Effect of Corticotomy on the Orthodontic Tooth Movement

NCT ID: NCT01630473

Last Updated: 2014-08-15

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 10 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2011-08-31
• Study Completion Date: 2013-08-31

Brief Summary

Orthodontic therapy allows for the treatment of dental malpositions in order to produce an adequate relationship between teeth during occlusion. Conventional orthodontic therapy applies slight forces and moves teeth slowly. It is generally performed during a 2 year minimum of time. Recent studies seem to suggest that orthodontic therapy time can be shortened by surgical assistance (corticotomy). This investigation is aimed to determine the velocity of tooth movement and changes in periodontal clinical parameters between corticotomy-assisted orthodontic therapy and conventional orthodontic therapy.

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. This balances the rate of bone resorption and bone apposition. An interesting finding was the reduced rate of hyalinization at the compression site, which may be due to increased width of the periodontal ligament and thus facilitating tooth movement.

As opposed to conventional osteotomy used in alveolar distraction, the preservation of the medullar vasculature during a corticotomy procedure provides and adequate blood supply and nutrition. This accelerates the rate of tissue healing and remodeling and hence orthodontic movement can start immediately after surgery. It has been calculated that the rate of tooth movement is doubled (2.5mm to 3mm at day 25) in comparison to standard orthodontics without any detrimental effects on periodontal tissues. This surgically assisted approach for improved tooth movement is beneficial for molar intrusion, space closure, de-crowding and open bite management.

This investigation is aimed to determine the velocity of tooth movement and changes in periodontal clinical parameters between corticotomy-assisted orthodontic therapy and conventional orthodontic therapy. Periodontally and systemically healthy subjects in need of orthodontic therapy for the treatment of teeth crowding in the anterior segment. The rate of tooth movement will be assessed by radiographs and cast models and periodontal clinical parameters will be recorded at each visit during the 4 month follow-up.

Conditions

Tooth Crowding

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Corticotomy-assisted orthodontics

This group of patients will receive corticotomy surgical procedure at day 0. Orthodontic activation will start immediately after surgery.

Group Type: EXPERIMENTAL

Corticotomy

Intervention Type: PROCEDURE

After a periodontal full flap is dissected, by using small round burs, vertical lines (2 mm depth corticotomy) parallel to each root of the teeth in the anterior segment (canines and incisors) are created 5 mm beyond the apex in the maxillary bones and interconnecting the lines at the apex by horizontal corticotomies. Marginal bone crest is not touched by the surgical procedure.

Conventional orthodontics

This group of patients will receive conventional orthodontics starting at day 0.

Group Type: ACTIVE_COMPARATOR

Conventional orthodontics

Intervention Type: PROCEDURE

Conventional orthodontic treatment

Interventions

Corticotomy

After a periodontal full flap is dissected, by using small round burs, vertical lines (2 mm depth corticotomy) parallel to each root of the teeth in the anterior segment (canines and incisors) are created 5 mm beyond the apex in the maxillary bones and interconnecting the lines at the apex by horizontal corticotomies. Marginal bone crest is not touched by the surgical procedure.

Intervention Type: PROCEDURE

Conventional orthodontics

Conventional orthodontic treatment

Intervention Type: PROCEDURE

Other Intervention Names

Osteotomy; Orthodontic treatment

Eligibility Criteria

Inclusion Criteria

• Voluntary participation
• Legally adult age (>18 years old)
• Full permanent dentition (28 teeth excluding third molars)
• Severe anterior teeth crowding
• Thick periodontal biotype

Exclusion Criteria

• Systemic diseases (i.e. diabetes, HIV)
• cigarette smoking
• Under medications: bisphosphonates, anti-epileptic drugs, contraceptives, corticosteroids, estrogen, antihistamine drugs, calcitonin, vitamin D
• Previous orthodontic treatment
• Periodontal disease
• Severe gingival recessions
• Pregnancy
• Previous root resorption

• Minimum Eligible Age: 20 Years
• Maximum Eligible Age: 40 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Universidad de Antioquia

OTHER

Sponsor Role: lead

Responsible Party

Javier Enrique Botero

Full Time Professor of Periodontics

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Juan D Arango, DDS

Role: PRINCIPAL_INVESTIGATOR

Faculty of Dentistry, Universidad de Antioquia

Javier E Botero, PhD

Role: STUDY_DIRECTOR

Faculty of Dentistry, Universidad de Antioquia

Locations

Faculty of Dentistry, Universidad de Antioquia

Medellín, Antioquia, Colombia

Countries

Colombia

References

Nowzari H, Yorita FK, Chang HC. Periodontally accelerated osteogenic orthodontics combined with autogenous bone grafting. Compend Contin Educ Dent. 2008 May;29(4):200-6; quiz 207, 218.

Reference Type: BACKGROUND

PMID: 18533317 (View on PubMed)

Wilcko WM, Wilcko T, Bouquot JE, Ferguson DJ. Rapid orthodontics with alveolar reshaping: two case reports of decrowding. Int J Periodontics Restorative Dent. 2001 Feb;21(1):9-19.

Reference Type: BACKGROUND

PMID: 11829041 (View on PubMed)

Ozturk M, Doruk C, Ozec I, Polat S, Babacan H, Bicakci AA. Pulpal blood flow: effects of corticotomy and midline osteotomy in surgically assisted rapid palatal expansion. J Craniomaxillofac Surg. 2003 Apr;31(2):97-100. doi: 10.1016/s1010-5182(02)00188-9.

Reference Type: BACKGROUND

PMID: 12628599 (View on PubMed)

Koudstaal MJ, Wolvius EB, Schulten AJ, Hop WC, van der Wal KG. Stability, tipping and relapse of bone-borne versus tooth-borne surgically assisted rapid maxillary expansion; a prospective randomized patient trial. Int J Oral Maxillofac Surg. 2009 Apr;38(4):308-15. doi: 10.1016/j.ijom.2009.02.012. Epub 2009 Mar 10.

Reference Type: BACKGROUND

PMID: 19278832 (View on PubMed)

Akay MC, Aras A, Gunbay T, Akyalcin S, Koyuncue BO. Enhanced effect of combined treatment with corticotomy and skeletal anchorage in open bite correction. J Oral Maxillofac Surg. 2009 Mar;67(3):563-9. doi: 10.1016/j.joms.2008.06.091.

Reference Type: BACKGROUND

PMID: 19231781 (View on PubMed)

Other Identifiers

CORT2011

Identifier Type: -

Identifier Source: org_study_id