The Effect of Autologous Platelet Concentrations on Orthodontic Treatment Time
Condition: Class II Division 1 Malocclusion
MeSH terms: Malocclusion
Study type: Interventional

Summary: 
      60 patients needed therapeutic extraction of the maxillary first premolars with subsequent
      retraction of the maxillary canines were divided to randomly three groups:

      (1) PRP group: Received PRP injections, (2) I-PRF group: Received I-PRF injections, (3)
      Control group: conventional treatment with no injections. TPAs were used as an anchor unit.
      Coil springs were used to distalize the upper canines on 0.019 x 0.025-inch stainless
      archwires. Alginate impressions and dental casts of the maxillary arch were done at five-time
      points over a 4-month follow-up period. The amount of canine movement, canine rotation, and
      anchorage loss were measured on three-dimensional digital models superimposed on the rugae
      area.
    

Detailed description: 
      One of the most important goals of orthodontic treatment is to decrease the treatment time
      via achieving faster tooth movement chiefly in adults. Adults have more bone density and less
      bone turnover than adolescence, which may be linked to potential root resorption, periodontal
      problems, and white spot lesions.

      Approaches to reduce orthodontic treatment time included surgical and non-surgical
      techniques. Non-surgical approaches such as systemic and local administration of chemical
      substances, low-level laser therapy, vibrations, and pulsed electrical stimulation therapy
      still need more studies to determine their safety and effectiveness.

      Surgical procedures such as corticotomy, corticision, and micro-osteoperforations have

      , in general high success rates, but they rely on incurring an injury to bone tissues. The
      latter has been linked to the regional acceleratory phenomenon (RAP). But the invasive nature
      of these procedures, associated risks of loss of alveolar bone and gingival recession, and
      the help needed from another specialist limit its routine application. Recently, the
      possibility of using platelet-based preparations from the patient's blood to accelerate
      orthodontic tooth movement like platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) has
      grown. PRF represents the second generation of biological materials derived from blood. It is
      obtained through a centrifuge of the patient's blood without adding any additives to the
      tube. The variety of growth factors in PRP and PRF may have the ability to stimulate the
      activation of osteoblasts and osteoclasts together, which supports the idea that PRP could
      affect orthodontic tooth movement The study sample consisted of 60 patients and was
      calculated using (G-power sample size calculator), depending on the rate of canine retraction
      with a study power of 90%.

      After ensuring the patient's compliance with the terms and conditions of this study, the
      purpose and methods of the study were explained to the patients using Information Sheet. In
      case of approval to participate, the patients were asked to sign the informed consent. Extra
      & Intra-oral photographs, impressions and clinical examinations were made.

      Canine retraction was initiated after completion of the leveling and alignment phase via
      closed nickel-titanium coil springs applying 150 g of force per side at the same time.
    

Intervention name(s): The platelet-rich plasma (PRP); The injectable platelet-rich fibrin (I-PRF) group; The control group
Intervention type(s): Other; Other; Device
Intervention description(s): Twenty ml of venous blood was drawn from each patient with the use of PRP tubes that contain anticoagulant citrate dextrose. The double-spin technique was used to prepare the PRP. The injection areas were anesthetized with lidocaine 2% with epinephrine 1/80000 and left for 10 minutes. 15 units (0. 15 mL) of PRP were injected interaligamentlly in the middle, distobuccal, and distopalatal areas of the distal surface of the upper canines (5 units in each area) together with submucosal injections buccally and palatally (100 units and 50 units
, respectively).; Twenty ml of venous blood was drawn from each patient in this experimental group.
I-PRF was prepared with the use of 20 ml of blood drawn from the patient in dry sterile tubes without anticoagulant (quickly before coagulation starts) by following the centrifugation protocol requires one cycle only (700 RPM for 3 minutes) Injection procedures, sites, and time were similar to the PRP group.; NiTi closed-coil springs (American Orthodontics, Sheboygan, WI) were used to impose 150 g force from the first molar band hook to the bracket of canine on each side on 0.019*0.025-in SS archwire Patients' follow-up appointments were two weeks intervals; at each visit, the force produced by the coil was checked and readjusted when needed in order to keep it at 150-g level and the appliances were examined for any deformation or change in the position because of chewing. Canine retraction continued until achieving Class I canine relationship.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Platelet-rich plasma; Platelet-rich fibrin; Acceleration