Intervenciones quirúrgicas mínimamente invasivas complementarias a la ortodoncia quirúrgicamente asistida: Resumen estructurado de evidencia

Introducción: Existen procedimientos quirúrgicos que pueden generar una disminución en la duración de los tratamientos de ortodoncia (TO) mediante una aceleración del movimiento dental. La técnica más estudiada corresponde a la corticotomía clásica, la cual muchas veces es desechada por los pacientes debido a su invasividad. Es por esto que nacen las intervenciones quirúrgicas mínimamente invasivas (IQMI), tales como las micro osteoperforaciones (MOP) y la piezocisión, que buscan el mismo resultado, pero sin realizar colgajos de espesor total, otorgándole al paciente nuevas alternativas terapéuticas para acortar el tratamiento de ortodoncia. La evidencia al respecto aún es controversial, debido a que la certeza de la evidencia es baja o muy baja con relación a estos procedimientos. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metaanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos 39 revisiones sistemáticas que en conjunto incluyeron 43 estudios primarios, de los cuales, 31 corresponden a ensayos aleatorizados. Concluimos que las intervenciones quirúrgicas mínimamente invasivas podrían aumentar la tasa de movimiento dental a las 12 semanas, la distancia total acumulada, la tasa de movimiento dental y reducir la duración total de tratamiento, pero la certeza de la evidencia es incierta. Además, podrían resultar en poca o ninguna diferencia sobre el índice gingival, la profundidad de sondaje y el índice de placa.

Introduction: There are surgical procedures that can generate a decrease in the orthodontic (OT) treatments duration through a Acceleration of tooth movement. The most studied technique corresponds to classical corticotomy, which is often discarded by patients due to its invasiveness. This is why minimally invasive surgical interventions (MISI) are born, such as micro osteoperforations (MOP) and piezocision, which seek the same result, but without making total thickness flaps, giving the patient new therapeutic alternatives to shorten orthodontic treatment. The evidence on this is still controversial, because the certainty of the evidence is low or very low in relation to these procedures. Methods: A search was performed using Epistemonikos, the biggest database for systematic reviews in health, which is maintained by screening of multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. Data from systematic reviews were extracted, and analysis of the primary studies was performed, including a meta-analysis and a summary of findings table using GRADE approach. Results and conclusions: We identified 39 systematic reviews that together included 43 primary studies, of which 31 correspond to randomized clinical trials. We conclude that minimally invasive surgical interventions could increase the rate of tooth movement at 12 weeks, distance total accumulated, the rate of tooth movement and reduce the total duration of treatment, but the certainty of the evidence is uncertain. In addition, they could result in little or no difference in gingival index, probing depth and plaque index.

Comparison of second molar protraction using different timing for piezocision application: A randomized clinical trial

ABSTRACT Objective: To compare second molar protraction between early, late and no piezocision groups. Material and Methods: Forty subjects with bilaterally extracted mandibular first molars were selected to participate in the study. Subjects were subdivided into two groups: piezocision and no piezocision. The piezocision group was further subdivided into two subgroups: early piezocision (piezocision performed immediately before second molar protraction) and late piezocision (piezocision performed three months after starting molar protraction). In the no piezocision group, molar protraction was done without surgery. The intervention (piezocision group and timing of piezocision/side within group) was randomly allocated using the permuted random block size of 2, with 1:1 allocation ratio. The amount of second molar protraction, duration of space closure and anterior anchorage loss were measured. A repeated measures analysis of variance was conducted to define the differences between the measured variables at the different time intervals. Differences between groups were assessed using ANOVA test. Results: No difference was detected between early and late piezocision groups in the amount of molar protraction at the end of space closure. Duration of complete space closure was 9 and 10 months in the piezocision and no piezocision groups. Anchorage loss was similar between the three studied groups. Conclusions: Early and late piezocision have similar effect and both increased the amount of second molar protraction temporarily in the first 2-3 months after surgery. Duration of mandibular first molar space closure was reduced by one month when piezocision was applied. Anchorage loss was similar in the three groups.

RESUMO Objetivo: Comparar o efeito dos tempos de aplicação precoce, tardia e sem piezocisão, na protração de segundos molares. Métodos: Quarenta indivíduos com os primeiros molares inferiores extraídos bilateralmente foram selecionados para participar do estudo, sendo divididos em dois grupos: piezocisão e sem piezocisão. O grupo de piezocisão foi subdividido em dois subgrupos: piezocisão precoce (piezocisão realizada imediatamente antes da protração de segundos molares) e piezocisão tardia (realizada três meses após o início da protração dos molares). No grupo sem piezocisão, a protração de molares foi feita sem cirurgia. A intervenção (grupo de piezocisão e momento da piezocisão/lado dentro do grupo) foi alocada aleatoriamente usando o tamanho de bloco aleatório permutado de 2 com proporção de alocação de 1:1. A quantidade de protração de segundos molares, tempo para fechamento de espaços e perda de ancoragem anterior foram medidos. Uma análise de variância para medidas repetidas foi realizada para definir as diferenças entre as variáveis medidas nos diferentes intervalos de tempo. As diferenças entre os grupos foram avaliadas pelo teste ANOVA. Resultados: Não foi detectada diferença entre os grupos de piezocisão precoce e tardia, em relação à quantidade de protração de molares ao fim do fechamento dos espaços. O tempo para o fechamento completo do espaço foi de nove e dez meses nos grupos piezocisão e sem piezocisão, respectivamente. A perda de ancoragem foi semelhante nos três grupos avaliados. Conclusões: As piezocisões precoce e tardia têm efeito semelhante e ambas aumentaram temporariamente a quantidade de protração dos segundos molares nos primeiros dois a três meses após a cirurgia. A duração do fechamento de espaço dos primeiros molares inferiores foi reduzida em um mês quando a piezocisão foi aplicada. A perda de ancoragem foi semelhante nos três grupos.

Innovations in Flapless Corticotomy to Accelerate Orthodontic Tooth Movement: A Review Focusing on the Different Techniques, Limitations and Future Possibilities

@#The aim of this narrative review is to discuss on different approaches of the flapless corticotomy techniques to accelerate orthodontic tooth movement. There was limited understanding about the effect of the surgical procedures because of the great variations in the procedures between the flapless corticotomy techniques. Hence, no specific technique can be claimed to be superior to another. Eleven clinical trials have been reviewed from PubMed, Science Direct, and Google Scholar using the keywords such as accelerated, orthodontic tooth movement (OTM), minimally invasive corticotomy, RAP, corticision, piezocision, lasercision/laser assisted flapless corticotomy (LAFC), micro-osteoperforations (MOPs), discision and their combinations in the last 10 years. Early reports showed that Piezocision, MOPs and LAFC procedures are comparatively less aggressive flapless corticotomy procedure to accelerate OTM and more comfortable to the patient.

Clinical study of accelerating orthodontic space closure for missed mandible first molar by Piezocision / 实用口腔医学杂志

Objective: To study the clinical effects of minimally invasive corticotomy, Piezocision, as an adjunct to orthodontic treatment for the cases with missing mandibular first molar. Methods: 29 patients without mandibular first molar were devided into 2 groups and treated by orthodontic treatment with Piezocision (group A, n = 14) and routine orthodontic treatment (group B, n = 15) respectively. The movement distance and periodontal status of mandible second molar after force loading were compared between the 2 groups. Results: At 14, 28, 56, 84 days after add force loading, the movement distance of mandible second molar in group A were longer than in group B (P ＜ 0. 05) . 84 days after force loading, there was no significant difference (P＞ 0. 05) about the periodontal indices in group A compared with those before force loading. Bleeding index (BI) and periodontal depth (PD) in group B were increased 84 days after loading (P ＜ 0. 05) . There was no significant (P＞ 0. 05) of periodontal indices between the 2 groups at 84 days after force loading.Conclusion: Piezocision can accelerate orthodontic tooth movement of mandible second molar and can enture the periodontal health.

Comparative study of root resorption between two methods for accelerated orthodontic tooth movement

Objective: the aim of this study was to assess apical root resorption (RR) following the application of micro-osteoperforation (MOP) and piezocision (PzC) assisted orthodontics for the acceleration of tooth movement (TM). materials and methods: a total number of 16 patients seeking orthodontic therapy were included in this study. all patients had undergone 1st premolars extraction and were indicated for canine retraction. these patients were divided into two groups; one was treated using MOP in one side while the other side served as control. in the other group PzC was performed in one side with no intervention done on the other side. cone-beam computed tomography (CBCT) scans were obtained for every patient before and after canine retraction in order to evaluate amount of RR. results: in the MOP group, there was no significant difference in canine root length between experimental and control sides. whereas, in the PzC group, there was a statistically significant decrease in root length in the experimental side compared with the control side. when comparing both groups, the experimental PzC side showed a statistically significant decrease in root length compared to experimental MOP side postoperatively. conclusion: experimental PzC showed statistically significant decreases in canine root length compared to both experimental MOP and control side after canine retraction.

The effectiveness of minimally invasive surgery on accelerating tooth movement: A systematic review / 实用口腔医学杂志

Objective: To evaluate the effect of minimally invasive surgery on acceleration orthodontic tooth movement by meta-analysis. Methods: All literatures about minimally invasive surgery accelerating tooth moment were searched from the database in general. The literatures were screened according to the correlation and the inclusion criteria, included literatures were analyzed by RevMan 5. 3. Results: 5 articles including 85 patients were included in this review, 4 of which reported that minimally invasive surgery can accelerate orthodontic tooth movement, but 1 reported no statistical difference in alleviating mandibular anterior crowding between minimally invasive surgery acceleration orthodontic group and conventional orthodontic group. Higher tooth movement rate was found with the minimally invasive surgical procedures by a weighted mean difference of 0. 70 mm in 1 month of canine retraction (WMD = 0. 7: 95％ CI(0. 57, 0. 82); P＜ 0. 001) and by a weighted mean difference 1. 31 mm in 2 months (WMD = 1. 31: 95％ CI (0. 69, 1. 92), P＜ 0. 001). No obvious adverse effects were observed in periodontal condition, pain, satisfaction, root resorption and anchorage control. Conclusion: According to current studies, minimally invasive surgery can accelerate single tooth movement, but the evidence is insufficient to prove that the entire orthodontic treatment time can be shortened.

The effectiveness of corticotomy and piezocision on canine retraction: A systematic review / 대한치과교정학회지

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.

The combined use of computer-guided, minimally invasive, flapless corticotomy and clear aligners as a novel approach to moderate crowding: A case report / 대한치과교정학회지

The aim of this case report was to describe an innovative orthodontic treatment method that combined surgical and orthodontic techniques. The novel method was used to achieve a positive result in a case of moderate crowding by employing a computer-guided piezocision procedure followed by the use of clear aligners. A 23-year-old woman had a malocclusion with moderate crowding. Her periodontal indices, oral health-related quality of life (OHRQoL), and treatment time were evaluated. The treatment included interproximal corticotomy cuts extending through the entire thickness of the cortical layer, without a full-thickness flap reflection. This was achieved with a three-dimensionally printed surgical guide using computer-aided design and computer-aided manufacturing. Orthodontic force was applied to the teeth immediately after surgery by using clear appliances for better control of tooth movement. The total treatment time was 8 months. The periodontal indices improved after crowding correction, but the oral health impact profile showed a slight deterioration of OHRQoL during the 3 days following surgery. At the 2-year retention follow-up, the stability of treatment was excellent. The reduction in surgical time and patient discomfort, increased periodontal safety and patient acceptability, and accurate control of orthodontic movement without the risk of losing anchorage may encourage the use of this combined technique in appropriate cases.