Abstract
Background
Among the recent modalities introduced to accelerate orthodontic tooth movement (OTM) is micro-osteoperforations (MOPs), in other words, bone puncturing. The aim of this split-mouth trial was to investigate the effects of MOPs on the rate of OTM.
Methods
Eighteen patients requiring bilateral first premolar extraction and upper canine retraction with maximum anchorage were enrolled in this study. Immediately before canine retraction, three MOPs were randomly allocated to either the right or left sides. MOPs were performed using a mini-screw (1.8 mm diameter, 8 mm length) distal to the canine. Canine retraction continued for 4 months. Data were collected from monthly digital models, in addition to pre- and post-retraction maxillary CBCT images. The primary outcomes were the rate of canine retraction per month and the total distance moved by the canines. The secondary outcomes were the effect of MOPs on anchorage loss, canine root resorption, and pain.
Results
The mean rate of canine retraction in both sides was 0.99 ± 0.3 mm/month. The total distance moved by the canine cusp tip was greater in the MOP than the control side (mean difference 0.06 ± 0.7 mm), which was statistically insignificant (P > 0.05(. The total distances moved by the canine center and apex were significantly greater in the MOP than the control side (mean difference 0.37 ± 0.63 mm (P < 0.05) and 0.47 ± 0.56 mm (P < 0.01) respectively). Insignificant differences were detected regarding anchorage loss and root resorption between both sides (P > 0.05). Mild to moderate pain was experienced following the MOP procedure, which rapidly faded away within 1 week.
Conclusions
Micro-osteoperforations were not able to accelerate the rate of canine retraction; however, it seemed to facilitate root movement.
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Background
Orthodontic treatment is well known to be a prolonged one, that is why a considerable number of patients, particularly adults, avoid orthodontic treatments and would rather accept less superior esthetics offered by aligners or fixed prosthodontics. The average orthodontic treatment duration is 2 years [1]. Not only longer treatment duration poses greater risks of gingival inflammation, root resorption [2], and enamel decalcification [3], but most importantly, it can burnout patients’ cooperation [1], which is another factor that detains orthodontic treatment.
Consequently, accelerated orthodontics has gained much popularity in the recent research work. Many modalities have been proposed to accelerate orthodontic tooth movement (OTM) such as low-level laser therapy, corticotomy, interseptal bone reduction, photobiomodulation, or pulsed electromagnetic fields [28]. Yet, this pattern of canine retraction seemed to be less noticeable in the MOP side. By analyzing the canine root movement as measured from the CBCT images in both sides, it has been shown that the total distance moved by the center and apex of the canine was significantly greater in the MOP than the control side. Very much earlier, Reitan [29] emphasized that during canine retraction, the tooth acted as a two-armed lever, with the applied force concentrated at the alveolar crest, where the areas of hyalinization are concentrated. MOPs performed distal to the cervical two thirds of the canine root have probably decreased the resistance offered by the alveolar crest allowing greater root movement. However, the canine cusp tips moved a greater distance than the apices in both sides, indicating that canine retraction was mostly due to controlled tip** movement.
Very mild anchorage loss (< 1 mm) occurred in both the control and MOP sides, with no statistically significant difference. Minor anchorage loss, even with the utilization of absolute anchorage means, was documented formerly by El-Beialy et al. [30]
Results of the current study demonstrated that MOP neither increased nor decreased root resorption, in contrast to a recent systematic review which accused corticotomy of increasing the orthodontically induced root resorption [31].
The fundamental aim of all minimally invasive surgical procedures was to achieve accelerated OTM utilizing patient-friendly approaches; consequently, patients’ feedback was of utmost importance. The pain severity experienced by the patients ranged from mild to moderate pain that rapidly faded away after 1 week. Yet, the mean pain scores obtained in the current study were higher than those reported by Alikhani et al. [11].
Limitations
The current study did not evaluate the effect of different numbers, sites, and repetition of MOP on the rate and type of tooth movement. The current study did not evaluate the effect of MOP on the overall treatment duration.
Conclusions
Within the limitations of this study, the following conclusions could be withdrawn:
-
Micro-osteoperforations (MOP) were not able to accelerate the rate of canine retraction; however, it seemed to facilitate root movement.
-
MOP did not augment posterior anchorage.
-
MOP did not increase nor decrease orthodontically induced root resorption. No long-term adverse effects on the alveolar mucosa were detected following the MOP procedure.
-
Mild to moderate transient pain was experienced following the MOP procedures that almost disappeared 1 week later.
Abbreviations
- CBCT:
-
Cone beam computed tomography
- FP:
-
Frontal plane
- MB:
-
Mesiobuccal
- MOP:
-
Micro-osteoperforation
- OTM:
-
Orthodontic tooth movement
- TADs:
-
Temporary anchorage devices
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Acknowledgements
We would like to acknowledge Dr. Mohamed Abd El-Ghafour for performing the inter-observer measurements blindly.
Funding
No funding to be declared. This study was a part of the Doctorate degree in Orthodontics of the first author. The study was self-funded by the first author.
Availability of data and materials
The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
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AA recruited the patients for the study and performed the history taking, clinical examination, orthodontic treatment, micro-osteoperforation procedure, and monthly impressions, in addition to the interpretation of the results and writing of the manuscript. MF supervised the clinical examination, treatment procedures, and writing of the manuscript. NE performed the digital models and CBCT measurements blindly. SS supervised the interpretation of the results and revised the manuscript. All authors read and approved the final manuscript.
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The current study was approved by the Research Ethics Committee of the Faculty of Dentistry, Cairo University. Eighteen subjects were selected from the outpatient clinic of the Department of Orthodontics, Faculty of Dentistry, Cairo University, who were acquainted with the study procedures and radiation exposures, then informed written consents were signed.
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Aboalnaga, A.A., Salah Fayed, M.M., El-Ashmawi, N.A. et al. Effect of micro-osteoperforation on the rate of canine retraction: a split-mouth randomized controlled trial. Prog Orthod. 20, 21 (2019). https://doi.org/10.1186/s40510-019-0274-0
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DOI: https://doi.org/10.1186/s40510-019-0274-0