Effects of Flapless Laser Corticotomy in Canine Retraction

Study Overview
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Brief Summary
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This study is conducted to evaluate the effects of flapless laser corticotomy on the rate of canine retraction.

Official Title
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Effects of Flapless Laser Corticotomy in Canine Retraction: A Randomized Controlled Trial

Conditions
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Dental Malocclusion, Bimaxillary Protrusion

Intervention / Treatment
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* Other: Flapless laser corticotomy
* Other: Canine retraction


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Full complement of teeth with no congenitally missing teeth except 3rd molars. Minor or no crowding cases requires four premolars extraction, canine retraction & maximum anchorage with bimaxillary dentoalveolar protrusion. No history of previous orthodontic treatment Clinically healthy patients with no history of drug intake and\or no history for any systemic illness, syndromes, craniofacial deformities. Vital teeth with normal periodontium and no root resorption. Adequate oral hygiene; probing depth values not exceeding 3 mm across the entire dentition; adequate thickness of the attached gingiva (1-2 mm). No radiographic evidence of bone loss. Exclusion Criteria: Systemic disease that might have affected bone formation or density, such as osteoporosis, hyperparathyroidism, or vitamin D deficiency. Presence of any local or systemic surgical contraindication. Extracted or missing permanent tooth/teeth except for 3rd molars. Facial asymmetry

Ages Eligible for Study
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Minimum Age: 18 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
Interventional Model Description: The 14 patients maxillary and mandibular arches will be allocated into a split-mouth design, so the sample will be set up each patient to act as his/her own control
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Maxillary flapless laser corticotomy group<br>Flapless laser corticotomy will randomly be assigned to one side of the 14 maxillary arches (experimental side) before canine retraction. | Other: Flapless laser corticotomy<br>* The flapless laser corticotomy will be done by Er, Cr: YSGG laser as a series of circular holes will be made along with the planned position. The depth of laser cutting will be measured and controlled continuously during the operation by the periodontal probe with stopper read to each 3mm depth in addition to a few parts of a millimetre depth into the medullary bone to enhance bleeding. Canine retraction will be started after this procedure.<br>Other: Canine retraction<br>* canine retraction will be done on 17x25 stst archwire using coil spring adjusted to 150 gm, and miniscrews will be used as an indirect method of anchorage reinforcement<br>|
| Active Comparator: Maxillary control group<br>Canine retraction will be done on the other side without Laser corticotomy . | Other: Canine retraction<br>* canine retraction will be done on 17x25 stst archwire using coil spring adjusted to 150 gm, and miniscrews will be used as an indirect method of anchorage reinforcement<br>|
| Experimental: Mandibular flapless laser corticotomy group<br>Flapless laser corticotomy will randomly be assigned to one side of the 14 mandibular arches (experimental side) before canine retraction. | Other: Flapless laser corticotomy<br>* The flapless laser corticotomy will be done by Er, Cr: YSGG laser as a series of circular holes will be made along with the planned position. The depth of laser cutting will be measured and controlled continuously during the operation by the periodontal probe with stopper read to each 3mm depth in addition to a few parts of a millimetre depth into the medullary bone to enhance bleeding. Canine retraction will be started after this procedure.<br>Other: Canine retraction<br>* canine retraction will be done on 17x25 stst archwire using coil spring adjusted to 150 gm, and miniscrews will be used as an indirect method of anchorage reinforcement<br>|
| Active Comparator: Mandibular control group<br>Canine retraction will be done on the other side without Laser corticotomy . | Other: Canine retraction<br>* canine retraction will be done on 17x25 stst archwire using coil spring adjusted to 150 gm, and miniscrews will be used as an indirect method of anchorage reinforcement<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of canine retraction. | distal movement of the canine , measurement unit mm divided by time unit month , using scanned digital models | 3 months of canine retraction , distance (mm) moved by the canine distally per month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Canine rotation | rotation of canine measured in degrees , after 3 months of canine retraction using scanned digital models | 3 months, assessed at the beginning of treatment (base line ), and at the end of 3 months of canine retraction | 
| First molar anchorage loss | mesial movement of first molar measured in mm , after 3 months of canine retraction using scanned digital models | 3 months, assessed immediately before canine retraction and at the end of 3 months of canine retraction | 
| Root resorption | canine root length measured in mm using cone beam CT scans | 3 months , assessed at the beginning of treatment (base line ), and at the end of 3 months of canine retraction | 
| Periodontal condition | assessed using periodontal probe to measure : probing depth in mm | 3 months , immediately before canine retraction , and at the end of 3 months of canine retraction | 
| Pulp vitality | assessed using thermal (Cold ) test , by application of dry cotton sprayed with ethyl chloride | 3 months, assessed immediately before canine retraction , and at the end of 3 months of canine retraction | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Flapless laser corticotomy, Canine retraction