Which is Better Piezosurgery or Piezosurgery With Laser in Accelerating Orthodontic Tooth Movement
Condition: Angle Class II
MeSH terms: Malocclusion, Angle Class II; Overbite
Study type: Interventional

Summary: 
      Sixty patients who need extraction-based treatment of the maxillary first premolars with
      subsequent retraction of the maxillary anterior teeth will be divided randomly into three
      groups: piezocision group, piezocision with low-level laser therapy group, and control group.
      In each group, after the levelling and alignment phase is completed, the rectangular
      stainless steel archwires (0.019" × 0.025") will be inserted, then after two weeks, the en
      masse retraction will be started via closed nickel-titanium coil springs applying 250 g of
      force per side. For anchorage, mini implants will be inserted between the second premolars
      and the first molar on each side.
    

Detailed description: 
      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 six weeks of piezosurgery, a 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 two
      halves; gingival and cervical, and the laser will be applied in the center of each half from
      both buccal and palatal sides which means four application points and total energy of 16
      Joules per tooth. LLLT irradiation will be performed in the sixth week after the onset of
      mass retraction (day 0). After that, irradiation is repeated on days 3, 7, and 14, then every
      two weeks, until the class I canine relationship is achieved and/or spaces lateral to
      incisors are closed
    

Intervention name(s): Piezosurgery and GaALAs diode laser; Piezosurgery; Fixed orthodontic appliance
Intervention type(s): Procedure; Procedure; Other
Intervention description(s): 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.
After six weeks of piezosurgery, GaALAs diode laser (wavelength: 810 nm and exposure time of 10 seconds\point) 10 seconds per point will be applied.; 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.; After the levelling and alignment phase is completed, the rectangular stainless steel archwires (0.019" × 0.025") will be inserted, then after two weeks, the en masse retraction will be started via closed nickel-titanium coil springs applying 250 g of force per side.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment