Evaluation of the Levels of Pain and Discomfort and Periodontal Status Between Two Acceleration Methods of Upper Anterior Teeth Retraction
Condition: Class II Malocclusion
MeSH terms: Malocclusion; Malocclusion, Angle Class II; Overbite
Study type: Interventional

Summary: 
      60 patients will be treated by extraction of maxillary first premolars by applying
      mini-screws between the maxillary second premolar and first molar as temporary skeletal
      anchorage devices (TSADs). They will be divided randomly into three groups in this trial. The
      prolonged duration of the treatment period can cause many side effects such as white spots,
      caries, periodontal diseases, and pain and discomfort. So many efforts have been made to
      reduce the treatment time. Many procedures have been introduced to accelerate orthodontic
      tooth movement, which can category as surgical or non-surgical. Piezocision is a minimally
      invasive surgical method for accelerating orthodontic tooth movement and shortening treatment
      time. Low-level laser therapy (LLLT) is one of the physical acceleration methods that have
      contributed to decreasing treatment time.
    

Detailed description: 
      Closed nickel-titanium coil springs applying 250 g of force per side will be used for
      retraction of the maxillary anterior teeth.

      The en-masse retraction will be obtained with two nickel-titanium coil springs placed between
      the mini-implants and the soldered hooks in a direction approximately parallel to the
      occlusal plane, a force of 250 g will be applied on each side to perform en-masse retraction.
      The retraction will be stopped when a Class I canine relation is achieved and a good incisor
      relation is obtained or spaces lateral to canines are closed.

      Regarding the Piezocision, vertical soft-tissue incisions will be made on the buccal and
      palatal gingiva. One incision will be made between the roots of the six upper anterior teeth,
      and two incisions will be made between the upper canines and the second premolars. The
      incisions will be 5 mm long and start 4 mm apical to the interdental papilla. Then a
      piezosurgery knife will be inserted to perform the cortical alveolar incisions with 3-mm
      in-depth and 8 mm in length. No suturing will be needed.

      Regarding the piezocision with the later application of low-level laser therapy (LLLT):

      After seven weeks of piezosurgery, GaALAs diode laser (wavelength: 810 nm and exposure time
      of 10 seconds\point) 10 seconds per point will be applied on each tooth of the six maxillary
      anterior teeth according to this protocol: the root will be divided theoretically into 2
      halves; gingival and cervical, and the laser will be applied in the centre of each half from
      both buccal and palatal sides which means 4 application points and total energy of 16 Joules
      per tooth. The LLLT will be applied 5 times in the first month of en masse retraction. After
      that, the irradiation will be repeated every two weeks, until the class, I canine
      relationship will be achieved and/or spaces lateral to incisors were closed
    

Intervention name(s): Piezocision+GaALAs diode laser; Piezocision; Orthodontic fixed appliance
Intervention type(s): Device; Device; Device
Intervention description(s): After seven weeks of piezosurgery, GaALAs diode laser (wavelength: 810 nm and exposure time of 10 seconds\point) 10 seconds per point will be applied on each tooth of the six maxillary anterior teeth .; Vertical soft-tissue incisions will be made on the buccal and palatal gingiva. One incision will be made between the roots of the six upper anterior teeth, and two incisions will be made between the upper canines and the second premolars.; Closed nickel-titanium coil springs applying 250 g of force per side will be used for retraction of the maxillary anterior teeth.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment