Periodontally accelerated osteogenic orthodontics treatment and corticotomy Hello doctor Chamberland, I would like to undergo a rapid orthodontic treatment and my orthodontist is proposing an orthodontic treatment with corticotomy. I would like to get your opinion on corticotomy: Is it a safe technique? Is remission good and does the bone become completely normal and viable again? Is durability of teeth compromised? In short, are there any risks? Thanks a lot for your help!
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This article has been cited by other articles in PMC. Abstract Corticotomy-assisted orthodontic treatment is an established and efficient orthodontic technique that has recently been studied in a number of publications. It has gradually gained popularity as an adjunct treatment option for the orthodontic treatment of adults. It involves selective alveolar decortication in the form of decortication lines and dots performed around the teeth that are to be moved.
It is done to induce a state of increased tissue turnover and a transient osteopenia, which is followed by a faster rate of orthodontic tooth movement.
This technique has several advantages, including faster tooth movement, shorter treatment time, safer expansion of constricted arches, enhanced post-orthodontic treatment stability and extended envelope of tooth movement. The aim of this article is to present a comprehensive review of the literature, including historical background, contemporary clinical techniques, indications, contraindications, complications and side effects.
Keywords: Corticotomy, decortication, review, orthodontic treatment. There are several psychological, biological and clinical differences between the orthodontic treatment of adults and adolescents. Adults have more specific objectives and concerns related to facial and dental aesthetics, the type of orthodontic appliance and the duration of treatment.
Growth is an almost insignificant factor in adults compared to children, and there is increasing chance that hyalinization will occur during treatment [ 2 ]. In addition, cell mobilization and conversion of collagen fibers is much slower in adults than in children. Finally, adult patients are more prone to periodontal complications since their teeth are confined in non-flexible alveolar bone [ 2 ].
These considerations make orthodontic treatment of adults different and challenging as well as necessitate special concepts and procedures, such as the use of invisible appliances, shorter periods of treatment, the use of lighter forces and more precise tooth movements.
The development of corticotomy-assisted orthodontic treatment CAOT opened doors and offered solutions to many limitations in the orthodontic treatment of adults. This method claims to have several advantages. These include a reduced treatment time, enhanced expansion, differential tooth movement, increased traction of impacted teeth and, finally, more post-orthodontic stability. The evidence of the success of corticotomy as an adjunct to orthodontic treatment has not been well documented, and few published reports are available.
The aim of this article is to present a comprehensive review of the literature, including the historical background, the contemporary clinical techniques, indications, contraindications, complications and side effects. In , it was first defined as a linear cutting technique in the cortical plates surrounding the teeth to produce mobilization of the teeth for immediate movement [ 3 ].
This theory of en bloc movement to enhance tooth movement prevailed in several subsequent reports [ 5 - 8 ]. Suya specified that most orthodontic treatments should be completed in the first three to four months after corticotomy and before fusion of the tooth-bone units [ 7 ]. Generson et al. RAP was explained as a temporary stage of localized soft and hard-tissue remodeling that resulted in rebuilding of the injured sites to a normal state through recruitment of osteoclasts and osteoblasts via local intercellular mediator mechanisms involving precursors, supporting cells, blood capillaries and lymph [ 10 ].
This accelerated remodeling is influenced by bone density and the hyalinization of the periodontal ligament PDL [ 11 - 14 ]. This technique is similar to conventional corticotomy except that selective decortication in the form of lines and points is performed over all of the teeth that are to be moved.
In addition, a resorbable bone graft is placed over the surgical sites to augment the confining bone during tooth movement. After a healing period of one or two weeks, orthodontic tooth movement is started and then followed up using a faster rate of activation at two week intervals [ 15 , 16 ]. Wilcko explained the concept of reversible osteopenia in a study of five patients using computed tomographic imaging [ 17 ].
After corticotomy, demineralization occurs in the alveolar bone and the remaining collagenous matrix of the bone is transported with the tooth during its movement. The matrix then remineralizes after the orthodontic movement. This introduced new concepts to the CAOT field, including bone matrix transportation and osteopenia-facilitated rapid tooth movement [ 17 ]. The evidence presented in support of CAOT thus far is case report studies, which is considered weak evidence to support the purported advantages and the mechanism of action.
Recent animal studies have added more evidence to the effect of CAOT. Ren et al. The tooth on the experimental side moved more rapidly than the tooth on the control side, without any associated root resorption or irreversible pulp injury.
In addition, active and extensive bone remodeling around the moved tooth was shown. Mostafa et al. In another animal study using CAOT, the third premolar was mesialized significantly faster than the control side in 12 dogs.
Cortictomy was found to increase tooth movement for at least 2 weeks after the surgery and to limit the hyalinization of the periodontal ligaments on the alveolar wall to the first week after corticotomy.
This was also attributed to a rapid alveolar bone reaction [ 20 ]. Two recent histological studies were conducted to evaluate tissue response to decortication [ 21 , 22 ]. Sebaoun et al. This study demonstrated an increased turnover of alveolar spongiosa as a response to alveolar decortication. Three weeks after surgery, the catabolic activity osteoclast count and anabolic activity apposition rate were three times greater, calcified spongiosa decreased by two-fold and PDL surface increased by two-fold.
This dramatic increase in bone turnover decreased to a steady state by the eleventh week after surgery. The observed effect of corticotomy was localized to the area immediately adjacent to the decortication cuts. In the other histological study, Wang et al.
CAOT was compared to osteotomy-assisted tooth movement and to controls. Corticotomy was found to produce bone resorption around the moving teeth by day 21 after surgery and the area refilled with bone after 60 days. This confirms the occurrence of reversible osteopenia during CAOT. The CAOT Technique Case selection is a very important step; both the orthodontist and the periodontist should agree upon the need for corticotomy, treatment plan and the extent and location of the decortication cuts.
The PAOO technique described by Wilcko is as follows [ 23 ]: full-thickness flaps are reflected labially and lingually using sulcular releasing incisions. The releasing incision can also be made within the thickness of the gingival attachment or at the base of the gingival attachment mucogingival junction.
Flaps should be carefully reflected beyond the apices of the teeth to avoid damaging the neurovascular complexes exiting the alveolus and to allow adequate decortication around the apices. Selective alveolar decortication is performed in the form of decortication cuts and at points up to 0.
This poses little threat to tooth vitality and makes PAOO much safer than the osteotomy technique, in which cuts extend into the medullary bone around the teeth that are to be moved. Adequate bio-absorbable grafting material is placed over the injured bone. Flaps are then repositioned and sutured into place. Sutures should be left in place for a minimum of two weeks. Tooth movement should start one or two weeks after surgery. Unlike conventional orthodontics, the orthodontic appliance should be activated every two weeks until the end of treatment after PAOO Fig.
Effect of Corticotomy on the Orthodontic Tooth Movement
Corticotomy is a relatively new method of treatment for selected deformities and defects of the jaw and skull. Gabriel Ilizarov, slowly perfected the surgical and postoperative management of corticotomy treatment to correct deformities and repair defects in the arms and legs. His work went mostly unnoticed until he presented to the Western Medical Society in the mids. Corticotomy was first used to treat defects of the oral and facial region in Since then, the surgical and technological advances made in the field of surgical orthodontics have provided oral and maxillofacial surgeons and orthodontists with a safe and predictable method to treat selected deformities. Call us Today! Simply stated, corticotomy means creating surgical bony cuts around teeth or tooth segments and is used in conjunction with orthodontics to achieve movements that may not be possible with orthodontics alone.
Department of Buccofacial Medicine and Surgery. School of Dentistry, Complutense University of Madrid. Private practice. Madrid 4MD, PhD. Maxillofacial surgeon. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Procedure: Corticotomy Procedure: Conventional orthodontics Not Applicable Detailed Description: The use of surgical techniques to accelerate orthodontic tooth movement has been developed. By means of surgical burs, vertical grooves in the cortical plate corticotomy are produced mesial and distal to the roots of teeth that are being moved 3 mm below the marginal crest and extending beyond the apex. Animal studies showed that the rapid orthodontic tooth movement was due to increased cellular activity in the surrounding periodontal tissues, a regional acceleratory phenomenon RAP. A high osteoclastic activity is observed in the compression side although is also observed in the tension side to a less degree. Histological analysis indicates that at day 21 the remodeling tissues are replaced by a fibrous tissue and later 60 days by bone. Furthermore, the tissues immediately adjacent to the corticotomy are characterized by an increased width of the periodontal ligament, less calcified spongiosa bone surface and higher counts of osteoclasts. But not only the catabolic activity is increased osteoclasts but also the anabolic activity osteoblasts is increased 3-fold as well.
Corticotomy and rapid orthodontics