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 Table of Contents  
Year : 2021  |  Volume : 13  |  Issue : 6  |  Page : 1286-1290  

Miniscrew implant supported maxillary canine retraction with and without Corticotomy Facilitated Orthodontics (CFO)

1 Department of Orthodontics and Dentofacial Orthopaedics, Mithila Minority Dental College and Hospital, Darbhanga, Bihar, India
2 Associate Professor, Department of Dentistry, Narayan Medical College and Hospital, Sasaram, Bihar, India
3 Private Dental Practitioner, Ara, Bhojpur, Bihar, India
4 Private Dental Practioner, Pune, Maharashtra, India
5 Department of Paediatric and Preventive Dentistry, Mithila Minority Dental College and Hospital, Darbhanga, Bihar, India
6 Private Dental Practioner, Hajipur, Bihar, India

Date of Submission26-Feb-2021
Date of Decision02-Mar-2021
Date of Acceptance09-Mar-2021
Date of Web Publication10-Nov-2021

Correspondence Address:
Saurav Kumar
Department of Orthodontics and Dentofacial Orthopaedics, Mithila Minority Dental College and Hospital, Darbhanga, Bihar
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpbs.jpbs_106_21

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Introduction: The purpose of the study was to scientifically test maxillary canine retraction assisted by miniscrew implant with corticotomy-facilitated orthodontics. Materials and Methods: Fifteen patients (six males, nine females) who had Class II division malocclusion with enhanced overjet were included in the study. Maxillary first premolars were surgical displaced along with retraction of maxillary. In the canine-premolar region, corticotomy was performed on one side of the maxillary arch; the other side served as the control region. Over a 4-month follow-up span, the following variables were examined: plaque index, tooth movement intensity, attachment degree, gingival regression, molar anchorage failure, gingival index, and scope of testing. Results: After 2 months, the canine retraction rate on the corticotomy side was more significant than on the control side by twice. The tooth movement rate steadily decreased to 1.6 times faster at the end of the 3rd month and to 1.06 times faster at the end of the 4th month. No failure of molar anchorage occurred on either the controlled or nonoperated hand during canine retraction. Conclusions: For people requiring orthodontic care with shortened treatment periods, corticotomy-facilitated orthodontics may be a viable treatment modality.

Keywords: Canine retraction, corticotomy, implants, malocclusion

How to cite this article:
Kumar S, Verma G, Hassan N, Shaikh S, Anand B, Anjan R. Miniscrew implant supported maxillary canine retraction with and without Corticotomy Facilitated Orthodontics (CFO). J Pharm Bioall Sci 2021;13, Suppl S2:1286-90

How to cite this URL:
Kumar S, Verma G, Hassan N, Shaikh S, Anand B, Anjan R. Miniscrew implant supported maxillary canine retraction with and without Corticotomy Facilitated Orthodontics (CFO). J Pharm Bioall Sci [serial online] 2021 [cited 2022 Dec 7];13, Suppl S2:1286-90. Available from:

   Introduction Top

The orthodontics procedure aims to enable the patient to maximize individuals' well-being by enhanced dentofacial functions and esthetics. A concern of significance is the disturbance of the temporomandibular joint as braces are shortened in adult patients. By removing teeth in and around the gingiva, it may accomplish quick orthodontic mobility. At the same time, surgical alveolar corticectomy causes the gingiva to diminish. This combination enables the fast recovery possible. A corticotomy is a word originating from medicine, which involves the cutting of cortical tissue. Any patients are advised this procedure decreases the time taken to manage teeth with braces. This argument focuses on reducing the oral swelling due to the removal of the compacted enamel. Several scientists, along with other surgeons, conducted a revolutionary procedure.[1],[2],[3] The intervention was intended to boost blood vessels in the patient's lower jaw and provide sufficient oxygen to the teeth because of a shortage of blood supply to the region.[4] Although the patient might still have the same condition, the operation has seen several improvements and adjustments to decrease the detrimental factors better. Based upon Kole's analysis,[2] the procedure includes acombined inter-radicular and supra-apical osteotomy such that the medullary bone is enclosed within buccal and lingual cortical plates with a tooth located inside this block. Furthermore, within the block was the cervical enamel to surround the tooth. On the other side, Wilcko et al. related the improved tooth movement rate during Corticotomy Facilitated Orthodontics (CFO) to the Regional Accelerating Phenomenon (RAP), and they are distinguished by a rise in turnover side of the bone, and the mineral content is decreased.[1]

The brackets must be appropriately positioned to meet the goals of orthodontic care. Due to several anchorage losses, everybody is not happy with the outcomes, especially with those who need optimum anchorage and thereby increasing the treatment time.[5] Temporary anchorage strategies have proven to high yield by practice and over time, have become mainstream orthodontic techniques to build a grin.[6] Compared to utilizing traditional equipment for anchorage, a nonsystemic method of using implants, the patient's implants have a way of anchoring the system. They should use titanium screws because they stay fast during minimal dentofacial movements without extra work on the part of the patient. An orthodontist can quickly push the tooth into the screw and start tightening it up in a matter of seconds. Orally administered antibiotics, coupled with the severing of one or more teeth and the temporary anchorage placement system, could shorten the orthodontic care time, mainly if the teeth are maxillary, maxillary central incisors. This research planned to establish the presence of perioperative maxillary canine retraction with or without the facilitation of orthodontic surgery with miniscrew implant-assisted titanium posts.[1]

   Materials and Methods Top

The present study was conducted in the Department of Orthodontics and Dentofacial Orthopaedics of the Dental College. The ethical committee approved the ethical clearance for the study of the Dental institution. All the patients were informed regarding the study, and their consent was obtained. A total of 15 patients (six males, nine females) who had class II division I malocclusion with enhanced overjet were included in the study. For all the patients who had a stable systematic state, no prior orthodontic care, the same degree of oral hygiene as other people, depth values are measures as the distance between sulcus base to gingival margin apical part, which is not reaching 3 mm in the entire dentition, and their no change for periodontal attachment (it is evaluated as the length from sulcus base to cementoenamel junction), and absence of radiology signs of bone loss were included in this study. Maxillary first premolars were surgical displaced along with retraction of maxillary. In the canine-premolar region, corticotomy was performed on one side of the maxillary arch; the other side served as the control region.

Since the maxillary and mandibular stabilizing instruments were installed in the patient and then digital elaboration, they placed tiny screws. The implants used were 1.3 mm AbsoAnchor, Dentos, Daegu.

One maxillary premolar was removed on a random glabellar anteroposterior incision. It was found during the patient's planned operation that the other premolar had been removed and that the inferior alveolar subneural flaps were done by utilizing the LuebkeOchsenbein flap design.[7] Using a periodontal probe, 4 mm is estimated from the margin of free gingival relating to the gingiva's contours and reaching toward the mesial surface of the maxillary lateral incisor to the mesial surface of the second premolar maxillary [Figure 1]. To create the buccolabial incision No. 11 blade was used. Not interrupting the blood flow to the residual nonflapped skin to a full-thickness scab incision was made at the top.
Figure 1: The cortical perforation was done and extended toward the canine apex

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A mucoperiosteal flap was raised using a mucoperiosteal elevator. The flap reflection, such as the root tip, was stretched as far as possible past the canines' apex. An electric drill was used to press to build the hole, rotate the head at low speed, and then use a No. 2 flat bur.

Then copious drainage was used, and the hole was cut to the correct size. When the electric drill drilled, it the gaps through the complete width of the buccal cortical bone. Once the flap was correctly placed and then sutured with a nonresorbable black thread, it was repositioned and sutured again with a black thread. The maxillary archwire was then wrapped around each top tooth with a custom titanium noose wire, and the nickeltitanium closed-coil springs were then connected to the under canine hooks on each foot.

Overall periodontal health was evaluated by measuring the following criteria:

Attachment degree, plaque index, gingival recession, gingival index, and probing depth are done according to Silness system method.[8] Following the Ziegler and Ingerval method dental casts were used to quantify the anteroposterior movement of the anterior teeth and the first molars every 30 days.[9]

Statistical analysis

Descriptive analysis was done for tooth movement variables (canine retraction and molar anchorage loss) and periodontal indices before and after canine retraction [Table 1], [Table 2] and [Figure 2], [Figure 3]. A paired t-test was used to determine the statistical significance of the difference between the experimental and control sides.
Table 1: Descriptive statistics of molar anchorage loss in the experimental and control site

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Table 2: Mean rates of the anteroposterior position of the maxillary canines in the corticotomy and control sides per month (mm)

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Figure 2: Cumulative mean for canines in corticotomy procedure

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Figure 3: Mean values of canines in corticotomy procedure

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   Results Top

This study was conducted with a follow-up of 4 months. Nearly 15 patients were included in this study. Among them, six were male, and nine were female. Statistically significant variations (P ≤ 0.01) were found in canine anteroposterior movement patterns between the controlled and nonoperated sides at all measurement periods. Comparing to control sides, canine retraction rates were favorably seen on the operated side. In plaque index ratings, connection depletion, gingival recession, and measuring depth values, no statistically relevant difference (P > 0.05) was observed.

Preoperatively and at 4 months postoperatively, assessed between the surgical and nonoperated arms. On the other hand, by the analysis conclusion, gingival index scores were slightly larger (P < 0.05) on the controlled side relative to the nonoperated side.

   Discussion Top

The patient was chosen for this analysis all have a mild-to-severe malocclusion in Class II division 1. Extracting maxillary first premolars was necessary, accompanied by the maxillary canine's retraction. In this study, we picked fifteen patients, but two were omitted from the sample because of missing appointments or inadequate oral hygiene. The patients needed to cooperate with the guidance regarding oral hygiene and compliance with follow-up visits.

Researchers decided to see whether a method that could shift a tooth quicker would minimize recovery time. Accelerated orthodontics is believed to significantly decrease the care period since the thick cortical bone resists orthodontic tooth movement.[1],[3] An incision was produced along with the buccal cortical plate, without vertical or subapical slices, without reflecting a palatal fold.

The presumption that the buccal corticotomy will cause a regional acceleratory phenomenon on the palatal side is justifiable. Reducing the operating period and postoperative pain by minimizing the patient's sensitivity to extra palatal procedure complications. A nonprosthetic flap must have gingival tissue extending 2 mm below the sulcus, and enough tissue must remain to enable suture positioning. They created vertical incisions for preventing and compromising the blood flow to nonflapped tissue.

By strengthening the bone and soft-tissue sutures, the surgical operations obtained a more successful result with few if any impact on the periodontium. There is a lot of proof that anchorage management is of prime significance. During canine interaction, miniscrew implants can offer outstanding skeletal anchorage because of their more effortless positioning procedure and the potential to remove patient enforcement dependence. After loading, the versatility assessment of the miniscrew shows no mobility except two miniscrews. One screw loosened after loading in 1 month, and then another one gets loosed after 1.5 months. Teeth are repositioned, and canine retraction resumed. The results of this analysis revealed that miniscrews effectively perform roughly 93% of procedures.[10],[11],[12] This accompanied the guidelines of Kuroda et al.[6] this gave a justification to enhance the mechanical retention of the screws and remove any chance of root interaction during care. Based on the advice of Schnelle et al., they chose the site for the miniscrews, who claimed this was a protected position in the maxillary arch. Instead of the gingival blade, the miniscrews were installed in the gingiva.

These screws are more susceptible to success when the cartilage is not too dense, and the bubble will not likely contact the tissues because it will not increase. The reality the miniscrews were mounted in soft tissue and cannot accessible may have led to their high stability and patient approval of the overall treatment. These findings confirm Kuroda et al.,[6] who stated the miniscrews mounted without incision have better results than those done with the incision. Nylon stringing was used to accomplish continuous force application. The third palatal rugae have been used as a reference point to estimate the movement of the tooth and quantification of tooth place changes mostly on dental casts. It showed in this study that orthodontic retraction is feasible by using a corticotomy process. The canines on the corticotomy side were slightly more displaced in their anteroposterior role during the 1st and 2nd months of the follow-up phase. After 2 months, the canine retraction rate was marginally higher on the corticotomy side (approximately 2 times faster) than the control side. Even if the healed the tibial wound at an earlier period than the control group, it took 2 months to minimize the corticotomy scar by 1.6 and 1.06 twice as long as the control group. The regional accelerator phenomenon is compatible with its transitory existence. They reached a Class I canine partnership in six patients (approximately 45%) after 2 months in four patients and after 3 months of retraction in two patients.

On the other side, until the analysis concludes, no canine was retracted into a Class I canine partnership on the control side. This study's results align with that of Wilcko et al.,[1] who stated that on the corticotomy side, tooth movement velocity was two to three times faster than on the control side. The justification for the quick canine, on the other side, the retraction may only be inferred since no histological analysis has been conducted. Since the cortical bone was kept unchanged and no blocks inbone were produced across the teeth, the rate of the tooth's rapid movement appeared to rely more on the regional accelerated phenomenon rather than the movement in the bony block. However, to explore the underlying biological context of the corticotomy technique, more previous studies with longer duration of follow-up periods are needed. The traditional corticotomy flap style, with an intra sulcular incision, was substituted by the submarginal LuebkeOchsenbein in our study flap. The periodontal disease occurs after the operation due to incision of median bone and intrasulcular, which is optimized during the surgery. Since the corticotomy process, the explanation for the lack of any effects on the periodontium may be due to bone removal, since the corticotomy was not conducted as a traditional osteotomy, in that they extract the bone which is blocks. Just the bone was perforated by the operation, leaving unchanged the initial bony architecture. This enabled the cellular process of resorption-deposition in the current bony architecture to continue. On the other side, it recorded that the regional accelerator phenomenon starts a few days after the procedure, peaks between 1 and 2 months, and requires 6–2 years to resolve completely.[13] Compared to this analysis's control side, these results may clarify the higher corticotomy-side gingival index scores when the longer periods needed for maximum resolution of the regional accelerator phenomenon during the surgical procedure corticotomy may have contributed to elevated the score of the gingival index.

   Conclusions Top

The following hypotheses may be taken based on the findings gained from this analysis. Corticotomy-facilitated orthodontics may be an optimal procedure for desire's patients also reduced the length of orthodontic therapy. As feasible alternatives to traditional molar anchorage, miniscrew implants may work. For canine retraction, they are comfortable and efficient anchors, particularly in medium to full anchorage circumstances.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Wilcko WM, Wilcko T, Bouquot JE, Ferguson DJ. Rapid orthodontics with alveolar reshaping: Two case reports of decrowding. Int J Periodontics Restorative Dent 2001;21:9-19.  Back to cited text no. 1
Kole H. Surgical operations on the alveolar ridge to correct occlusal abnormalities. Oral Surg 1959;12:515-29.  Back to cited text no. 2
Chung KR, Oh MY, Ko SJ. Corticotomy-assisted orthodontics. J Clin Orthod 2001;35:331-9.  Back to cited text no. 3
Bell WH, Levy BM. Revascularization and bone healing after maxillary corticotomies. J Oral Surg 1972;30:640-8.  Back to cited text no. 4
El Beialy AR. Clinical and Radiographic Assessment of Self-Drilling Surgical Screws used for Anchorage Reinforcement [Thesis]. Cairo, Egypt: Cairo University; 2007.  Back to cited text no. 5
Kuroda S, Yamada K, Deguchi T, Hashimoto T, Kyung HM, Takano-Yamamoto T. Root proximity is a major factor for screw failure in orthodontic anchorage. Am J Orthod Dentofacial Orthop 2007;131:S68-73.  Back to cited text no. 6
Heasman P. Master dentistry: Restorative dentistry, paediatric dentistry and orthodontics. 1st ed. Oxford: Churchill Livingstone; 2003.  Back to cited text no. 7
Silness J, Loe H. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condtion. Acta Odontol Scand 1964;22:121-35.  Back to cited text no. 8
Ziegler P, Ingervall B. A clinical study of maxillary canine retraction with a retraction spring and with sliding mechanics. Am J Orthod Dentofacial Orthop 1989;95:99-106.  Back to cited text no. 9
Thiruvenkatachari B, Pavithranand A, Rajasigamani K, Kyung HM. Comparison and measurement of the amount of anchorage loss ofthe molars with and without the use of implant anchorage duringcanine retraction. Am J Orthod Dentofacial Orthop 2006;129:551-4.  Back to cited text no. 10
Owens SE, Buschang PH, Cope JB, Franco PF, Rossouw PE. Experimental evaluation of tooth movement in the beagle dog with the mini-screw implant for orthodontic anchorage. Am J Orthod Dentofacial Orthop 2007;132:639-46.  Back to cited text no. 11
Park HS, Jeong SH, Kwon OW. Factors affecting the clinical success of screw implants used as orthodontic anchorage. Am J Orthod Dentofacial Orthop 2006;130:18-25.  Back to cited text no. 12
Yaffe A, Fine N, Binderman I. Regional accelerated phenomenon in the mandible following mucoperiosteal flap surgery. J Periodontol1994;65:79-83.  Back to cited text no. 13


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2]


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