Evaluation of the Effectiveness of Piezocision and Micro-osteoperforation in Alleviating Mandibular Anterior Crowding

Study Overview
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Brief Summary
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In recent times, many patients want their treatment duration to be reduced, because lengthy orthodontic treatment duration is associated with negative sequelae such as discomfort, pain, white spot lesions, and decreased patient's compliance. Several techniques have been employed in an attempt to accelerate the tooth movement and shorten the lengthy orthodontic treatment duration. So, this study will investigate the effectiveness of minimal invasive technique like piezocision and microosteoperforation in alleviating mandibular anterior crowding which is one of the common malocclusiom and provide scientific knowledge regarding which minimal invasive tecnique will relieve the crowding faster.

Detailed Description
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Records will be taken from patients who are meeting selection criteria and then analysis of record will be done to attain a proper diagnosis and treatment plan. Afterthat, those patients will be referred to oral surgery department for extraction of first premolar. After healing, orthodontic treatment will be started with bonding of preadjusted MBT 0.022 slot straight wire appliance(Patient will be instructed to report immediately in case of breakage of appliance), after that, randomisation and allocation of two groups will be done and on the day of initial aligning archwire placement i.e., 0.014 NiTi, active interventions(piezocision and micro-osteoperforations) will be done for each group and then levelling and alignment will be continued with the following arch wire sequence 0.016 , 0.016 x 0.022 and 0.017 x 0.025 NiTi. Levelling and alignment will be considered finished when 0.017x0.025 NiTi archwire will be engaged passively in the brackets. Records i.e,. mandibular study models will be taken on the day of surgical procedure before surgery (T0) and then after every 4th week i.e., 4th week(T1), 8th week(T2), 12th week(T3), 16th week(T4). Following this, data collection and interpretation of results will be done. And also, CBCT will be taken at post levelling and alignment with 0.017 x 0.025 arch wire to assess the root resorption and marginal alveolar bone loss.

Official Title
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Comparative Evaluation of the Effectiveness of Piezocision and Micro-osteoperforation in Alleviating Mandibular Anterior Crowding: A Randomized Clinical Trial

Conditions
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Crowding of Anterior Mandibular Teeth

Intervention / Treatment
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* Procedure: GROUP - A: PIEZOCISION GROUP
* Procedure: GROUP- B: MICRO-OSTEOPERFORATION GROUP


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient satisfying the following criteria will be included in this clinical study: Patients with age between 16-25 years Patients with either Angle's class I or class II malocclusion with moderate crowding in the anterior mandible(LII- 4-6mm) who requires extraction in the lower arch (tooth-size-arch-length discrepancy>5 mm) Permanent dentition Existence of all tooth in the mandibular arch (except third molars which may or may not be present) Good oral hygiene and periodontal health No smoking habit. Exclusion Criteria: medical conditions that would affect tooth movement (corticosteroid treatments, NSAIDs consumption, bisphosphonates, hyperparathyroidism, osteoporosis, uncontrolled diabetes) Contraindication to oral surgery (medical, social, psychological) Missing tooth in the mandibular arch Presence of primary or supernumerary tooth in mandibular arch Previous orthodontic treatment Poor oral hygiene and current periodontal disease Smoking habit.

Ages Eligible for Study
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Minimum Age: 16 Years
Maximum Age: 25 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: GROUP - A: PIEZOCISION GROUP<br>This group will receive piezocision using piezotome inbetween the roots of mandibular anteriors after the placement of initial arch wire. | Procedure: GROUP - A: PIEZOCISION GROUP<br>* This group will receive piezocisions after placement of initial arch wire, in between the roots of mandibular anteriors (in a vertical line) i.e., between mandibular canine and lateral incisors bilaterally, lateral incisors and central incisors bilaterally and between two cental incisors with the help of piezotome. These piezocisions will be performed on the labial cortical bone only, 4mm below the interdental papilla under 2% lidocaine with 1:100,000 epinephrine and with standard asepsis, and gingival overlying will be incised first with blade number 15 in a Bard Parker handle. A piezosurgical microsaw with piezosurgical drill will be placed over that incision with irrigation. Then, vertical 5- to 8-mm and 3mm deep corticotomies will be perform using periapical radiographs as a guide to avoid penetrating into the adjacent roots. No subsequent sutures required.<br>|
| Experimental: GROUP- B: MICRO-OSTEOPERFORATION GROUP<br>This group will receive Micro-Osteoperforation using orthodontic mini-implants and mini-implant screw driver after the placement of initial arch wire. | Procedure: GROUP- B: MICRO-OSTEOPERFORATION GROUP<br>* This group will receive MOPs after initial arch wire placement. These MOPs will be performed under local anesthesia with standard asepsis, using a self drilling 1.6mm x 8mm orthodontic mini-implants and mini-implant screw driver and no flap will be raised. MOP's will be placed on five sites i.e., interproximally between mandibular canine and lateral incisors bilaterally, central incisor and lateral incisor bilaterally and between two central incisors. Each site will receive two MOP's, first 2mm apical to alveolar crest and second 2mm below the first in a vertical line and 2mm deep into the bone. Then the mini-implant will be removed by rotating the screw driver anticlockwise and pressure will be applied to achieve hemostasis.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Amount of Crowding Relieved | Measured with Little Irregularity index using Digital caliper | 4 weeks | 
| Amount of Crowding Relieved | Measured with Little Irregularity index using Digital caliper | 8 weeks | 
| Amount of Crowding Relieved | Measured with Little Irregularity index using Digital caliper | 12 weeks | 
| Amount of Crowding Relieved | Measured with Little Irregularity index using Digital caliper | 16 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall Alignment Time | Time taken to align the mandibular anteriors calculated in days | 16 weeks | 
| Root resorption of mandibular anteriors | Root length of mandibular anteriors measured before and after alignment using CBCT | 16 weeks | 
| Marginal Alveolar Bone Loss | Alveolar bone length measured before and after alignment using CBCT | 16 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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dental crowding