teeth when treating Class II division 1 malocclusion patients using traditional corticotomy or flapless corticotomy. In addition, an assessment of patients' satisfaction with the selected surgical intervention was undertaken at one-month post-operatively.Materials and methodsThe study sample comprised 40 patients with Class II division 1 malocclusion, randomly assigned to either the traditional corticotomy group (n=20) or the flapless corticotomy group (n=20). Patients underwent extraction of the maxillary first premolars, and orthodontic mini-screws were placed between the maxillary second premolars and the first molars for skeletal anchorage. An en-masse retraction was accomplished in both groups. Patients were asked to fill in a questionnaire at 24 hours (T1), four days (T2), seven days (T3), 14 days (T4), and 28 days (T5) after the surgical intervention using standardized questionnaires. Most questions were answered on a visual analog scale where zero scores meant the absence of pain, discomfort, or functional impairment, and 100 scores meant the worst feelings of these traits.ResultsAll patients in both groups entered data analysis with no dropouts. All measured levels were significantly greater in the traditional corticotomy group during the first two weeks following the corticotomy intervention in terms of pain perception (P˂0.001), discomfort (P=0.004), and difficulty in chewing (P=0.015). Additionally, during the first week following corticotomy, levels of perception of discomfort (P˂0.001), difficulty in swallowing (P=0.001), and limitation of jaw movement (P˂0.001) were significantly greater in the traditional corticotomy group. Patient satisfaction, the recommendation to a friend, and acceptance of flapless corticotomy were significantly greater than traditional corticotomy (P=0.002, P=0.001, respectively). 78% of patients in the traditional corticotomy group considered it more discomfort than a tooth extraction, while 50% of patients in the flapless corticotomy group considered tooth extraction more discomfort, with a significant difference between the two groups (P=0.001).ConclusionsThe levels of negative patients' reported outcomes were significantly smaller with flapless corticotomy than with traditional corticotomy. Traditional corticotomy was associated with mild to moderate levels of pain, swallowing difficulty, moderate levels of discomfort, chewing difficulty, and jaw movement limitation after 24 hours of the surgical procedure. In contrast, flapless corticotomy was less problematic and associated with mild pain, swelling, chewing difficulty, jaw movement limitation, and swallowing difficulty at the same assessment time. Patient satisfaction, acceptance, and recommendation to a friend were greater for flapless corticotomy than traditional intervention.
| S-EPMC10361784 | biostudies-literature
Project description:(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.
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Project description:BACKGROUND:To evaluate the effectiveness of two minimally invasive surgical procedures in the acceleration of canine retraction: piezocision and laser-assisted flapless corticotomy (LAFC). METHODS:Trial design: A single-centre randomized controlled trial with a compound design (two-arm parallel-group design and a split-mouth design for each arm). PARTICIPANTS:36 Class II division I patients (12 males, 24 females; age range: 15 to 27 years) requiring first upper premolars extraction followed by canine retraction. INTERVENTIONS:piezocision group (PG; n?=?18) and laser-assisted flapless corticotomy group (LG; n?=?18). A split-mouth design was applied for each group where the flapless surgical intervention was randomly allocated to one side and the other side served as a control side. OUTCOMES:the rate of canine retraction (primary outcome), anchorage loss and canine rotation, which were assessed at 1, 2, 3 and 4 months following the onset of canine retraction. Also the duration of canine retraction was recorded. Random sequence: Computer-generated random numbers. Allocation concealment: sequentially numbered, opaque, sealed envelopes. Blinding: Single blinded (outcomes' assessor). RESULTS:Seventeen patients in each group were enrolled in the statistical analysis. The rate of canine retraction was significantly greater in the experimental side than in the control side in both groups by two-fold in the first month and 1.5-fold in the second month (p?<?0.001). Also the overall canine retraction duration was significantly reduced in the experimental side as compared with control side in both groups about 25% (p???0.001). There were no significant differences between the experimental and the control sides regarding loss of anchorage and upper canine rotation in both groups (p?>?0.05). There were no significant differences between the two flapless techniques regarding the studied variables during all evaluation times (p?>?0.05). CONCLUSIONS:Piezocision and laser-assisted flapless corticotomy appeared to be effective treatment methods for accelerating canine retraction without any significant untoward effect on anchorage or canine rotation during rapid retraction. TRIALS REGISTRATION:ClinicalTrials.gov (Identifier: NCT02606331 ).
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Project description:ObjectiveThe main objective is to evaluate the effectiveness of en masse retraction with temporary skeletal anchorage devices (TSADs) versus two-step retraction with conventional anchorage (CA) in terms of the skeletal, dental, and soft-tissue variables, as well as the duration of retraction or overall orthodontic treatment.Materials and methodsAn electronic search of PubMed and nine other major databases for prospective, randomized controlled trials (RCTs) and clinical controlled trials (CCTs) was carried out between January 1990 and April 2018. The bibliography in each identified article was checked out. In addition, manual searching was performed in the same time frame in five major orthodontic journals. Adult patients undergoing fixed orthodontic treatment with extraction of maxillary premolars followed by an en masse retraction in the experimental group and two-step retraction of upper anterior teeth in the control group. Methodological index for nonrandomized studies for CCTs and Cochrane's risk of bias tool for RCTs were applied.ResultsFour articles (two RCTs and two CCTs) were included in this review and all articles were appropriate for the quantitative synthesis. There was no significant difference between the en masse retraction and two-step retraction groups in terms of SNA, SNB, ANB, and MP-SN angles. Using TSADs gave significantly better results in terms of posterior anchorage and incisors inclination, and greater anterior teeth retraction in comparison with CA (standardized mean difference [SMD] = -3.03 mm, P < 0.001; SMD = 0.74°, P = 0.003; SMD = -0.46 mm, P = 0.03, respectively). En masse/TSAD combination caused a significantly greater increase in nasolabial angle, higher decrease in facial convexity angle, and greater lower lip retraction in comparison with two-step/CA combination (weighted mean difference = 4.73°, P = 0.007; P = 0.0435; SMD = -0.95 mm, P = 0.01, respectively).ConclusionThere is weak-to-moderate evidence that using either en masse/TSAD combination or two-step/CA combination would lead to similar skeletal improvement. There is a very weak-to-moderate evidence that using TSADs with en masse retraction would cause better posterior anchorage and incisors inclination, and greater anterior teeth retraction than using CA with two-step retraction. There is weak-to-moderate evidence that using en masse/TSAD combination would lead to a better improvement in the facial profile. According to the quality of evidence, we confirm the need for more well-conducted RCTs in the en masse retraction field.
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Project description:ObjectiveThe objective of this two-arm parallel trial was to compare the type of tooth movement during en masse retraction of the maxillary anterior teeth using labial versus lingual biocreative therapy.MethodsTwenty-eight subjects were randomized in a 1 : 1 ratio to either the labial or lingual group. En masse anterior retraction was performed using labial biocreative therapy in group A and lingual biocreative therapy in group B. Cone beam computed tomography scans were taken before and after retraction and the primary outcome was the type of tooth movement during anterior retraction. Data were analyzed using paired t-tests for comparisons within each group and independent-sample t-test for comparison of the mean treatment changes between the two groups.ResultsSignificant differences were found between the two groups in relation to the type of tooth movement (labiolingual inclination of the central incisor; mean difference, 5.85 ± 1.85°). The canine showed significant distal tipping in the lingual group (mean difference, 6.98 ± 1.25°). The canine was significantly more intruded in the lingual group (mean difference, 1.67 ± 0.49 mm). Good anchorage control and significant soft tissue changes occurred in both groups. No serious adverse effects were detected.ConclusionsWith a 10-mm retraction hook, the labial biocreative technique with the reverse curve overlay provided anterior retraction with good torque control, while in the lingual group, anterior retraction occurred with controlled tipping movement with significant distal tipping and intrusion of the canine (trial registration: The trial was registered at ClinicalTrials.gov [NCT03239275]).
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