Mandibular Second Molar Protraction Assisted by Piezocision

Study Overview
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Brief Summary
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This study was conducted to compare the rate of second molar protraction, level of Interleukin1-β in gingival crevicular fluid, periodontal health (gingival index, plaque index, and periodontal pocket depth) and perception of pain in patients treated by molar protraction with piezocision vs control (no piezocision).

Detailed Description
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Twenty-six subjects (39 Molars) who presented with at least one extracted mandibular first molar were selected to participate in the study. The subjects were subdivided into one of 3 groups as follows: group 1 consisted of 18 molars (13 molars from patients with bilateral first molar extraction space and 5 molars from patients with unilateral first molar extraction space) where piezocision was performed immediately before molar protraction; group 2 consisted of 21 molars (13 from patients with bilateral first molar extraction space and 8 molars from patients with unilateral first molar extraction space) where molar protraction was performed with no piezocision; group 3 consisted of 21 molars (group 2 subjects where piezocision was carried on after 3 months of molar protraction with no piezocision. After reaching 0.019X0.025 SS arch wire, NiTi coil spring was used for space closure (protraction force was 150g) attached from the lower second molar hook to the head of the mini-screw. Piezocision was performed by making 2 vertical incisions mesial and distal to the extraction space. Piezotome was inserted in the incisions previously made and bone cuts were done with a length up to mucogingival line and depth of 3 mm. Gingival crevicular fluid (GCF) sample was obtained from the mesiogingival side of the lower second permanent molar with use of Periopaper. GCF sample was repeated 1 day, 1 week and 4 weeks after molar protraction with piezocision or with no piezocision. Pain was assessed using visual analog scale (VAS). Patients were requested to report the level of pain for 7 consecutive days.

Official Title
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Mandibular Second Molar Protraction Assisted by and Piezocision

Conditions
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Acceleration of Tooth Movement, Piezocision

Intervention / Treatment
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* Procedure: Piezocision


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age range from 20 to 27 years at least one extracted mandibular first molar (first molar extracted more than one year ago and residual extraction space more than 5 mm) Class 1 malocclusion where molar protraction is indicated all permanent teeth are present except for the extracted mandibular first molar/molars. Exclusion Criteria:- Ggingival index score > 2 Plaque index score > 2 Probing depth > 4mm Previous orthodontic treatment Systemic disease and Smoker.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 27 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
Interventional Model Description: Three models:- Split mouth design where piezocision will be performed on the right of left side of the patient in bilateral first molar extraction space subjects. comparison between 2 groups of subjects; one group where protraction is done with piezocision and the other group where protraction was done with no piezocision. third part where the same side of space receives the 2 interventions. Molar protraction started with no piezocision for 3 months followed by piezocision and protraction for another 3 months,


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: piezosurgery<br>group 1 consisted of 18 molars (13 molars from patients with bilateral first molar extraction space and 5 molars from patients with unilateral first molar extraction space) where piezocesion was performed immediately before molar protraction | Procedure: Piezocision<br>* Piezocesion was performed by making 2 vertical incisions mesial and distal to the extraction space. Piezotome was inserted in the incisions previously made and bone cuts were done with a length up to mucogingival line and depth of 3 mm.<br>|
| No Intervention: No piezocision<br>group 2 consisted of 21 molars (13 from patients with bilateral first molar extraction space and 8 molars from patients with unilateral first molar extraction space) where molar protraction was performed with no piezocesion | |
| Other: Late piezocision<br>group 3 consisted of 21 molars (group 2 subjects where piezocession was carried on after 3 months of molar protraction with no piezocesion. | Procedure: Piezocision<br>* Piezocesion was performed by making 2 vertical incisions mesial and distal to the extraction space. Piezotome was inserted in the incisions previously made and bone cuts were done with a length up to mucogingival line and depth of 3 mm.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of second molar protraction | measured in mm/month from onscreen dental cast | up to 3 months | 
| Changes in the level of of Interleukin1-β | detected in Gingival crevicular fluid (GCF) | Immediately before protraction/piezocision, 1 day, 1 week and 4 weeks after protraction/piezocision | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Anchorage loss | Distal movement of second premolar in mm per month | Each month up to 3 months | 
| Pain Perception: Visual analogue scale (VAS) | Assessed using visual analog scale (VAS) where 0 = no pain and 10 = worst pain. The participants filled out questionnaire to assess the pain intensity and interference after second molar protraction with or without piezocision on 1, 2, 3, 4, 5, 6 and 7 days of intervention. | Every day up to 7 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Piezocision, Temporary anchorage device, molar protraction