Patient Outcomes Associated With Two Accelerated Method of Retraction of Upper Front Teeth
Condition: Class II Division 1 Malocclusion
MeSH terms: Malocclusion
Study type: Interventional

Summary: 
      This study aimed to evaluate the levels of pain, discomfort, and functional impairment
      associated with traditional corticotomy and flapless corticotomy in the retraction of upper
      anterior teeth.

      40 patients requiring extraction of maxillary first premolars and maximum anchorage to
      retract the upper anterior teeth will participate in the study. They will be divided randomly
      into two groups: flapless corticotomy (20 patients) and traditional corticotomy (20
      patients).
    

Detailed description: 
      A corticotomy is the cutting of the bone that involves cortical bone only, leaving intact the
      medullary vessels and periosteum. It offers an advantage to adult patients in reducing
      orthodontic treatment time. The definition of traditional corticotomy is: elevating
      full-thickness periodontal flaps from a coronal approach, and vertical corticotomies are made
      between the teeth extending from 2-3 mm apical of the alveolar crest to 2 mm beyond the tooth
      apices and connected by a horizontal corticotomy; this process is done on both the labial and
      palatal aspects.

      The definition of flapless corticotomy is a minimally invasive version of corticotomy, using
      a piezotome to inflict bone injury. This technique entails labial and palatal interproximal
      piezoelectric micro-incisions into the cortical bone without reflecting periodontal flaps.

      Before enrolling each subject into the study, they will be examined completely to determine
      the orthodontic treatment plan. The operator will inform them about the aim of the study and
      ask them to provide written informed consent.

      Self-drilling titanium mini-implants (1.6mm diameter and 8mm length) will be used. they will
      be inserted between the maxillary second premolar and first molar at approximately 8-10mm
      above the archwires at the mucogingival junction and will be checked for primary stability
      (mechanical retention). Then the maxillary first premolar will be extracted. The maxillary
      arch will be leveled and aligned. The rectangular stainless steel archwires (0.019" × 0.025")
      with anterior 8mm height soldered hooks distal to the lateral incisors will be inserted.

      The surgery will be carried out under local anesthesia. The traditional corticotomy will be
      handled by the same maxillofacial surgeon, and the flapless corticotomy will be handled by
      the same orthodontist.

      For traditional corticotomy, incisions in the mesial aspect of one-second premolar to the
      mesial surface of the contralateral second premolar will be placed, and a full-thickness flap
      will be elevated 3 mm above the apical region of the tooth. piezoelectric under copious
      irrigation will make vertical and horizontal cuts (only cortical surface). The vertical cuts
      will be between the dental roots in the interdental cortical surfaces, stopping 2 mm short of
      the alveolar crest occlusally. The horizontal cut will connect the vertical cuts 2 mm beyond
      the root apex. These cuts will be performed from the mesial aspect one-second premolar to the
      mesial surface of the contralateral second premolar involving the anterior. Similarly, a
      palatal flap incision will be raised immediately for doing the same vertical and horizontal
      cuts in the superficial surface of the palatal bone.

      For the flapless corticotomy, the depth of gingival tissue will be determined through bone
      sounding using a periodontal probe. A scalpel will be used to make the incisions through the
      gingiva, 4mm below the interdental papilla, to preserve the coronal attached gingiva. These
      vertical incisions will be placed from the mesial aspect of the one-second premolar to the
      mesial surface of the contralateral second premolar on the labial and palatal aspects of the
      maxilla through the gingiva and the underlying bone. A piezo-surgery knife will be used to
      create the cortical alveolar incisions to a depth of 1 mm within the cortical bone.

      The surgical procedure will be performed, and (250-300) g force will be applied on each side
      (3-4 days) after corticotomy using two Nickle-Titanium (NiTi) springs attached between the
      mini-implants and the soldered hooks in a direction approximately parallel to the occlusal
      plane for conducting an en-masse retraction. The force level will be measured every 2 weeks
      after the corticotomy. Retraction will be stopped when a class I canine relationship is
      achieved, and a good incisor relationship will be obtained.
    

Intervention name(s): Traditional corticotomy; Flapless corticotomy
Intervention type(s): Procedure; Procedure
Intervention description(s): A flap covering the alveolar process will be elevated. Perforations will be done using surgical burs, and then the flap will be returned, and sutures will be performed.; Some incisions will be made in the mucosa of the alveolar process. Then these incisions will allow the working head of the piezotome to cut the bone in grooves. The whole procedure will not require flap elevation and replacement.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment