Corticotomy depth and regional acceleratory phenomenon intensity:: A preliminary study

ObjectivesTo determine if the depth of corticotomy done with the piezoelectric knife could play a role in the intensity of the regional acceleratory phenomenon (RAP).Materials and MethodsEighteen Sprague-Dawley rats were divided into two groups: untreated (3 rats) and treatment (15 rats). In the treatment group, a split-model design was used. The right tibia received transcortical (deep) penetrations with the piezoelectric knife, while intracortical (shallow) penetrations were performed on the left tibia of the same animal. The rats were euthanized at day 1, 3, 7, 14, and 28. Cone-beam computed tomography scans were taken for each sample and then assessed by histological analysis.ResultsHigher amounts of osteoclastic activity and new collagen formation were observed in the deep penetration group when compared with the shallow penetration group. The former peaked at day 14 for both groups (1.53% ± 0.01% vs 0.03% ± 0.0004%, respectively), and the latter peaked at day 28 (0.65 × 10⁶ ± 0.01 vs 0.08 × 10⁶ ± 0.0008, respectively).ConclusionsWithin the limitations of this study, it appears that the intensity of the RAP in the rat is corticotomy depth dependent. This is to be kept in mind when decorticating the bone during surgically facilitated orthodontic procedures.     

牙槽骨增量骨皮质切开术的发展现状

错(牙合)畸形是临床常见疾病,需要正畸治疗.有些患者存在牙槽骨量不足,牙根外露,无法进行牙移动,严重限制了正畸治疗的开展.因此,增加牙槽骨量以及促进牙的排齐移动就显得尤为重要.牙槽骨增量骨皮质切开术(augmented corticotomy-assisted surgical orthodontics)能有效增加牙槽...     

Alveolar corticotomies for accelerated orthodontics: A systematic review

Introduction

It has been suggested that alveolar corticotomies may accelerate tooth movement, broaden the scope of malocclusion types that can be treated orthodontically, decrease the need for extractions, and support long-term stability. Several techniques have been proposed, although the indications, ideal design and technical characteristics, potential complications, and objective clinician and patient satisfaction remain unclear. This systematic review aimed to provide scientific support to validate alveolar corticotomies as a reliable approach to accelerated orthodontics.

骨皮质切开辅助正畸研究进展

近年研究发现骨皮质切开术可以有效加速正畸治疗,该技术以局部加速修复现象为理论基础发展而来,术式在其发展的百年间几经改良。在骨皮质切开的基础上发展出牙周快速成骨正畸,使用这种技术可使正畸治疗时间减少到传统正畸治疗时间的1/3到1/4,增强牙周组织支持,增加骨覆盖,减少牙根吸收,降低复发率。该文综合概述了骨皮质切开发展史,骨皮质切开后牙齿移动的机理与传统正畸的不同之处,以及相关临床、实验研究。     

Effectiveness of platelet rich fibrin versus demineralized bone xenograft in periodontally accelerated osteogenic orthodontics:: A pilot comparative clinical study

ObjectivesTo compare the rate of extraction space closure between periodontally accelerated osteogenic orthodontics (PAOO) using platelet-rich fibrin (PRF) (Group 1) and PAOO using demineralized bone xenograft (DMBM) (Group 2) and to compare the level of wound healing between the PRF group vs the DMBM group after PAOO.Materials and MethodsA two-arm prospective single blind pilot study with a split-mouth design was used in which 14 patients requiring premolar extraction were divided into two groups: PRF and DMBM. En-masse space closure was carried out with using mini implants after the PAOO procedure. The amount of space closure was measured at five time points with 2-week intervals within 2 months. The gingival healing levels were assessed using early wound healing scores on the first postoperative day.ResultsThe rate of extraction space closure was faster in the experimental quadrant at all time points (T1-T4) in the PRF group and at time points (T3, T4) in the DMBM group. Comparison between experimental quadrants showed a significant increase in the rate of space closure in the PRF group T1 to T3 (P < .05). The PRF group showed higher total early healing scores than the DMBM group.ConclusionsPRF, when used in the PAOO procedure, produces a faster rate of space closure with better early wound healing than DMBM.     

一种牙槽骨再生正畸治疗骨开裂、骨开窗的新术式：骨膜“包饺子”植骨法

目的 ：介绍并评价一种牙槽骨再生正畸治疗(periodontal accelerated osteogenic orthodontics, PAOO) 下前牙区唇侧骨开裂、骨开窗的新术式,即采用骨膜“包饺子”植骨法对牙根表面牙槽骨 缺损行骨增量术。方法 ：自2014年3月—2014年8月,对8例 (男2例,女6例)下前牙唇侧骨开窗、骨开裂患者行骨膜“包饺子”植骨法。首先向根方分离半厚瓣,于半厚瓣最下方切开骨膜层,仔细将骨膜层剥离牙槽骨骨膜,以利于骨膜下植入骨移植材料,最后将骨膜缝合固定于骨面,形似“饺子”, 以防止植骨材料移位与外漏。所有患者术前、术后1周进行锥形束CT(cone-beam computed tomography,CBCT)检查,评价下前牙唇侧牙槽骨高度的变化及冠1/3、中1/3、根1/3的中部牙槽骨宽度改变。采用SPSS 16.0软件包对数据进行配对t检验。结果 ：术后无严重并发症出现。CBCT显示骨植入物形态维持良好。冠1/3中部唇侧牙槽骨宽度增加(0.65±0.89) mm,牙根中部牙槽骨宽度增加(3.30±1.09) mm,根1/3中部宽度增加至(3.96±1.35) mm,所有改变均具有统计学意义（P<0.01）;下前牙垂直向牙槽骨增加(5.35±1.90) mm（P<0.01）。结论 ：采用骨膜“包饺子”植骨法能防止移植材料移位,利于其塑形,促进骨再生在需要的部位发生,最终有效增加了缺损牙槽骨的高度及宽度。该方法并发症少,近期疗效好,但远期效果有待进一步评价。     

牙周加速成骨正畸临床应用效果的研究进展

牙周加速成骨正畸(PAOO)是指对牙槽骨进行骨皮质切开,并在切开骨表面进行颗粒骨移植以辅助正畸治疗。骨皮质切开诱导的局部加速现象可诱导破骨活性增加,加速骨代谢,从而有效加速正畸牙移动,缩短疗程,并可以减少牙根吸收等正畸并发症的发生。颗粒骨的植入能扩大正畸牙的移动范围,拓宽正畸治疗的适应证,保证牙周健康,提高治疗稳定性。本文就PAOO对正畸治疗中牙移动速率、骨增量效果以及牙根吸收的临床效果作一综述,以便为该技术的临床应用提供参考。     

A pilot clinical study of Class III surgical patients facilitated by improved accelerated osteogenic orthodontic treatments

Objective:To evaluate if the improved accelerated osteogenic orthodontics (IAOO) procedure could speed Class III surgical patients'' preoperative orthodontic treatment duration and, if yes, to what extent. This study was also designed to determine whether or not an IAOO procedure affects the tooth-moving pattern during extraction space closure.Materials and Methods:The samples in this study consisted of 24 Class III surgical patients. Twelve skeletal Class III surgery patients served as an experimental group (group 1) and the others as a control group (group 2). Before treatment, the maxillary first premolars were removed. For group 1, after the maxillary dental arch was aligned and leveled (T2), IAOO procedures were performed in the maxillary alveolar bone. Except for this IAOO procedure in group 1, all 24 patients experienced similar combined orthodontic and orthognathic treatment. Study casts of the maxillary dentitions were made before orthodontic treatment (T1) and after extraction space closure (T3). All of the casts were laser scanned, and the amount of movement of the maxillary central incisor, canine, and first molar, as well as arch widths, were digitally measured and analyzed by using the three-dimensional model superimposition method.Results:The time durations T3–T2 were significantly reduced in group 1 by 8.65 ± 2.67 months and for T3–T1 were reduced by 6.39 ± 2.00 months (P < .001). Meanwhile, the tooth movement rates were all higher in group 1 (P < .05). There were no significant differences in the amount of teeth movement in the sagittal, vertical, and transverse dimensions between the two groups (P > .05).Conclusion:The IAOO can reduce the surgical orthodontic treatment time for the skeletal Class III surgical patient by more than half a year on average. The IAOO procedures do not save anchorage.     

压电骨皮质切开术在正畸中加速牙移动临床效果Meta分析

目的评价压电骨皮质切开术在正畸治疗中加速牙齿移动的临床效果。 方法根据Cochrane Handbook规范化要求，分别在中国知网（CNKI）、万方、维普、Cochrane Library、PubMed、Embase、Web of Science、ClinicalTrials.gov等数据库，以"Piezosurgery" "Orthodontics" "Tooth Movement Techniques"等主题词及其下位词，以及"加速牙齿移动" "骨皮质切开术" "超声骨刀" "正畸"为检索关键词进行检索，将检索时间限定为2009年1月至2021年6月。由3名成员进行独立标准化检索，根据预先制定标准对检索获得的文献进行筛选、偏倚风险评估和数据搜集。由于研究之间存在异质性，选择随机效应模型，选择RevMan 5.3软件对纳入文献进行Meta分析。 结果最终纳入临床随机对照试验4篇，其中共有57例受试者。Meta分析结果示，压电骨皮质切开术后第1个月和第3个月的移动速率与常规正畸治疗相比差异无统计学意义，第2个月移动速率提高0.48毫米/月，差异有统计学意义[WMD = 0.48，95%CI（0.36，0.59），P<0.001]。压电骨皮质切开术后前2个月尖牙移动速率提高0.52毫米/月，差异具有统计学意义[WMD = 0.52，95%CI（0.45，0.59），P<0.001]，研究之间异质性高（I² = 69%）。 结论压电骨皮质切开术可以在术后第2个月加快尖牙移动的速度，但是这种操作在临床上起到的效果并不显著，且术后第1个月和第3个月对牙齿移动速率可能无影响。     

Adult orthodontics: a quality assessment of Internet information

Objectives: This study evaluated the quality, reliability and readability of information on the Internet on adult orthodontics. Design: A quality assessment of adult orthodontic websites. Setting: Postgraduate Orthodontic Unit, Cork University Dental School and Hospital, Cork, Ireland. Method: An Internet search using three search engines (Google, Yahoo and Bing) was conducted using the terms (‘adult orthodontics’ and ‘adult braces’). The first 50 websites from each engine and under each search term were screened and exclusion criteria applied. Included websites were then assessed for quality using four methods: the HON seal, JAMA benchmarks, the DISCERN instrument and the LIDA tool. Readability of included websites was assessed using the Flesch Reading Ease Score (FRES). Results: Only 13 websites met the inclusion criteria. Most were of US origin (n?=?8; 61%). The authors of the websites were dentists (n?=?5; 39%), professional organizations (n?=?2; 15%), past patients (n?=?2; 15%) and unspecified (n?=?4; 31%). Only 1 website displayed the HON seal and three websites contained all JAMA benchmarks. The mean overall score for DISCERN was 3.9/5 and the mean total LIDA score was 115/144. The average FRES score was 63.1/100. Conclusions: The number of informative websites on adult orthodontics is low and these are of moderate quality. More accurate, high-quality Internet resources are required on adult orthodontics. Recommendations are made as to how this may be achieved.     

牙周加速成骨正畸技术辅助治疗骨性II类错牙合1例

目的 本病例报道1例改良的牙周加速成骨正畸（periodontally accelerated osteogenic orthodontics,PAOO）技术于骨性Ⅱ类错牙合畸形患者正畸正颌联合治疗中的辅助应用。诊治经过：在明确诊断及患者知情同意后,对患者进行正畸—正颌联合治疗。正畸去代偿前行改良的PAOO术式,包括保留龈乳头切口,全厚瓣翻开,牙根间骨皮质切开,填充骨移植材料但不放置屏障膜材料,以及改良的缝合方法。正畸去代偿后行正颌手术,且正颌术后进行术后正畸治疗。结果 PAOO术后17月,正畸去代偿结束时,临床疗效稳定,术区唇侧牙槽骨厚度增加,角化龈宽度增加,未见明显牙龈退缩及严重牙周炎症。结论 PAOO在正畸正颌治疗中的辅助应用能一定程度上改善患者的牙周表型,减少牙龈退缩、牙槽骨骨开窗、骨开裂等牙周并发症的风险。     

Adult orthodontics in the absence of orthognathic treatment: a hospital perspective

Abstract

Objective: To examine adult orthodontic treatment within two hospital settings and ascertain whether any factors have a statistically significant effect on treatment outcomes.

Design: A retrospective observational study.

Materials and methods: Through the analysis of hospital case notes, variables relating to adult patients undergoing orthodontic treatment that did not involve orthognathic surgery between 1991 and 2008 at the Eastman Dental and Croydon University Hospitals, were studied. In addition, a proportion of study models were Peer Assessment Rating (PAR) scored to determine treatment outcome.

Results: Females accounted for 76·2% of the adults studied, with a mean age of 31·24 years. The most commonly presenting malocclusion was a class II division 1 incisor relationship on a class II skeletal base, with over half of all patients studied having missing teeth upon presentation. The mean treatment length was 2·29 years. Only the type of orthodontic treatment (orthodontic-only or multidisciplinary) and/or the presence of a crowded upper labial segment had a statistically significant effect on treatment outcomes, as measured by PAR scores.

Conclusion: This study has highlighted demographical and treatment trends from a cohort of adult patients studied within two hospital orthodontic departments. It also illustrates that a crowded upper labial segment and the type of treatment provided has a statistically significant effect on post-treatment PAR scores     

Palatal orthodontic miniscrew insertion using a CAD-CAM surgical guide: description of a technique

The aim of this report was to describe a new computer-guided technique for a controlled site preparation and palatal orthodontic miniscrew insertion using a dedicated software. A surgical guide was designed after planning the appropriate insertion sites on three-dimensional images created by the fusion of cone-beam computed tomography (CBCT) and digital dental model images. Pre- and postoperative CBCT images were compared and the angular, coronal, and apical deviations between the planned and the placed miniscrews were calculated. The mean coronal and apical deviations were 1.38 mm (range: 3.48–0.15 mm; standard deviation (SD): 0.65) and 1.73 mm (range: 5.41–0.10 mm; SD: 1.03), respectively, while the mean angular deviation was 4.60° (range: 15.23–0.54°; SD: 2.54). The present surgical guide allows a controlled and accurate palatal miniscrew placement in three dimensions.