Évaluation de la chirurgie parodontale piézoélectrique sur le traitement orthodontique : étude pilote prospective

OBJECTIVES: The aims of the study were to: (1) compare the duration of piezo-corticision assisted orthodontic treatments (OT-PC) with conventional orthodontic treatments (COT), (2) assess pain and the interference with daily activities of patients undergoing OT-PC, (3) analyzing calcified tissue changes induced by OT-PC, (4) evaluating the inflammatory process, and (5) examining patient satisfaction on OT-PC. METHODOLOGY: Twelve adult patients (mean discrepancy index (DI) = 16) underwent OT-PC. The control group was selected retrospectively and was composed of twelve patients (mean DI = 9) with the same selection criteria. For pain and impact on daily activities assessments, a questionnaire using a visual digital scale (VAS) was used during the first week post-surgery. To assess satisfaction, a questionnaire was given to the patient a the end of treatment. Root resorptions and changes in height and thickness of the alveolar bone were measured using pre- and post-treatment CBCT. The evaluation of the inflammatory process was made by quantifying the gingival fluid interleukins 1, 2, 6, 8, 10, tumor necrosis factor α, interferon γ, granulocyte and macrophage growth factor, activator receptor ligand Nuclear Kappa B, osteoprotegerin and macrophage inflammatory protein at 6 different time points for 6 months. RESULTS: The experimental group and the control group were comparable except for age, DI and bonded failure. The treatment time was significantly reduced in the OT-PC group compared to the COT for primary brackets alignment on the maxilla (43%, p = 0.002) and the mandible (28%, p = 0.041), as well as the overall treatment time (53%, p <0.0001). Median pain was low (EVN = 1/10) and temporary (<5 days) with average acetaminophen consumption of 3.5g (1- 8.5) during the first week post-surgery. Chewing was the function most affected by OT-PC and impacted daily life the most. After one week, 92.3% of patients would redo the surgery. At the end of treatment, all patients were satisfied with OT-PC. Root resorptions were generalized. On average, they were minimal in the posterior (<0.5 mm and <grade 1 Levander and Malmgren index) and less than moderate in anterior (<1 mm and <grade 2 Levander and Malmgren index). OT-PCs caused a mean buccal bone alveolar dehiscence on lower incisors of 3.3 mm. The thickness of the alveolar bone did not vary significantly, except on the upper incisors where it decreased by about 1 mm. Only one iatrogenic root damage was detected and 4 cortical bone incisions were not completely remineralized. Several inflammatory mediators demonstrated two peaks at 3 and 16 weeks, but these variations were not significant. CONCLUSION: OT-PCs were safe and effective at reducing the duration of orthodontic treatments while causing minimal postoperative pain with a high level of patient’s satisfaction. Iatrogenic lesions on roots and the alveolar bone were minimal, except at the buccal aspect of the lower incisors where they were bone dehiscence observed.

Keyphrases: PiézocisionTM, Orthodontie accélérée, Piezocision™, Accelerated orthodontics, Pain, Root resorption