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JOURNAL CLUBJOURNAL CLUB
www.indiandentalacademy.comwww.indiandentalacademy.com

““ LOWER INCISOR RETRACTIONLOWER INCISOR RETRACTION
WITH A MODIFIEDWITH A MODIFIED
CORTICOTOMY “CORTICOTOMY “
AO 2006,76(6);880-88AO 2006,76(6);880-88

INTRODUCTIONINTRODUCTION
 SURGERY – combined for better orthoSURGERY – combined for better ortho
TxTx
 CORTICOTOMYCORTICOTOMY
 RAPRAP
 AOOAOO

CORTICOTOMYCORTICOTOMY
 ““ Surgical removal of alveo bone “Surgical removal of alveo bone “
OROR
Osteotomy of the cortical bonOsteotomy of the cortical bon
 It distract the bone – growth of new boneIt distract the bone – growth of new bone
 Moving group of teeth with alveo process-Moving group of teeth with alveo process-
spongiosa intactspongiosa intact

Review of literatureReview of literature
 1950 Periodontists - rate of OTM1950 Periodontists - rate of OTM
 1959 Kole – 11959 Kole – 1stst
labial & palatallabial & palatal
corticotomycorticotomy
 1990 Dr.Wilcko: AOO - (CT scan)1990 Dr.Wilcko: AOO - (CT scan)
mineralisation of alveolar bone –mineralisation of alveolar bone –
responsible for OTMresponsible for OTM
 2001 chung et al- ant retraction in2001 chung et al- ant retraction in
bimaxbimax

CORTICOTOMY INCORTICOTOMY IN
ORTHODONTICSORTHODONTICS
 AlternativeAlternative to ortho Txto ortho Tx
 FASTER, less side effects & ptFASTER, less side effects & pt
compliancecompliance
 Moving blocks of boneMoving blocks of bone
 ORTHO Tx TIMEORTHO Tx TIME – resistance of the– resistance of the
dense cortical bone to OTM is removeddense cortical bone to OTM is removed

INDICATIONS / USES :INDICATIONS / USES :
 Non-growing / Old / faster ortho TxNon-growing / Old / faster ortho Tx

 Retraction- Class II div 1, bimaxRetraction- Class II div 1, bimax
 Spacing, rotationSpacing, rotation
 Intrusion (AOB)Intrusion (AOB)
 AnkylossisAnkylossis
 Teeth with narrow cortical boneTeeth with narrow cortical bone
 TSALDTSALD
 T/S constricted maxillaeT/S constricted maxillae

AdvantagesAdvantages
 rate of OTM – Tx timerate of OTM – Tx time
 Avoid adverse effects of ortho Tx :Avoid adverse effects of ortho Tx :
 No gingival/PDL damageNo gingival/PDL damage
 Root resorptionRoot resorption
 Loss of vitality of teeth/boneLoss of vitality of teeth/bone
 Conservative surgeryConservative surgery
 No retention problems & tongueNo retention problems & tongue
functions – after Txfunctions – after Txwww.indiandentalacademy.comwww.indiandentalacademy.com

Conventional :Conventional :
 Both B-L cutsBoth B-L cuts
 2 stage surgery2 stage surgery
Modified :Modified :
 LABIAL- only noLABIAL- only no
lingual V & sub apicallingual V & sub apical
H/Z cutsH/Z cuts
 Conservative – 1stgeConservative – 1stge
Less time & ptLess time & pt
discomfortdiscomfort
 Corticotomy site-Corticotomy site-
mobilisedmobilised

AIMAIM
““ Rapid & effective modified alveolarRapid & effective modified alveolar
corticotomy-facilitated ortho Tx of ancorticotomy-facilitated ortho Tx of an
adult case with severe malocclusion -adult case with severe malocclusion -
A CASE REPORT “A CASE REPORT “

Tx objectives:Tx objectives:
Tx plan :Tx plan :
 X of al 4s-maxi anchorageX of al 4s-maxi anchorage
 Segmental canine retraction-at endSegmental canine retraction-at end
accelaration by – corticotomy-accelaration by – corticotomy-
facilitated incisor retractionfacilitated incisor retraction

 Pre op –Pre op –
OPG,OCCLUSALOPG,OCCLUSAL
 Retraction-0.016 xRetraction-0.016 x
0.022 S.S with T0.022 S.S with T
loop-1wk b4loop-1wk b4

SURGERY :SURGERY :
 0.5mm S.S bur,0.5mm S.S bur,
1.5-2mm depth,1.5-2mm depth,
2-3mm below2-3mm below
apicesapices

 Immediate consolidationImmediate consolidation
 3 wks- Dec OJ, Xn space closed3 wks- Dec OJ, Xn space closed
 LI retraction - 1.5 mosLI retraction - 1.5 mos
 No problems of vascularity/vitality/rootNo problems of vascularity/vitality/root
resoption/gingivalresoption/gingival

ResultsResults
 Correction of ptCorrection of pt
problem listproblem list
 Tx completion – 16Tx completion – 16
mosmos

ConclusionConclusion
 Effective alternative Tx – adults,sevreEffective alternative Tx – adults,sevre
malocclusion,malocclusion, the Tx time (50%)the Tx time (50%)
 Beneficial- in difficult surgical lingualBeneficial- in difficult surgical lingual
accessibilityaccessibility
 Modified CORTI- coservative, lessModified CORTI- coservative, less
time & pt discomfort, cost effectivetime & pt discomfort, cost effective
 Risk of tissue damage-Risk of tissue damage-
teeth,bone,PDLteeth,bone,PDL

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