|Year : 2021 | Volume
| Issue : 6 | Page : 1320-1323
Comparison of the efficiency and treatment outcome of patients treated with corticotomy-assisted En masse orthodontic retraction with the en masse retraction without corticotomy
Shubham Kumar1, Saurav Kumar2, Nadira Hassan3, Sabika Mazhar4, Ravi Anjan5, Bharti Anand6
1 Department of Dentistry, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India
2 Department of Orthodontics and Dentofacial Orthopaedics, Mithila Minority Dental College and Hospital, Darbhanga, Bihar, India
3 Private Dental Practitioner, ARA, Bhojpur, Bihar, India
4 Private Dental Practitioner (Pedodontist), Kishanganj, Bihar, India
5 Private Dental Practitioner, Hajipur, Bihar, India
6 Department of Paediatric and Preventive Dentistry, Mithila Minority Dental College and Hospital, Darbhanga, Bihar, India
|Date of Submission||05-Mar-2021|
|Date of Decision||18-Mar-2021|
|Date of Acceptance||22-Mar-2021|
|Date of Web Publication||10-Nov-2021|
Department of Orthodontics and Dentofacial Orthopaedics, Mithila Minority Dental College and Hospital, Darbhanga, Bihar
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Corticotomy in fixed orthodontic treatment gives a potential approach to reduce the treatment duration. Typically, this duration of rapid tooth movement lasts 4–6 months. Aim: The aim of this study was to compare the treatment outcome and effectiveness in en masse retraction with and without corticotomy. Materials and Methods: Thirty-two patients (male 16 and female 16) who opted to undergo surgery to reduce the orthodontic treatment time were chosen for the research, and the group consisted of 26 patients (male 13 and female 13) who did not opt for the corticotomy procedure were selected as the control. There was no blindness of the party distribution. It was focused on the patient's ability to opt for an additional minor surgical procedure that may affect orthodontic treatment length. The operation was conducted under local anesthesia (Lignox 2%). The same maxillofacial surgeon performed all the surgical operations. Results: The space present in the maxillary and mandibular arch at the time of retraction had no statistically significant difference in both the control and study groups (P > 0.05). In comparison, the mean amount of retraction space in the maxillary arch and maxillary arch was significant in the control and study groups at 1 month, 2 months, 3 months, and 4 months of the time interval. Conclusion: It can be concluded that corticotomy-assisted retraction significantly decreases the total length of orthodontic care. Effectively stationary anchorage segment was made, thereby removing the need for other anchorage boosters, instrumental in maximum anchorage cases using corticotomy technique.
Keywords: Corticotomy, orthodontic retraction, orthodontics
|How to cite this article:|
Kumar S, Kumar S, Hassan N, Mazhar S, Anjan R, Anand B. Comparison of the efficiency and treatment outcome of patients treated with corticotomy-assisted En masse orthodontic retraction with the en masse retraction without corticotomy. J Pharm Bioall Sci 2021;13, Suppl S2:1320-3
|How to cite this URL:|
Kumar S, Kumar S, Hassan N, Mazhar S, Anjan R, Anand B. Comparison of the efficiency and treatment outcome of patients treated with corticotomy-assisted En masse orthodontic retraction with the en masse retraction without corticotomy. J Pharm Bioall Sci [serial online] 2021 [cited 2022 Jun 25];13, Suppl S2:1320-3. Available from: https://www.jpbsonline.org/text.asp?2021/13/6/1320/329976
| Introduction|| |
In patients with a maxillary-mandibular protrusion, orthodontic care is obtained to minimize lip procumbency. The most common way to straighten the profile is to extract the four first premolars and retract the anteriors with optimum anchorage. Incisor apices' level is an anatomical limit set by the alveolus' cortical plates, which serve as an obstacle to incisor retraction. Bone loss, root resorption, gingival recession, root dehiscence, and fenestration are few side effects of orthodontic retraction. Adult patients requiring orthodontic care also want their treatment to be done within the shortest possible time.,
Köle introduced selective alveolar decortication in 1959, where the entire bone segment's movement was possible. However, in 2001, Wilcko et al. came up with a new technique called periodontally accelerated osteogenic orthodontics, where they combined corticotomy with alveolar augmentation and orthodontic therapy. In this, regional acceleratory phenomenon (RAP) is observed, where there is increased bone turnover rate and decreased bone density, thereby accelerating the orthodontic tooth movement.,
One potential approach for shortening the orthodontic treatment time is by combining it with corticotomy. Typically, this duration of rapid tooth movement lasts 4–6 months., Because of the restricted corticotomy-facilitated orthodontics studies in bimaxillary cases, this study aimed to assess the effectiveness and treatment outcome in en-masse retraction with and without corticotomy.
| Materials and Methods|| |
Thirty-two patients (male 16 and female 16) who opted to undergo surgery to reduce the orthodontic treatment time were chosen for the research, and the group consisted of 26 patients (male 13 and female 13) who did not opt for the coticotomy procedure were selected as the control. There was no blindness of the party distribution. It was focused on the patient's ability to opt for an additional minor surgical procedure that may affect orthodontic treatment length. The operation was conducted under local anesthesia (Lignox 2%). The same maxillofacial surgeon performed all the surgical operations.
For the upper arch before flap elevation, premolars were removed at the time of corticotomy, and 0.019 × 0.025 in stainless steel wire with hooks was placed in the experimental group. From the distal aspect of the right canine to the left canine, a sulcular incision was placed, and up to 3 mm beyond that teeth apices full-thickness flap was raised. Selective alveolar decortication was performed. Number 2 round bur was used for surface punch holes, and 701 fissure bur was used for interdental scoring. At 2 mm beyond the teeth root apices, vertical cuts were connected by horizontal decortication. For palatal decortication, the palatal flap was raised, and decortication was performed accordingly. Demineralized freeze-dried allograft was mixed with normal saline was placed on the buccal and palatal region. A full-thickness flap was placed back and sutured using 4–0 silk suture, and archwire was placed again.
After 5–7 days, with a closed coil, nickeltitanium springs from the soldered hook to the first molar for en-masse retraction with 250 gf. Every month, that extraction space was measured using a digital vernier caliper on the study models. The distance between the pterygoid vertical to the first molar was measured on the lateral cephalogram. The jig's distance on the incisor and molar bracket to the sella vertical was measured to determine anchor loss and retraction. The space closure was contrasted before the beginning of retraction in both categories. The time taken in the corticotomy community for space closure was contrasted with space closure in the control group.
Data analyses were done using the Statistical package for the social sciences (SPSS) version 21 (IBM Corp., Chicago, Illinois, USA). The mean and the standard deviation were determined for any linear distance measured on the lateral cephalogram. To assess the statistical significance of the difference between left and right side variables within the maxilla and mandible, the paired t-test was used.
Independent t-tests were used to evaluate the statistical significance for retraction rate, anchor loss at T1 (before retraction), and T2 (during retraction period) between the sample and control groups. One-way ANOVA was used to check the anchor loss and rate of space closure every month, and Tukey's HSD was used for intergroup comparison. A (P < 0.05) was considered statistically substantial. The intensity of the sample is 0.95.
| Results|| |
Maxillary arch and mandibular arch's mean retraction space difference at the time of retraction was not significant. In comparison, the mean amount of retraction space in the test and control group's maxillary arch was significantly different at T0, 1 month, 2 months, 3 months, and 4-month of the time interval [Table 1].
|Table 1: Comparison of rate of retraction in the mandible and the maxilla during monthly intervals in the control group and study group|
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The mean anchor loss was significantly different in the maxillary arch at the monthly interval of 0–2 months, 2–4 months, while it was not significantly different in more than 4 months. The mean anchor loss was significantly different in the mandibular arch at the monthly interval of 0–2 months, 2–4 months, and more than 4 months [Table 2].
|Table 2: Comparison of anchor loss rate in the mandible and the maxilla during monthly intervals in the control and study groups|
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| Discussion|| |
Two critical considerations in the treatment of maxillomandibular protrusion are the achievement of stable dental relations and esthetic rehabilitation. Several patients with protrusive jaws seek treatment to reduce the dental and lips' protrusion., Typically, the treatment strategy includes retracting the anterior segment with maximum anchorage after extracting the four first premolars. During orthodontic treatment, time is an essential factor. In systematic analysis, Mavreas suggested that the treatment period for the four cases of premolar extraction was approximately 18.6 months.,
Long assessed the efficacy of orthodontic tooth movement acceleration interventions, corticotomy to be an efficient and secure treatment for accelerating orthodontic tooth movement. The protocol used in the current study may therefore be considered to be an efficient form of intervention., In the literature, there is enough evidence indicating corticotomy to be a practical choice for accelerated orthodontics.,
Thus, delayed extraction of the first bicuspid would help accelerate tooth movement to take advantage of the maximum RAP response for 4 months. Furthermore, during the time of retraction, the undecorticated molar segment functions as an anchorage module. Compared to traditional en mass retraction in maxillary-mandibular protrusion patients, this technique is used efficiently for better the anterior section's en masse retraction. During retraction, for reducing torque loss and for bodily or controlled tipping tooth movements, stainless steel archwire (0.019” × 0.025”) is placed to stabilize dentition.
To serve as a stabilizing unit, the posterior section of the arch was not decorticated. Corticotomy was performed before aligning in Wilcko et al. protocol, and a supplementary procedure in which in the extraction space osteotomy is done, as would be inconvenient to the patient and costly. Thus, instead of extracting a large quantity of cortical bone around the first bicuspid, delayed extraction without removing the first bicuspid's cortical bone, more selected cases were conducted with very minimal crowding and delayed extraction did not prolong care.,
Nevertheless, during the treatment, the mild inconvenience was seen as a result of temporary inflammation. In the corticotomy-assisted retraction, literature has not credibly reported molar anchor failure. Therefore, our analysis was designed to determine the retraction rate and molar anchor loss's degree throughout the retraction period. With lateral cephalogram aid, anchor loss was evaluated similarly to the method suggested by Badri Thiruvengadachari, where in order to distinguish between right and left molar, modified jigs were mounted on the upper and lower the first molar of both sides.
Closure of extraction space, successful retraction, and anchor loss were evaluated for approximately 4–5 months in the test and control groups. The test and control groups were comparable as the extraction space did not differ significantly though extraction was done early in the control group. The mean for maxilla was 7.63 mm and 6.77 mm in the mandible.
The study results are in conjunction with the study done by Aboul-Ela et al., in which they found that after 2 months, the amount of space closure peaked and decreased eventually at the end of the 4th month. As Frost stated, the above phenomenon may be purely linked to the RAP phase for a brief period of our months. Therefore, the retraction was fastest during the first 4 months. There was a loss of space for 4–6 months due to anchor loss of 0.6 mm in an average in the maxilla and mandible.,
As most of the studies used temporary anchorage devices, there is no substantial literature on anchor loss in corticotomy-assisted orthodontics. This research will possibly be the first to link, to the best of our knowledge, loss of anchor value and the nondecorticated posterior arch section as the stabilizing unit. Likewise, in a previous analysis of WookHeo's traditional en-masse retraction, approximately 1 mm of anchor loss results from 4 mm of incisor retraction., As the current study did not assess the entire retraction period; therefore anchor loss during the later retraction stages cannot be commented on.
| Conclusion|| |
It can be concluded that corticotomy-assisted retraction significantly decreases the total length of orthodontic care. The need for anchorage boosters can be eliminated by making the anchorage segment stationary in maximum anchorage cases by selective decortication.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lewis SJ. Bimaxillary protrusion. Angle Orthod 1943;13:51-9.
Chung KR, Kim SH, Baek SL. Speedy surgical-orthodontic treatmentwith temporary anchorage devices as an alternative to orthognathicsurgery. Am J Orthod Dentofacial Orthop 2009;135:787.
Handelman CS. The anterior alveolus: its importance in limiting orthodontic treatment and its influence on the occurrence of iatrogenic sequelae. Angle Orthod 1996;66:95-109.
Wehrbein H, Bauer W, Diedrich P. Mandibular incisors, alveolar bone, and symphysis after orthodontic treatment. A retrospective study. Am J Orthod Dentofacial Orthop 1996;110:239-46.
Suya H. Corticotomy in orthodontics. In: Hosl E, Baldauf A, editors. Mechanical and Biological Basics in Orthodontic Therapy. Heidelberg, Germany: Huthig Buch Verlag; 1991. p. 207-26.
Baek SH, Kim BH. Determinants of successful treatment of bimaxillary protrusion: orthodontic treatment versus anterior segmental osteotomy. J Craniofac Surg 2005;16:234-46.
Miyawaki S, Koh Y, Kim R, Kobayasi M, Sugimura M. Survey of youngadults women regarding men's orofacial features. J Clin Orthod 2000;34:367-70.
Köle H. Surgical operations of the alveolar ridge to correct occlusalabnormalities. Oral Surg Oral Med Oral Pathol 1959;12:515-29.
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.
Frost HM. Biology of fracture healing – An overview for clinicians Part Iand II. Clin Orthop Relat Res 1989;248:283.
Kim SJ, Park YG, Kang SG. Effects of corticision on paradental remodeling in orthodontic tooth movement. Angle Orthod 2009;79:284-91.
Iino S, Sakoda S, Miyawaki S. An adult bimaxillary protrusion treatedwith corticotomy-facilitated orthodontics and titanium miniplates. Angle Orthod 2006;76:1074-82.
Germeç D, Giray B, Kocadereli I, Enacar A. Lower incisor retraction with a modified corticotomy. Angle Orthod 2006;76:882-90.
Hajji SS. The Influence of Accelerated Osteogenic Response on Mandibular Decrowding [Master's Thesis]. St. Louis, Mo: St. Louis University; 2000.
Wilcko MT, Wilcko WM, Bissada NF. An evidence-based analysis ofperiodontally accelerated orthodontic and osteogenic techniques: A synthesis of scientific perspectives. Semin Orthod 2008;14:305-16.
Mavreas D, Athanasiou AE. Factors affecting the duration of orthodontic treatment: A systematic review. Eur J Orthod 2008;30:386-95.
Long H, Pyakurel U, Wang Y, Liao L, Zhou Y, Lai W. Interventions for accelerating orthodontic tooth movement: A systematic review. Angle Orthod 2013;83:164-71.
Spena R, Caiazzo A, Gracco A, Siciliani G. The use of segmental corticotomy to enhance molar distalization. J Clin Orthod 2007;41:693-9.
Fischer TJ. Orthodontic treatment acceleration with corticotomy-assisted exposure of palatally impacted canines. Angle Orthod 2007;77:417-20.
Moon CH, Wee JU, Lee HS. Intrusion of overerupted molars by corticotomy and orthodontic skeletal anchorage. Angle Orthod 2007;77:1119-25.
[Table 1], [Table 2]