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Table of Contents
ORIGINAL ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 4  |  Page : 57-59

A comparative evaluation of maxillary canine retraction using flap and flapless corticotomy: A clinical study


1 Reader, Department of Orthodontics and Dentofacial Orthopaedics, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India
2 Senior Lecturer, Department of Orthodontics and Dentofacial Orthopaedics, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India
3 Senior lecturer, Department of Public Health Dentistry, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India
4 Ex-Associate Professor, Department of Orthodontics and Dentofacial Orthopaedics, Government Dental College, Aurangabad, Maharashtra, India
5 Reader, Department of Oral Pathology and Microbiology, Maharana Pratap College of Dentistry and Research Centre, Gwalior, Madhya Pradesh, India

Date of Web Publication29-May-2019

Correspondence Address:
Dr. Sarvesh P Agrawal
Department of Orthodontics and Dentofacial Orthopaedics, Manubhai Patel Denta College, Vadodara, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INPC.INPC_12_19

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  Abstract 


Objective: The objective of this study is to compare and evaluate the effectiveness of maxillary canine retraction using flap and flapless corticotomy.
Materials and Methods: A sample of 10 adult patients undergoing orthodontic treatment requiring therapeutic extraction of maxillary first premolars bilaterally were selected, compliant with the inclusion criteria. By random allocation, one site was selected for flap corticotomy-facilitated orthodontics (CFO) and opposite site for flapless CFO. After corticotomy procedure, maxillary canine retractions were done on both the sides using sliding mechanics. A paired t-test was used to determine the statistical significance of the difference in the amount of tooth movement between the flap and flapless sides.
Results: There were statistically significant differences (P ≤ 0.01) in the rates of anteroposterior movement of the canines between the flap and flapless sides at all measurement times, and the rates of canine retraction were consistently higher in the flap side than in the flapless side.
Conclusions: Flap corticotomy technique is more effective as compared to that of flapless corticotomy technique.
Clinical Relevance: Flap corticotomy will be more effective clinically; however, the histologic correlation in regard to the changes in both the technique would be more beneficial.

Keywords: Corticotomy, flap technique, periodontium, regional accelaration phenomenon (RAP), retraction


How to cite this article:
Agrawal SP, Iyengar S, Thakkar UA, Agrawal R, Ali SM, Sargaiyan V. A comparative evaluation of maxillary canine retraction using flap and flapless corticotomy: A clinical study. Int J Prev Clin Dent Res 2018;5:57-9

How to cite this URL:
Agrawal SP, Iyengar S, Thakkar UA, Agrawal R, Ali SM, Sargaiyan V. A comparative evaluation of maxillary canine retraction using flap and flapless corticotomy: A clinical study. Int J Prev Clin Dent Res [serial online] 2018 [cited 2019 Jun 20];5:57-9. Available from: http://www.ijpcdr.org/text.asp?2018/5/4/57/259258




  Introduction Top


The goal of orthodontic treatment is to improve the patient's life adjustment through the enhancement of dentofacial functions and esthetics. Reducing orthodontic treatment duration is an issue of importance, particularly for adults. Rapid orthodontic tooth movement with a concomitant reduction in treatment time can be attained through the combination of orthodontic treatment and surgical alveolar corticotomies.[1]

Corticotomy is defined as any intentional surgical injury to the cortical bone. In adult patients, this technique has been claimed to dramatically reduce the treatment time because the resistance of the dense cortical bone to orthodontic tooth movement is removed.[1],[2]

To reduce the treatment time with minimal invasiveness, a new technique called flapless bur decortication is developed. In this technique, small holes are made along the buccal bone of the tooth that requires orthodontic movement using a fine surgical fissure bur without reflection of the flap.

Thus, the purpose of this study is to compare the effectiveness of flapless corticotomy compared to that of the modified flap corticotomy during canine retraction.

Aims and objectives

The aim is to compare and evaluate the effectiveness of maxillary canine retraction using flap and flapless corticotomy.


  Materials and Methods Top


The sample consisted of 10 adult patients (5 men and 5 women; mean age, 19 years) exhibiting Class II Division 1 malocclusion with increased overjet requiring the therapeutic extraction of the maxillary first premolars, with subsequent retraction of the maxillary canines were selected for the study. Ethical approval was obtained from the Ethics Review Committee of Manubhai Patel Dental College and Oral Research Center. All patients had to fulfill all the inclusion criteria. All patients were informed of the procedure and signed informed consent. After the placement of maxillary and mandibular fixed appliances and completion of the leveling and alignment phase of treatment, individual canine retraction was planned.[3] On the day before the corticotomy surgery, one maxillary premolar was extracted on a random basis (coin toss). When the patient was scheduled for the surgery, the other premolar was extracted, and corticotomy-facilitated orthodontics (CFO) was performed using the submarginal Luebke–Ochsenbein flap design [4] [Figure 1].
Figure 1: Conventional flap technique

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On the flapless CFO site, incision were placed mesial to and distal to maxillary canine, during the process of decortication, small holes, without gingival flaps, were created through mesial and distal attached gingiva of canine. Holes were made on each side using a pointed tungsten carbide fissure bur (The contouring fissure bur C1, Technicare Dental Supplies Ltd., GB).[5]

The maxillary archwire (0.018 inch) was then ligated, and nickel-titanium closed-coil springs applying 150 g on each side were used for retraction, stretched bilaterally from the molar hook to the canine hooks [Figure 2].
Figure 2: Retraction using Niti coil spring

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Statistical analysis

Descriptive statistics were computed for the variables of age, gender, and tooth movement (canine retraction) before and after canine retraction, and the results were graphically represented. A paired t-test was used to determine the statistical significance of the difference in the amount of tooth movement between the flap and flapless side.


  Results Top


There were statistically significant differences (P ≤ 0.01) in the rates of anteroposterior movement of the canines between the flap and flapless sides at all measurement times, and the rates of canine retraction were consistently higher in the flap side than in the flapless side [Table 1] and [Graph 1].
Table 1: Mean rates of the anteroposterior position of the maxillary canines in the flap corticotomy site and flapless corticotomy site per month (mm)

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  Discussion Top


All participants selected for this study had a Class II Division 1 malocclusion. The treatment plan required the extraction of the maxillary first premolars and the subsequent retraction of the maxillary canines. We started with 15 patients, but five patients were excluded from the study because of multiple missed appointments and poor oral hygiene. A considerable amount of patient cooperation was necessary; the patients were expected to comply with the instructions regarding strict attention to oral hygiene measures and keeping the follow-up visits for every 14 days.

Nickel-titanium springs were used for retraction to permit constant force application. The medial end of the third palatal rugae was used as the reference point to construct reference planes for the measurement of tooth movement and quantification of changes in tooth position on the dental casts.[6]

The results in this study have demonstrated that it is possible to rapidly retract the canines using CFO. The anteroposterior changes in the position of the canines were significantly higher on the flap corticotomy side than on the flapless side during the 14 day and 28 day follow-up period. During the first 2 weeks after the corticotomy surgery, the average weekly rate of canine retraction was significantly higher, approximately two times faster on the flap corticotomy side compared with the flapless corticotomy side. On the other hand, during the third and fourth recall visits, this mean weekly rate, though still higher on the flap corticotomy site than the flapless side, declined to only 1.6 times higher in the third visit and 1.06 times by the fourth visit by the end of the 2 months. This information is consistent with the transient nature of the RAP.[7]

The results of the present study indicated that in spite of effectiveness during the 1st month, flapless bur decortication technique had limited effect on orthodontic tooth movements in later stages. Limited or less than enough area of decortications probably played an important role in the limited acceleration of tooth movement during the 1st month.[8]


  Conclusions Top


On the basis of the results obtained from this study, the following conclusions can be drawn.

  1. Flap corticotomy technique is more effective as compared to that of the flapless corticotomy technique.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kole H. Surgical operations on the alveolar ridge to correct occlusal abnormalities. Oral Surg Oral Med Oral Pathol 1959;12:515-29.  Back to cited text no. 1
    
2.
Bell WH, Levy BM. Revascularization and bone healing after maxillary corticotomies. J Oral Surg 1972;30:640-8.  Back to cited text no. 2
    
3.
Chung KR, Oh MY, Ko SJ. Corticotomy-assisted orthodontics. J Clin Orthod 2001;35:331-9.  Back to cited text no. 3
    
4.
Düker J. Experimental animal research into segmental alveolar movement aftercorticotomy. J Maxillofac Surg 1975;3:81-4.  Back to cited text no. 4
    
5.
Mostafa YA, Mohamed Salah Fayed M, Mehanni S, ElBokle NN, Heider AM. Comparison of corticotomy-facilitated vs. standard tooth-movement techniques in dogs with miniscrews as anchor units. Am J Orthod Dentofacial Orthop 2009;136:570-7.  Back to cited text no. 5
    
6.
Generson RM, Porter JM, Zell A, Stratigos GT. Combined surgical and orthodontic management of anterior open bite using corticotomy. J Oral Surg 1978;36:216-9.  Back to cited text no. 6
    
7.
Gantes B, Rathbun E, Anholm M. Effects on the periodontium following corticotomy-facilitated orthodontics. Case reports. J Periodontol 1990;61:234-8.  Back to cited text no. 7
    
8.
Suya H. Corticotomy in orthodontics. In: Hosl E, Baldauf A, editors. Mechanical and Biological Basics in Orthodontic Therapy. Heidelberg, Germany: Huthig Buch Verlag; 1991. p. 207-26.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

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