Corticotomy-assisted orthodontic treatment

ةدوجو روشنلما يملعلا بدلأا مييقتل ةيجهنم ةسارد :فادهلأا يموقتل ةدناسلما مظعلا ريشقت ةيلمع لوح اهيلإ لصوتلما ينهاربلا .نانسلأا كللما ةعماج ،نانسلأا ةيلك يف ةساردلا هذه تيرجأُ :ةقيرطلا ةرتفلا للاخ كلذو ةيدوعسلا ةيبرعلا ةكلملما ،ةدج ،زيزعلادبع تانايبلا تادعاق يف ثحبلاب انمق دقل .م2014 ىلإ م2013 نم .ثاحبلأا تاصلاخ ضعب عيمجتب انمق اهدعبو ،ةينورتكللاا ماق هنيعم ةيثحب ريياعم ىلإ ثحبلا اهنمضت يتلا تاساردلا تعضخو ريياعم تلمش .امهضعب نع ينلقتسلما ينققدلما نم نانثا اهمييقتب مييقتب تماق يتلا ةيناويلحاو ةيرشبلا تاساردلا نم لًاك ةساردلا نانسلأا يموقتل ةدناسلما مظعلا ريشقت ةيلمعب ةقلعتلما بناولجا ضعب تلااقم داعبتسا تم اميف ،هقيبطتب ةقلعتلما ةيويلحا سسلأا كلذكو هذه مييقت تم اهدعبو .ةيلسلستلا تلاالحا تلااقم كلذكو تلاالحا .ةيريرسلا براجتلل يجهنلما رايعلما مادختساب تاساردلا ريياعم مهيلع تقبطنا نمم لًااقم 12 ةساردلا تلمش :جئاتنلا ثحبلا اذه جئاتن تراشأ دقلو .لًااقم 14 لصأ نم كلذو ةساردلا نانسلأا يموقتل ةدناسلما مظعلا ريشقت ةيلمع ينب ةقلاع كلانه نأب ةقيرطلا عم ةنراقلماب كلذو فاعضأ 2-2.5 عقاوب نانسلأا كرتح ةعرسو ىلع ةنمآ مظعلا ريشقت ةقيرط تناكو .نانسلأا يموقتل ةيديلقتلا ىلع ًارطخ لكشت مل وأ لًايلق ارطخ تلكش اهنأ امك ،ةثللا ةحص يمظع ديدتج لوصح ىلإ يويلحا ريثأتلا كلذ عجريو .روذلجا لكآت .ةطيلمحا ةقطنلما سكنت مدعو ،مظعلل ةيخنسلا ةجنفسلإا يف يلحم ىلع مظعلا ريشقت ةيلمع ريثأت معدي ليلد كلانه نكي مل هنأ ريغ رارقتساو ،ةقباسلا لاصئتسلاا نكامأ رومضو ،ةطوسقلما نانسلأا .يضرعلا ددمتلا كلذكو يموقتلا ةلاح دنع ةطيلحا ذخأ بجي هنأب ةيجهنلما ةساردلا هذه ترهظأ :ةتمالخا نحنف كلذلو ،نانسلأا يموقتل ةدناسلما مظعلا ريشقت ةيلمعل ءوجللا .ىدلما ةليوطلاو ةيئاوشعلا ةيريرسلا براجتلا نم ديزلما ىلإ ةجاحب Objectives: To systematically review the literature to assess the quality of evidence related to corticotomyassisted orthodontic treatment (CAOT) as adjunctive treatment in orthodontics. Systematic Review Methods: The study was conducted in the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia between 2013 and 2014. Various electronic databases were searched and abstracts were retrieved. Defined inclusion criteria were then applied to the obtained original articles for further evaluation by 2 examiners independently. The criteria of selection included human, or animal studies, which assessed some aspects of CAOT and/or the biological principles behind it. Case reports and series were excluded. The quality of the studies was evaluated by the methodological score for clinical trials developed. Results: Fourteen articles were retrieved initially, but only 12 articles were finally selected for the study. The CAOT was found to accelerate tooth movement by 2-2.5 folds when compared with conventional orthodontic tooth movement. The CAOT was found safe on periodontal health and exhibits no or little risk of root resorption. A localized turnover of alveolar spongiosa and the absence of a hyalinized zone was the acceptable biological explanation of CAOT. There is no evidence to support that CAOT enhances the movement of ankylosed teeth, closing old extraction sites, post-orthodontic stability, or transverse expansion. Conclusions: Corticotomy-assisted orthodontic treatment should be considered with caution. Long term randomized clinical trials are still needed. Saudi Med J 2015; Vol. 36 (7): 794-801 doi: 10.15537/smj.2015.7.12437 From the Department of Orthodontics (Hassan, Al-Saeed, Linjawi), Department of Periodontics (Bahammam), Faculty of Dentistry, King Abdulaziz University, Jeddah, the Dental Center (Al Maghlouth), Dammam Medical Complex, Dammam, Kingdom of Saudi Arabia, and the Faculty of Medicine and Dentistry (Elbialy), University of Alberta, Edmonton, Canada. Received 6th May 2015. Accepted 17th May 2015. Address correspondence and reprint request to: Prof. Ali H. Hassan, Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, PO Box 80209, Jeddah 21589, Kingdom of Saudi Arabia. E-mail: [email protected] OPEN ACCESS 794 Saudi Med J 2015; Vol. 36 (7) www.smj.org.sa 795 www.smj.org.sa Saudi Med J 2015; Vol. 36 (7) Corticotomy-assisted orthodontic treatment ... Hassan et al O have attempted several methods to decrease treatment time while maintaining good quality of orthodontic treatment.1 Corticotomyassisted orthodontic treatment (CAOT) is considered one of these modern methods that aims at reducing the treatment time and overcoming some limitations of orthodontic treatment, especially in adult patients.2 The concept of performing surgical cuts to accelerate orthodontic tooth movement is not new. However, it was not introduced properly until the late 20th century when Wilkco et al2-4 proposed selective alveolar corticotomy with augmentation grafting, followed immediately by fixed orthodontic treatment. They patented and trade marked their technique as Periodontally Accelerated Osteogenic Orthodontics (PAOO). They observed a rapid orthodontic movement following PAOO, which was estimated to be 6-8 months faster than the conventional orthodontic treatment.2-4 Several indications and effects of CAOT were reported, which included: reducing treatment time and facilitating the treatment of several orthodontic modalities such as impacted canine traction, closing old extraction sites, slow expansion, post-orthodontic stability, open bite correction, the treatment of bimaxillary dento-alveolar protrusion, molar intrusion, and manipulation of anchorage.4-23 Controversies exist in regard to the different surgical and orthodontic aspects of the technique of CAOT. For example, the use of buccal and palatal decortication with the help of bone grafting was adopted in the initial description of the procedure with a rate of activation of the fixed orthodontic appliance after CAOT of 2 weeks. This showed a 3-4 fold increase in tooth movement.2-4 Others, however, used only buccal decortications, and showed a 2-2.5 fold increase in tooth movement.14,24,25 Recently, modifications of the CAOT technique such as the use of piezocision and corticision, which are performed without reflecting gingival flaps, were introduced in an attempt to minimize the risk associated with the conventional technique. These techniques, while all involve surgical cortical injuries, they seem to be different in their effects and healing process and so far, they were described only in case reports.26,27 The biological principle behind CAOT was investigated in many animal studies. The increasing velocity of tooth movement after corticotomy (cortical injuries) was attributed to accelerating bone turnover, which was called the regional accelerating phenomenon (RAP). The RAP was defined as a re-organization activity and physiologic event that occurred adjacent to the site of injury, resulting in regional decrease in bone density in the healthy tissue.22 Most of the animal studies confirmed RAP as the main biological mechanism behind the acceleration of orthodontic tooth movement. The most recent explanation of the biological mechanism behind CAOT concluded that localized selective decortication surgery in combination with orthodontic tooth movement results in a rapid alveolar bone remodeling in bone marrow cavities, leads to reduced hyalinization of the PDL, and absence of the lag phase during later stages of orthodontic tooth movement.12 That was used to explain the observed decreased root resorption in the corticotomy side, an apparently added advantage to CAOT.23 Rationale. Corticotomy-assisted orthodontic treatment was initially presented in case reports.2-6 Many human and animal studies were later conducted to test the effectiveness of this technique.7-17,24,25 Most published papers indicated that performing cortical and alveolar bone cuts around the roots of teeth would help accelerate tooth movement.1 However, the evidence of the outcome and the effectiveness by experimental studies has not been well-documented especially in the presence of an increasing number of case reports. In addition, the available case reports and experimental studies lack consensus on the biological basis, the described technique of CAOT, and the indications of its use. These aspects need to be verified and supported by scientific evidences. The objective of this systematic review was to evaluate the quality of evidence behind the following: 1) CAOT accelerates tooth movement and enhances the traction of impacted canines when exposed surgically, the movement of ankylosed teeth, closure of old extraction sites, maxillary expansion, open bite correction, treatment of bimaxillary protrusion, and post orthodontic stability. 2) The technical variables involved in CAOT including the rate of activation, area of activation, the use of bone graft, and the use of flap versus flapless procedure. 3) The safety of CAOT compared with conventional orthodontics. 4) The biological principles behind CAOT in accelerating orthodontic movement in animal studies. Methods. Search strategy. This systematic review was conducted in the Faculty of Dentistry, King Disclosure. Authors have no conflict of interests, and the work was not supported or funded by any drug company.