Three- Dimensional Evaluation of Accelerated Tooth Movement
Condition: Malocclusion
MeSH terms: Malocclusion
Study type: Interventional

Summary: 
      The purpose of this research study is to assess the clinical effectiveness of a minimally
      invasive alveolar microperforation procedure to achieve accelerated tooth movement in
      patients undergoing orthodontic treatment for orthognathic surgery. "Accelerated tooth
      movement" means that Microperforation technique may help complete orthodontic treatment
      sooner than would be expected in conventional orthodontic treatment
    

Detailed description: 
      SAMPLE: For this prospective study, 22 subjects were selected, with skeletal discrepancies
      randomly divided into two groups: 1 - accelerated tooth movement technique (ATMT) and 2 -
      Control .

      METHODS: MATERIAL - Orthodontic records done in two times, initial and preoperative; Plaster
      models of dental extracted jaw every 28 days converted in digital models; Cone Beam Computed
      tomography done in two times, initial and in the end of extraction space closure.

      METHODS: Pre-molar extraction was performed before the Orthodontic Treatment to eliminate the
      RAP from the tooth extraction. After, at minimum 8 months for leveling, the extraction space
      closure was activated with light orthodontic traction (200 g each side) in anterior teeth, to
      maintain therapeutic osteopenia until contact point between the canine the second pre-molar
      is reached. Slide mechanic was chosen to performed anterior retraction on TADs in IZC.

      Cortical perforations - ATMT Group: Flapless cortical micro-osteoperforations has been
      performed in the dental extraction area. Surgical protocol is flapless to preserve
      periodontal health. After local anesthesia, 3 micro osteoperforations are done with manual
      instrument, between the contour of free gum and tooth apex, and the canine and second
      pre-molar roots. The perforations near each tooth adjacent to the extraction area has 6-8 mm
      depth.

      Results: On digital models - shortest distance between two adjacent teeth to the extraction
      space will be measured until the space closure.

      Cone-Beam Computed Tomography: after image acquisition , data will be previously converted to
      DICOM , to converted to GIPL in ITK-SNAP 3.2 software. In Slicer software voxels will be
      converted to size 0.5 mm for further construction of virtual three-dimensional models,
      through segmentation of anatomical structures again in ITK-SNAP 3.2 software. This
      segmentation will be made by the full selection of all maxilla and mandible anatomically and
      individually, with the limit all skeletal outline available, including teeth. After 3D models
      generation, specific control targeting to fill all narrow spaces, so that they are not
      excluded from the virtual model and the external cortical displacements are the only ones to
      be computed in the comparative evaluation between later time. Then regional overlay 3D models
      will be done using Slicer software. For overlapping structures: In mandible will use along
      the edge of the mandibular symphysis; maxilla, posterior nasal spine. Overlap is automatic
      because software compares voxels grayscale to reference region to overlap spatially.
      Displacement evaluation will be done with Slicer software through colorful maps generated by
      calculating the distances between points of two representatives surfaces. These maps
      differentiate the movements between surfaces. For quantification metric, specific online tool
      is used to measure the displacement in millimeters. We will evaluate quantitative
      displacement for space closure, closing speed, the possible changes throughout the
      maxillomandibular complex and compared between groups. After collecting data, the results
      will be statistically analyzed.
    

Intervention name(s): Micro-osteoperforation
Intervention type(s): Procedure
Intervention description(s): Flapless cortical perforations will be made 8 months minimum after dental extraction. Surgical protocol will be flapless to preserve periodontal health. After local anesthesia, 3 micro osteoperforations will be done with manual instrument, between apex to the contour of free gum between the canine and second pre-molar. Perforations near each tooth will have 6-8 mm depth
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: malocclusion; accelerated tooth movement; Tomography; Extraction