Dental and Periodontal Changes Following the Acceleration of Alignment of Crowded Lower Anterior Teeth Using a Surgical Technique

Study Overview
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Brief Summary
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Patients at the Orthodontic Department of the University of Damascus Dental School will be examined and subjects who meet the inclusion criteria will be included. Then, initial diagnostic records (diagnostic gypsum models, internal and external oral photographs, and radiographic images) will be studied to ensure that the selection criteria are accurately matched. This study aims to compare two groups of patients with moderate crowding of the lower anterior teeth. Experimental group: the patients in this group will be treated with periodontally accelerated osteogenic orthodontics Control group: the patients in this group will be treated using fixed appliances without any acceleration method.

Detailed Description
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Correction of irregular teeth can take a long time, and this depends on various factors such as the good compliance of the patient, the amount of dental crowding, and the need for extraction in the course of orthodontic treatment. Many methods have been used to accelerate tooth movement, and recently the PAOO technique has emerged as an effective therapeutic intervention. PAOO is a promising procedure but only a few cases were reported in the literature. Controlled clinical and histological studies are needed to understand the biology of tooth movement with this procedure, the effect on teeth and bone, post-retention stability, measuring the volume of mature bone formation, and determining the status of the periodontium and roots after treatment.

Official Title
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Dental and Periodontal Changes Following the Acceleration of Decrowding of Lower Anterior Teeth Using a PAOO Procedure: A Randomized Controlled Trial

Conditions
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Crowding, Tooth

Intervention / Treatment
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* Procedure: PAOO
* Other: Fixed appliance


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: skeletal class I malocclusion (ANB=2-4) normal vertical growth pattern. moderate crowding of lower anterior teeth (i.e., 4-6 millimeters of a tooth size-arch length discrepancy) 1 to 3 mm of overjet and 1 to 4 mm of the overbite good oral health Exclusion Criteria: medical, social, and psycho contraindications to oral surgery presence of periodontal diseases poor oral hygiene previous orthodontic treatment

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 28 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

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: Periodontally accelerated osteogenic orthodontics<br>The patients in this group will be treated by periodontally accelerated osteogenic orthodontics using fixed appliances. | Procedure: PAOO<br>* Periodontally accelerated osteogenic orthodontics will be applied to treat patients with moderate crowding.<br>|
| Active Comparator: Conventional treatment<br>The patients in this group will be treated using fixed appliances and conventional treatment without any surgical intervention to accelerate tooth movement. | Other: Fixed appliance<br>* Fixed appliances will be applied to treat patients with moderate crowding without any acceleration methods.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Little's Index of Irregularity | The irregularity of the lower incisors is calculated by measuring the amount of deviations of the anatomic contact points between the six anterior teeth in the horizontal direction in mm, since the sum of these measurements represents the value of the index (Little, 1975). The ordinary orthodontic treatment aims to keep this Index less than 1 mm at the end of treatment. | T0: one day before the beginning of treatment; T1: after 1 month; T2: after 2 months; T3: after 4 months; T4: after 5 months; T5: at the end of the alignment stage which is expected within 5 - 6 months | 
| Change in the inter-canine width | The distance between the cusp tips of the lower canines. This variable will be measured on plaster models. | T0: One day before the beginning of treatment; T1: at the end of the alignment stage | 
| Change in the inter-2nd premolar width | The distance between the central fossae of the lower second premolars. This variable will be measured on plaster models. | T0: One day before the beginning of treatment; T1: at the end of the alignment stage | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in the Gingival index | Measured by degrees at each tooth: (0) Normal gingival; (1) mild inflammation; (2) Moderate inflammation; (3) severe inflammation | T0: One day before the beginning of treatment; T1: at the end of the alignment stage | 
| Change in the Plaque index | Measured by degrees at each tooth: (0) No plaque; (1) thin plaque layer; (2) moderate plaque layer; (3) severe plaque along the gingival margin | T0: One day before the beginning of treatment; T1: at the end of the alignment stage | 
| Change in the Papillary Bleeding Index | Measured by the severity of any bleeding: (0) No bleeding; (1) a single discreet bleeding point; (2) several isolated bleeding points; (3) the interdental triangle fills with blood shortly after probing; (4) profuse bleeding occurs after probing. | T0: One day before the beginning of treatment; T1: at the end of the alignment stage | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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PAOO, moderate crowding, gingival index, plaque index, papillary bleeding index