Surgical adjunctive procedures for accelerating orthodontic treatment by Padhraig S Fleming, Zbys Fedorowicz, Ama Johal, Ahmed El-Angbawi, Nikolaos Pandis ppt

1. Literature review

2. Type of study Cochrane Database of Systematic Reviews
Authors
Padhraig S Fleming, Zbys Fedorowicz, Ama Johal, Ahmed El-
Angbawi, Nikolaos Pandis
Date of publication 2016
Name of Journal www.cochranelibrary.com

3. Where to find Systematic Reviews?
 ADA Center for Evidence-Based Dentistry.
 Cochrane Database of Systematic Reviews.
 PubMed.
 Evidence Based Dentistry Journal.
 Journal of Evidence-Based Dental Practice.
 Trip Database.

4. What are Cochrane Reviews?
 Cochrane Reviews are systematic reviews of primary research in human health care and
health policy, and are internationally recognized as the highest standard in evidence-based
health care.
 They investigate the effects of interventions for prevention, treatment and rehabilitation.
 They assess the accuracy of a diagnostic test for a given condition in a specific patient group
and setting.

5. What is the difference between Pubmed and Cochrane?
 PubMed: an unfiltered source of primary literature comprises all different kinds of
publication types occurring in academic journals (23 million references).
 The Cochrane Library: a pre-filtered source which offers access to either synthesized
publication types or critically appraised and carefully selected references. (800,000
references).

6. Outlines:
 BACKGROUND
 OBJECTIVES
 METHODS
 RESULTS
 DISCUSSION
 AUTHORS’ CONCLUSIONS

7.  BACKGROUND
 Approximately 35% of adolescents between 12 and 15 years in the UK have a
treatment needs (Chestnutt 2006)
 Conventional orthodontic treatment period 18-24 months
 Re-activation of the appliance at intervals of between 4 and 10 weeks
 Techniques to reduce treatment duration:
Surgical, vibratory stimulation, Low laser therapy and avoidance of extraction

8.  BACKGROUND
Surgically assisted orthodontics:
1. Distraction: separation of the dental segment from the jaw
A)Distraction of the dento-alveolus B) Distraction of PDL

9.  BACKGROUND
2. Decortication:
 A surgical procedure involving intentional surgical
insult to alveolar bone, designed to accelerate tooth
movement.
 Approach has been modified by the addition of bio
absorbable grafts (Wilcko 2001)

10.  BACKGROUND
3. Corticision (flapless corticotomy):
This is a more conservative surgical procedure to
divide cortices transmucosally without reflecting a
mucoperiosteal.

11.  BACKGROUND
 A corticotomy is defined as a surgical procedure whereby only the cortical bone is cut,
perforated, or mechanically altered (Murphy et al., 2009).
 Kole was the first to describe modern-day corticotomy-facilitated orthodontics. He used the
term “bony block” to describe the suspected mode of movement after corticotomy.
What is Corticotomy

12.  BACKGROUND
Indications How does it work
 Class I malocclusion with
moderate to severe crowding.
 Class II malocclusion requiring
moderate expansion or
extraction.
 Mild class III malocclusion
 RAP (Regional Acceleratory Phenomena): Characterized by
an increase in cortical bone porosity and trabecular
bone surface turnover due to augmented
osteoclastic activity (Wilcko et al., 2011).
 Reduction in bone mass not volume
 PEAK 1-2 M

13.  BACKGROUND
Timing of the procedure
 At the start ortho TX
 During Ortho TX at a particular stage(canine exposure)

14. Surgical adjunctive procedures for accelerating
orthodontic treatment (Review)

15.  The Aim
 To assess the effects of surgically assisted orthodontics on the
duration and outcome of orthodontic treatment.

16.  Methods:
 Criteria for considering studies for this review
 RCT
 Participants: No orthognathic or craniofacial deformity
 Types of intervention
Control Active intervention
 Any form of orthodontic treatment with fixed
appliances, including extraction and non-
extraction treatment with or without
interproximal reduction.
 Surgically assisted Orthodontic TX

17.  Methods:
Primary outcomes Secondary outcomes
 Duration of TX
 Number and duration of visits
 Rate of tooth movement
 Periodontal health and inflammatory response
 Patient-reported outcomes: impact of fixed appliances on daily
life, quality of life and pain experience
 Patient satisfaction
 Improvement in occlusion adjudged using Peer Assessment Rating
(PAR)
 Prolonged stability of treatment

18.  Methods:
Search Methods Data Collection and analysis
 The Cochrane Oral Health Group’s Trials
 The Cochrane Central Register of Controlled
Trials
 MEDLINE
 EMBASE via OVID ( to 10 September 2014)
 Two review authors assessed the full-text papers
independently and resolved any disagreement on the
eligibility of included studies through discussion with
a third review author.

19.  Methods:
Excluded study
 Three were non-randomized
 One without a negative control group

20.  Results:
1076
STUDIES
4
STUDIES
After exclusion and eligibility
assessment
Participants:
 57 Participants
 Mean age 19.5

21. Abou-Ela 2011 Alikhani2013 Leethanakul2014 Fischer2007
Participant
 N13
 19 Y
 Class II dev I
 N 20
 19.5-33 Y
 Class II dev I
 N 18
 21.9 Y
 Requiring upper 4
exo
 N 6
 11.1-12.9 Y
 Bilateral ectopic canine, Class I
non exo
Intervention
 Corticotomy:
 Full thickness
submarginal flap (at
time of exo)
 Perforation in cortical
bone from 2-4.
 Space closure:
miniscrew , NITI
spring
 (150 g)
 3 MOP (micro-
osteoperforations)
distal to the
canine
 No flap
 Repeated surgery
 Miniscrews, NITI
spring,
 (100 g)
 Interseptal bone
reduction
 Exo socket widened
BL and deepen to
canine apex level
 -Canine exposure
 Corticotomy,
 circular holes (l.5mm depth)
spaced 2mm made M&D to
the canine into the edenttulos
area.
 Attachments placed 2 weeks
 Visits 4-6 w, 2w
 Unitl the tip of canine is
aligned

22. Abou-Ela 2011 Alikhani2013 Leethanakul2014 Fischer2007
Primary outcome
-Tooth movement per
One month
3 months
Antero-posterior
movement of 3,6
1.14mm
2.25
Movement of upper
canine
0.6mm
====
Movement of upper
canine
0.7mm
2mm
Movement of upper
canine in 40 w mean
difference 0.08 mm
per weak
Secondary outcome
1) Periodontal health
2) Pain experience
PD,CAL, Bone level,
gingival recession show
no difference ,P >0.05
-------------------------------
GI higher in operated
side ,P<0.05 after 2m
GCF befor Tx ,after
canine retraction,at each
visit
---------------------------------
24 h,7 days,28 days
No significant difference
P>0.5
Follow up Over period of space
closure + 4m
One month 3 months of canine
retraction
Until alignment of
canine tip

23. Discussion and conclusion
 Outcomes within the selected studies were primarily clinician-centred, pain measured in
one study, no assessment of QOL. (Quaity of life ) So future study must patient oriented.
 The tooth movement or space closure not the overall duration of Tx are used to assess the
effectiveness of surgical therapy.
 Limited amount of evidence, small number of participants of the included studies.

24. Discussion and conclusion
 The included studies were undertaken predominantly on skeletally- mature individuals; it
is therefore not possible to confirm the effectiveness of these procedures on adolescent
populations.
 No agreed surgical technique (repeated versus single surgery, flap versus flapless),
periodontal effect of repeated surgery should be evaluated.
 The review by Kalemaj 2015 suggested that surgically-assisted procedures may have a
short-term effect, which may diminish over time.

25. Post-orthodontic Periodontal Treatment
After orthodontic treatment, the patient should remain on a 3 month periodontal maintenance program.
A nightguard is indicated to control parafunction and can also be used as a post-orthodontic retainer.
Occlusal adjustment to diminish any fremitus from lateral interferences
Take a new set of periapical radiographs.
It takes at least 6 months after band removal for adequate bone remodeling and cessation of mobility.