Corticotomy-assisted orthodontics

Abstract

The use of orthodontic treatment in adult patients is becoming more common and these patients have different requirements specially regarding duration of treatment and facial and dental aesthetics. Alveolar corticotomy is an effective means of accelerating orthodontic treatment. This literature revision include an historical background, biological and orthodontic fundamentals and the most significant clinical applications of this technique. Orthodontic treatment time is reduced with this technique to one-third of that in conventional orthodontics. Alveolar bone grafting of labial and palatal/lingual surfaces ensures root coverage as the dental arch is expanded. Corticotomy-assisted orthodontics has been reported in a few clinical cases, and seems to be a promising adjuvant technique, indicated for many situations in the orthodontic treatment of adults without active periodontal pathology. Its main advantages are reduction of treatment time and postorthodontic stability. Further controlled prospective and histological studies are needed to study tooth movement, post-retention stability, and microstructural features of teeth, periodontium, and regenerated bone after using this procedure. Key words:Corticotomy, osteotomy, accelerated orthodontics.

Orthodontic tooth movement: The biology and clinical implications

“…The initial approaches involve alveolar osteotomy alone (defined as a surgical cut through both the cortical and trabecular bones) or combined with corticotomy (defined as a surgical cut where only the cortical bone is involved) to create a movable “bony block”, and it was believed then teeth were moved faster by reducing the resistance exerted by the surround cortical bone. These approaches have been extremely invasive and associated with increased tooth morbidity and risk of periodontal damage (mainly in cases in which the interradicular space is less than 2 mm) [36–38]. Modern approaches have abandoned the concept of the bony block, and selective alveolar corticotomy has become a reproducible gold standard.…”

“…Surgical techniques to accelerate orthodontic treatment have been tested for over 100 years in clinical practice [36]. The initial approaches involve alveolar osteotomy alone (defined as a surgical cut through both the cortical and trabecular bones) or combined with corticotomy (defined as a surgical cut where only the cortical bone is involved) to create a movable "bony block", and it was believed then teeth were moved faster by reducing the resistance exerted by the surround cortical bone.…”

Accelerated orthodontic treatment ‐ what's the evidence?

“…A corticotomy involves the creation of shallow perforations or cuts made in the cortical alveolar bone while the trabecular or medullary bone is left intact which differs to an osteotomy. A corticotomy is not a new concept as it was mentioned in 1893 to rapidly reposition palatally‐inclined maxillary teeth . The processes associated with corticotomies are similar to the processes associated with normal fracture healing inducing a RAP.…”

Corticotomy assisted enmasse retraction

“…However, it has been reported that conventional orthodontic forces are sufficient in Corticotomy Assisted Orthodontics because forces are not concentrated in either the tooth-periodontal complex surrounded by a rigid bone structure or in the bone-tooth block delimitated by corticotomy, but is distributed on the tooth-periodontal-trabecular bone (low-density transitory trabecular bone.This better distributed mechanical loading may be the reason why corticotomy-assisted tooth movement is associated with a reduced period of PDL hyalinization on the compression side compared to conventional movement. 2 Since, it has been observed that the Stage II i.e., the retraction stage or the stage in which the extraction spaces are closed comparatively takes longer duration of time i.e., about 40 to 50 percent of the total orthodontic treatment time corticotomy was performed when the patient was in the retraction stage of the treatment. The faster rate of space closure with Corticotomy could be attributable to the fact that as more amount of optimal tooth movement requires the combination of well planned orthodontic forces and an alveolar bone that offers less resistance to movement, i.e., less dense bone and increased bone metabolism so when alveolar bone metabolism is increased, by performing corticotomy the orthodontic tooth movement is accelerated.…”