{"id":3436,"date":"2015-10-25T08:16:06","date_gmt":"2015-10-25T08:16:06","guid":{"rendered":"http:\/\/biomedpharmajournal.org\/?p=3436"},"modified":"2020-04-25T09:35:44","modified_gmt":"2020-04-25T09:35:44","slug":"a-one-stage-corticotomy-assisted-orthodontic-technique-for-accelerated-retraction","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol8octoberspledition\/a-one-stage-corticotomy-assisted-orthodontic-technique-for-accelerated-retraction\/","title":{"rendered":"A-One Stage Corticotomy Assisted Orthodontic Technique for Accelerated Retraction"},"content":{"rendered":"<p><strong>Introduction<\/strong><\/p>\n<p>Bimaxillary protrusion is a condition characterized by protrusive and proclined upper and lower anterior teeth and an increased procumbency of the lips<sup>1<\/sup>, many patients with bimaxillary protrusion seek orthodontic treatment to decrease this procumbency. During retraction, the characteristics of the anterior alveolar bone can \u00a0resist the efforts to remodel bone. The anatomic limits set by the cortical plates of the alveolus at the level of the incisor apices act as barriers to incisor retraction.<\/p>\n<p>Corticotomy is one of the surgical procedures that is commonly used in which only the cortical bone is cut and perforated but not the medullary bone. In 1959, K\u00f6le<sup>2 <\/sup>\u00a0introduced a technique called selective alveolar decortications to enable movement of a bone segment that included a tooth by sectioning the layer of compact bone. In 2001, Wilcko et al<sup>3 <\/sup>\u00a0developed \u00a0a new treatment method combining corticotomy, alveolar augmentation, and orthodontic treatment. They have observed that orthodontic tooth movement is accelerated by the increase of bone turnover and decrease of bone density because osteoclasts and osteoblasts are increased due to a regional acceleratory phenomenon (RAP).<sup>4, 5<\/sup><\/p>\n<p><strong>Concept and Indication<\/strong><\/p>\n<p>Stages of active orthodontic treatment depending on Class of malocclusion and extraction or nonextraction treatments, emphasizes the stage requiring the greatest tooth \u00a0movement. For extraction cases, the limited duration of the corticotomy (Selective alveolar decortications) effect might be best applied during the retraction stage of treatment, when the greatest tooth movements are required.<sup>6<\/sup><\/p>\n<p><strong>Indications<\/strong><\/p>\n<ul>\n<li>Bimaxillary protrusion cases with proclined incisors.<\/li>\n<li>Cases with aligned arches and crowding \u20393mm.<\/li>\n<li>Cases requiring all first bicuspid extraction.<\/li>\n<li>Dentoalveolar to moderate alveoloskeletal malocclusions<\/li>\n<\/ul>\n<p><strong>The potential advantages of the treatment in comparison with traditional orthodontics are<\/strong><\/p>\n<ul>\n<li>Increased rate of tooth movement.<\/li>\n<li>Increased alveolar volume and a more structurally complete periodontium.<\/li>\n<\/ul>\n<p><strong>Undecorticated segment serves as better source of anchorage.<\/strong><\/p>\n<p><strong>Technique<\/strong><\/p>\n<p><strong>Initial Preparation Stage<\/strong><\/p>\n<p>A treatment plan was developed by the orthodontist\/ surgeon team to determine the teeth that will undergo bone activation, anchorage, and the teeth that will need to be extracted.<strong>\u00a0\u00a0\u00a0\u00a0 <\/strong><\/p>\n<p>Typically, the orthodontic brackets were placed and a light wire engaged \u00a0with 0.022\u2019 slot Roth appliance. Leveling and aligning \u00a0(Fig. 1) was carried out until 0.019\u201dX 0.025\u201d stainless steel archwire could be fully engaged in the bracket slot, the first premolars were not-extracted till the time of\u00a0 selective alveolar decortications \u00a0stage.<\/p>\n<table style=\"width: 70%;\" border=\"1\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3440\" src=\"https:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ONE_Vij_fig1-150x150.jpg\" alt=\"Figure 1: Leveling and aligning\" width=\"150\" height=\"150\" srcset=\"https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ONE_Vij_fig1-150x150.jpg 150w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ONE_Vij_fig1.jpg 414w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/td>\n<td><strong>Figure 1: Leveling and aligning<\/strong><\/p>\n<p><a href=\"http:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ONE_Vij_fig1.jpg\" target=\"_blank\">Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong>Stage of Selective alveolar decortications (SAD)\/ Corticotomy:<\/strong><\/p>\n<p>Corticotomy after orthodontic alignment. A single arch requiring selective decortications \u00a0can require 1\/2 hour \u00a0to 1hour \u00a0carried out under local anesthesia (Lignox 2%A). Lower arch (Fig 2) procedure preceded 2 weeks ahead of the upper arch. First premolars were extracted at the time of the surgery and a stainless steel 0.019\u201d \u00d7 0.025\u201d archwire with soldered brass hooks was placed before flap elevation .<\/p>\n<p>Sulcular incisions from the distal aspect of one canine to the contralateral canine were placed, and full thickness flap was elevated, 3 mm above the apical region of the tooth. 701 fissure bur and number 2 size round bur mounted on a micromotor handpiece under copious<\/p>\n<p>irrigation was used for decortications (only cortical surface scoring and not through and through penetration). If there was a good amount of inter\u2011root distance between two adjacent teeth vertical interdental cortical surface scoring was done otherwise only surface punch hole were placed in the area, stopping 2 mm short of the alveolar crest, occlusally. Horizontal decortications connected the vertical 2 mm beyond root apex. Selective alveolar decortication from the mesial aspect of one canine to the mesial surface of the contralateral canine involving the anteriors was performed. Similarly, a palatal flap incision was raised immediately for decortications of the superficial surface of the palatal bone for RAP to occur (Fig. 2, 3). The graft was placed only in cases with evidence of bone loss (dehiscence and fenestration) on flap elevation . Demineralized demineralized freeze\u2011dried bone allograft, wetted with sterile saline and maintained in the desired position by full thickness flap, sutured with an interrupted loop, nonresorbable 4\u20110 black silk suture material, left in place for 1\u20132 weeks.<\/p>\n<table style=\"width: 70%;\" border=\"1\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3441\" src=\"https:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ONE_Vij_fig2-150x150.jpg\" alt=\"Figure 2: Mandibular corticotomy, start of retraction 1 week post operative.\" width=\"150\" height=\"150\" srcset=\"https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ONE_Vij_fig2-150x150.jpg 150w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ONE_Vij_fig2.jpg 454w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/td>\n<td><strong>Figure 2: Mandibular corticotomy, start of retraction 1 week post operative.<\/strong><\/p>\n<p><a href=\"http:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ONE_Vij_fig2.jpg\" target=\"_blank\">Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<table style=\"width: 70%;\" border=\"1\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3442\" src=\"https:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ONE_Vij_fig3-150x150.jpg\" alt=\"Figure 3: Maxillary corticotomy, start of retraction 1 week post operative\" width=\"150\" height=\"150\" srcset=\"https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ONE_Vij_fig3-150x150.jpg 150w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ONE_Vij_fig3.jpg 451w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/td>\n<td><strong>Figure 3: Maxillary corticotomy, start of retraction 1 week post operative<\/strong><\/p>\n<p><a href=\"http:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ONE_Vij_fig3.jpg\" target=\"_blank\">Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong>Stage of Retraction<\/strong><\/p>\n<p>Initiation of orthodontic force was done within 5\u20137 days after the surgery with the help of closed NiTi coil spring which was engaged from the first molar tube to the soldered hook on the archwire delivering a force of 250 g for en\u2011masse retraction using sliding mechanics. (Fig 4)<\/p>\n<table style=\"width: 70%;\" border=\"1\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3443\" src=\"https:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ONE_Vij_fig4-150x150.jpg\" alt=\"Figure 4: Retraction mechanics\" width=\"150\" height=\"150\" srcset=\"https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ONE_Vij_fig4-150x150.jpg 150w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ONE_Vij_fig4.jpg 449w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/td>\n<td><strong>Figure 4: Retraction mechanics<\/strong><\/p>\n<p><a href=\"http:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ONE_Vij_fig4.jpg\" target=\"_blank\">Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong>Discussion<\/strong><\/p>\n<p>In the treatment of bimaxillary protrusion, two important factors for consideration are: esthetic improvement of the dentofacial area and the establishment of the stable dental relationship that embodies the requirement of line of occlusion. Time is an important factor during the course of orthodontic treatment. Corticotomy (selective alveoloar decortictation) can be effectively used to correct dentoalveolar and moderate alveoloskeletal problems. As the severity increases from alveoloskeletal to pure skeletal problems osteotomy and\/or distraction osteogenesis would be the choice of treatment.<\/p>\n<p>In Wilcko\u2019s<sup>7 <\/sup>\u00a0protocol corticotomy was performed prior to aligning and an additional procedure namely Ostectomy (surgical removal of cortical plate) in the extraction space was required which is both cumbersome and expensive to the patient because of additional grafting required in the area. The procedure employed in our study has the advantage of being less invasive, is done under local anesthesia and is a simpler technique.<\/p>\n<p>Case selection with minimal crowding helps to maintain the tooth within the cortex during leveling and aligning stage. Thus the first bicuspids were delayed and extracted to act as a fresh extracted socket and reduced bony resistance to retraction, an added advantage to accelerated retraction. The use of rigid archwires during and after \u00a0selective alveolar decortications provided controlled retraction of the anteriors whereas the undecorticated posterior segment acted as good source of anchorage module.<\/p>\n<p>Aboul Ela et al<sup>8 <\/sup>\u00a0who reported that the rate of space closure peaked during the end of 1<sup>st<\/sup> and 2<sup>nd<\/sup> month and reduced by the end of 4<sup>th<\/sup> month. This could be biologically co-related with the transient RAP phenomenon as mentioned by Frost<sup>4 <\/sup><strong>\u00a0<\/strong>which remains active for 4 months. For extraction, the limited duration of the corticotomy effect might be best applied during the retraction stage of treatment, when the greatest tooth movements are required.<\/p>\n<p><strong>Table 1: Selective Alveolar Decortication<\/strong><\/p>\n<table width=\"90%\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\" width=\"169\"><strong>Key Characteristics<\/strong><\/td>\n<td style=\"text-align: center;\" width=\"256\"><strong>Traditional technique<\/strong><\/td>\n<td style=\"text-align: center;\" width=\"213\"><strong>Current Modified technique<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"169\">Decortication timing<\/td>\n<td style=\"text-align: center;\" width=\"256\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Beginning of orthodontic treatment.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 SAD as required throughout therapy.<\/td>\n<td style=\"text-align: center;\" width=\"213\">SAD planned just before stage of retraction.<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"169\">Exraction of teeth<\/td>\n<td style=\"text-align: center;\" width=\"256\">At the start of treatment.<\/td>\n<td style=\"text-align: center;\" width=\"213\">Delayed extraction along with SAD<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"169\">Flap reflection<\/td>\n<td style=\"text-align: center;\" width=\"256\">Buccal and lingual in cases of retraction<\/td>\n<td style=\"text-align: center;\" width=\"213\">Buccal and lingual for en- masse retraction.<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"169\">Activation intervals<\/td>\n<td style=\"text-align: center;\" width=\"256\">Biweekly<\/td>\n<td style=\"text-align: center;\" width=\"213\">Continuous moderate force.<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"169\">Archwire<\/td>\n<td style=\"text-align: center;\" width=\"256\">Flexible Niti archwires during decortication procedure.<\/td>\n<td style=\"text-align: center;\" width=\"213\">Rig.id archwires during decortications procedure.<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"169\">Indications<\/td>\n<td style=\"text-align: center;\" width=\"256\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Accelerated tooth movement.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mild to moderate crowding.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mild to moderate arch development.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Extraction site closure<\/td>\n<td style=\"text-align: center;\" width=\"213\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Accelerated tooth movement in extraction cases.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 En-masse retraction.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bimaxillary protrusion cases with mild crowding.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong>Conclusion<\/strong><\/p>\n<p>Corticotomy assisted retraction drastically reduces the overall duration of Orthodontic treatment. It is particularly useful in maximum anchorage cases since by Selective decortications the anchorage segment can be made virtually stationary and the entire extraction space can be utilized for retraction.\u00a0This novel technique also allows the possibility for severely proclined anterior\u00a0 to attain ideal axial inclination within the alveolar trough and retain stable occlusion.<\/p>\n<p><strong>Bibliography<\/strong><\/p>\n<ol>\n<li>Lewis SJ- Bimaxillary Protrusion. Angle Orthod. 1943;13:51-59.<\/li>\n<li>K\u00f6le H: Surgical operations of the alveolar ridge to correct occlusal abnormalities. Oral Surg Oral Med Oral Pathol. 1959; 12: 515-529.<\/li>\n<li>Wilcko WM, Wilcko T, Bouquot JE, Ferguson DJ. Rapid orthodontics with alveolar reshaping: Two case reports of decrowding. Int J Periodontics Restorative Dent 2001;21: 9\u2011<\/li>\n<li>Frost HM. Biology of fracture healing \u2013 An overview for clinicians Part I and II. Clini Orthop Relat Res 1989;248:283<\/li>\n<li>Yaffe A, Fine N, Binderman I. Regional accelerated phenomenon in the mandible following mucoperiosteal flap surgery. J Periodontol 1994;65: 79\u2011<\/li>\n<li>Peter H. Buschang, Phillip M. Campbell, and Stephen Rus. Accelerating Tooth Movement With Corticotomies: Is It Possible and Desirable?. Semin Orthod\u00a02012;18:286-294.<\/li>\n<li>Wilcko MT, Wilcko WM, Bissada NF. An evidence\u2011based analysis of periodontally accelerated orthodontic and osteogenic techniques: A synthesis of scientific perspectives. Semin Orthod 2008;14: 305\u2011<\/li>\n<li>Aboul-Ela SMB, Beialy AR, El-Sayed KMF, Selim EMN, EL-Mangoury NH, Mostafad YA. Miniscrew implant-supported maxillary canine retraction with and without corticotomy-facilitated orthodontics. Am J Orthodontics and Dentofacial Orthopedics 2011;139: 2.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Introduction Bimaxillary protrusion is a condition characterized by protrusive and  [&#8230;]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20],"tags":[],"class_list":["post-3436","post","type-post","status-publish","format-standard","hentry","category-vol8octoberspledition"],"_links":{"self":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/3436","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/comments?post=3436"}],"version-history":[{"count":4,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/3436\/revisions"}],"predecessor-version":[{"id":33065,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/3436\/revisions\/33065"}],"wp:attachment":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/media?parent=3436"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/categories?post=3436"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/tags?post=3436"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}