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.

Research progress on micro-osteoperforation-assisted orthodontic treatment / 口腔疾病防治

@#As a minimally invasive procedure, micro-osteoperforations (MOPs) achieve desired therapeutic effect with minimal surgical intervention. The operation is relatively simple, and the effect of assisted orthodontic treatment is obvious. However, due to the lack of long-term follow-up studies, there is no unified consensus on the long-term stability of the procedure. This article reviews the research status of MOPs, biological and biomechanical mechanisms, clinical applications and limitations. MOPs can shorten orthodontic treatment time and accelerate tooth movement by exerting regional acceleratory phenomena (RAP). At the same time, this procedure will not damage the health of the periodontal tissue, and the postoperative bleeding and postoperative reaction are minor. In addition, the pain and discomfort of patients were relatively mild and acceptable. However, it also has limitations, mainly including the limited time of the RAP effect of MOPs. Although this procedure is a minimally invasive surgery, there is still a risk of treating regional bone defects. At present, it is still necessary to increase the sample size and extend the follow-up time to evaluate the long-term stability of MOPs.

Current status of the surgery-first approach (part I): concepts and orthodontic protocols / 대한악안면성형재건외과학회지

The “surgery-first” approach, defined as a team approach between surgeons and orthodontists for orthognathic surgery without preoperative orthodontic treatment, is aimed at dental decompensation. A brief historical background and indications for the surgery-first approach are reviewed. Considering the complicated mechanism of postoperative orthodontic treatment, the proper selection of patients is a vital component of successful surgery-first approach.

Corticotomy for orthodontic tooth movement

Corticotomy was introduced as a surgical procedure to shorten orthodontic treatment time. Corticotomy removes the cortical bone that strongly resists orthodontic force in the jaw and keeps the marrow bone to maintain blood circulation and continuity of bone tissues to reduce risk of necrosis and facilitate tooth movement. In the 21st century, the concept of regional acceleratory phenomenon was introduced and the development of the skeletal anchorage system using screw and plate enabled application of orthopedic force beyond conventional orthodontic force, so corticotomy has been applied to more cases. Also, various modified methods of minimally invasive techniques have been introduced to reduce the patient's discomfort due to surgical intervention and complications after surgery. We will review the history of corticotomy, its mechanism of action, and various modified procedures and indications.

Clinical and systemic effects of periodontally accelerated osteogenic orthodontics: a pilot study / Efectos clínicos y sistémicos de la ortodoncia osteogénica periodontalmente acelerada: un estudio piloto

The aim of this study was to describe periodontal effects and treatment time of Periodontally Accelerated Osteogenic Orthodontics (PAOO) and to determine if Deoxypyridinoline could be used as a biochemical marker of bone turnover in patients undergoing PAOO. We compared 5 patients undergoing PAOO (5 males, mean age: 29.6±9.8 years) with 5 control patients undergoing self-ligating orthodontics (5 males, mean age: 28.5±6.3 years). All patients were evaluated using panoramic and lateral x-rays and CBCT and randomly selected in experimental and control groups. Both groups underwent self-ligating orthodontics using Damon Q braces. Only the experimental group underwent PAOO. The patients were evaluated periodontally at T1 (before surgery and orthodontic movement) and T2 (after orthodontic treatment). The total treatment time for the experimental group was 8.2±3.3 months and for the control group was 13.4±7.3 months. There were no differences between T2-T1 periodontal variables in either of the groups. Gingival recession was 0.49±0.26 mm at T1 and 0.42±0.3 mm at T2 in the experimental group. Gingival recession was 0.55±0.31 mm at T1 and 1.19±0.24 mm at T2 in the control group. Deoxypyridinoline urine levels showed great variance between individuals and between groups. There is a reduction in treatment time for patients undergoing PAOO with DAMON Q braces. There is no difference in the periodontal condition between PAOO and conventional orthodontics.

El objetivo de este estudio fue describir los efectos periodontales y el tiempo de tratamiento de ortodoncia osteogénica periodontalmente acelerada (OOPA) y para determinar si desoxipiridinolina podría ser utilizado como un marcador bioquímico de recambio óseo en pacientes sometidos a OOPA. Se estudiaron 5 pacientes sometidos a OOPA (hombres, edad media de 29,6±9,8 años) y 5 pacientes control sometidos a ortodoncia de autoligado (hombres, edad media de 28,5±6,3 años). Todos los pacientes fueron evaluados utilizando radiografías panorámicas y laterales, tomografía computadorizada de haz cónico, y luego distribuidos aleatoriamente en grupos experimentales y de control. Ambos grupos fueron sometidos a la ortodoncia de autoligado utilizando dispositivos ortodónticos Damon Q. Sólo el grupo experimental fue sometido a OOPA. Los pacientes fueron evaluados periodontalmente en T1 (antes de la cirugía y el movimiento de ortodoncia) y T2 (después de un tratamiento de ortodoncia). El tiempo total de tratamiento para el grupo experimental fue de 8,2±3,3 meses y para el grupo control 13,4±7,3 meses. No hubo diferencias entre las variables periodontales T2-T1 en cualquiera de los grupos. La recesión gingival en el grupo experimental fue de 0,49±0,26 mm en T1 y 0,42±0,3 mm en T2. En el grupo control, la recesión gingival fue 0,55±0,31 mm en T1 y 1,19±0,24 mm en T2. Los niveles de desoxipiridinolina en orina mostraron gran variación entre individuos y entre grupos. Hubo una reducción en el tiempo de tratamiento para los pacientes sometidos OOPA con dispositivos ortodónticos Damon Q. No hubo diferencia en la condición periodontal entre pacientes sometidos a OOPA y ortodoncia convencional.

Wilckodontics- A Magical Wand for Rapid Success-A Review.

The orthodontic treatment is, perhaps, in terms of duration, the longest-performed dental procedure. In this fast-paced world any treatment that would consume 1 – 2 years is unwelcome. It is universally accepted that if the duration of the orthodontic treatment is reduced, there will be an increased favorable attitude towards the orthodontic therapy. To accelerate the tooth movement the orthodontists and the periodontists together have worked out a success formula which is termed Periodontally Accelerated Osteogenic Orthodontics (PAOO) or wilckodontics. Theoretically this procedure is based on the healing property of bone known as (RAP) regional acceleratory phenomenon. This procedure involves the surgical demineralization of the cortical bone (corticotomy) thereby decreasing the resistance offered by the cortical bone of the teeth to the orthodontic force applied and use of particulate bone grafting. This method not only enhances the width of the alveolar bone but also decreases the duration of the treatment and chances of apical root resoption. It also increases the stability of the treatment by reducing the chances of relapse. A proper case selection, careful surgical procedure and accurate orthodontic movements are important for the success of wilckodontics. This review article includes history, biomechanics, indication, contraindication, case selection, treatment planning, surgical techniques and its modifications.

Comparación clínica entre el tratamiento ortodóncico facilitado por corticotomía y ortodoncia convencional (estudio piloto) / Clinical comparison of orthodontic treatment facilitated by corticotomy and conventional orthodontics (pilot study)

El objetivo de este estudio fue comparar clínicamente la velocidad del movimiento ortodóncico y cambios en los parámetros periodontales en pacientes con ortodoncia convencional y ortodoncia facilitada con corticotomía para el tratamiento de apiñamiento dental anterior. Un total de 10 pacientes participaron en el estudio de la siguiente forma: 5 pacientes grupo ortodoncia y corticotomía (EXP) y 5 pacientes grupo ortodoncia (CONT). Se realizó examen clínico completo que incluyó análisis radiográfico, periodontal y modelos de estudio. Las mediciones sobre los cambios periodontal, tabla ósea bucal, movimiento lineal y angular fueron medidos al inicio, 30, 90 y 210 días posterior a los procedimientos. Las diferencias entre los grupos fueron establecidas con la prueba t-Student para muestras pareadas y no pareadas dependiendo del caso. Los dientes sometidos a ortodoncia y corticotomía mostraron una mayor velocidad del movimiento en comparación con el grupo control durante los primero 30 días de examinación (P<0,05). No hubo diferencias estadísticamente significativas en los parámetros clínicos periodontales y grosor de la tabla ósea bucal entre los grupos. En conclusión, la corticotomía acelera el movimiento ortodóncico durante los primero 30 días postquirúrgicos con lo cual se puede reducir el tiempo de tratamiento en pacientes con apiñamiento severo. Adicionalmente, los parámetros clínicos periodontales y el volumen de la tabla ósea bucal de los dientes sometidos a corticotomía se mantienen estables después del procedimiento.

The aim of this study was to compare clinically speed orthodontic movement and changes in periodontal parameters in patients with conventional orthodontics and orthodontics with corticotomy for the treatment of anterior dental crowding. A total of 10 patients participated in the study: 5 patients in the orthodontics and corticotomy group (EXP) and 5 in the orthodontics patient group (CONT). Complete clinical examination included radiographic, periodontal and study models analysis was carried out. Measurements on periodontal changes, buccal bone plate, linear and angular movement were measured at baseline at 30, 90 and 210 days after the procedures. Differences between groups were established with the t-Student for paired and unpaired samples depending on the case. Teeth undergoing orthodontic corticotomy showed greater speed of movement compared to the control group during the first 30 days examination (P <0.05). There were no statistically significant differences in periodontal clinical parameters and thickness of the buccal bone plate between the groups. In conclusion, accelerated corticotomy orthodontic movement during the first 30 days postoperative, can reduce the treatment period in patients with severe crowding. Additionally, clinical periodontal parameters and volume of the buccal bone plate teeth undergoing corticotomy remained stable after the procedure.

Corticotomy‑assisted retraction: An outcome assessment.

Background: To assess the efficiency and treatment outcome of patients treated with corticotomy‑assisted en‑masse orthodontic retraction as compared with the en‑masse retraction without corticotomy. Materials and Methods: Forty adult patients with bimaxillary protrusion requiring correction of bidental proclination constituted the sample. The study group consisted of 22 patients (male 11, female 11) willing to undergo surgery to reduce the duration of their orthodontic treatment and 18 patients (male 9, female 9) desirous of undergoing conventional orthodontic treatment without surgical intervention constituted the control group. Comparison of rate of retraction and anchor loss between the study and the control group was assessed. Results: Average rate of space closure of 1.8 mm/month in the maxilla and 1.57 mm/month in the mandible was observed in the study group compared to 1.02 mm/month in the maxilla and 0.87 mm/month in the mandible in the control group. The rate of retraction accelerated during the first 2 months of retraction. Molar anchor loss of approximately 0.6 mm occurred in the study group, and 1.8 mm occurred in the control group during the 4 months. Conclusion: The rate of retraction with study group was twice as faster when compared to the control group, accelerating during the first 2 months of retraction. There was better anchorage control with the undecorticated molar segment during the retraction period but was found to increase as time advanced.

Observation of trabecular changes of the mandible after orthognathic surgery using fractal analysis

OBJECTIVES: This study sought to evaluate trabecular changes in the mandible using fractal analysis and to explain the transient osteopenia related to rapid orthodontic tooth movement after orthognathic surgery. MATERIALS AND METHODS: Panoramic radiographs were taken of 26 patients who underwent bilateral sagittal split ramus osteotomy. Radiographs taken before the surgery and 1 month after surgery were overlapped, and 40x40 pixel square regions of interest were selected near the mandibular canines and 1st molars. After the image processing procedure, the fractal dimension was calculated using the box-counting method. RESULTS: Fractal dimension after orthognathic surgery decreased in a statistically significant manner (P<0.05). The change in fractal dimension on the canine side had greater statistical significance as compared to that seen on the 1st molar side. CONCLUSION: This study found that bone density decreases after orthognathic surgery due to transient osteopenia related to the regional acceleratory phenomenon. This result can provide a guide to evaluating orthodontic tooth movement after orthognathic surgery.