An innovative approach for faster orthodontic tooth ...ijmdcr.com/eJournals/_eJournals/84_CASE REPORT.pdf · An innovative approach for faster orthodontic tooth movement – A case

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International Journal of Medical and Dental Case Reports (2018), Article ID 100418, 4 Pages

C A S E R E P O R T

An innovative approach for faster orthodontic tooth movement – A case reportSourav Chandra1, Mrudul Vaidya2, B. S. Avinash1, H. Jyothikiran2, N. Raghunath2

1Department of Periodontology, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India, 2Department of Orthodontics and Dentofacial Orthopaedics, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India

AbstractWilckodontics also known as Periodontally Accelerated Osteogenic Orthodontics (PAOO) is a technique used to reduce orthodontic treatment time and achieve faster tooth movement as compared with conventional orthodontics. This present case demonstrates the use of piezosurgery to facilitate rapid orthodontic tooth movement in relatively shorter treatment time. The total treatment time required to complete the orthodontic treatment was 13 months for this case.

Keywords: Accelerated orthodontics, periodontally accelerated osteogenic orthodontics, regional acceleratory phenomena, Wilckodontics

Correspondence Dr. Sourav Chandra, Department of Periodontology, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India. Mobile: +91-8105064416. E-mail: [email protected]

Received 02 February 2018; Accepted 22 March 2018

doi: 10.15713/ins.ijmdcr.84

How to cite the article: Chandra S, Vaidya M, Avinash BS, Jyothikiran H, Raghunath N. An innovative approach for faster orthodontic tooth movement – A case report. Int J Med Dent Case Rep 2018;5:1-4.

Introduction

• The benefits of orthodontic treatment often go beyond theobviousphysicalchangesofanimprovedocclusionandalignedteeth. It is also a great way to improve a person’s overall self-image. With all of the recent advancements in orthodontics, wearingbraceshaveneverbeeneasier.Today,manypeoplereceiveorthodontictreatment,butaperplexingchallengethathasnotbeencompletelydisentangledinclinicalorthodonticsis prolonged treatment time (on average 2–3 years). Figuring out these challenges will dramatically improve the quality of orthodontic care.[1]

• Atpresent,thereisanincreasedtendencyfortheresearchersto focus on accelerating methods for tooth movement due to the colossal demand by adults for a shorter orthodontictreatment time.[2] Methods to accelerate orthodontic tooth movement can be broadly studied under the followingcategories: Drugs, surgical methods, and physical/mechanical stimulation methods.[3]

• It has beenproved that the surgical-assisted approaches arethemosteffectivetechniquescomparedtoanyothermethodsof acceleration of orthodontic tooth movement.[4] Various surgicalapproachesavailableinthisfieldarecorticotomy,[5,6] Wilckodontics,[7,8] and piezocision.[9]

Case Report

Diagnosis and treatment planning

• A 22-year-old male patient in the permanent dentitionpresented with the chief complaint of forwardly placed upper and lower front teeth. His medical history showed no allergiesoranymedicalproblems.Nosignsandsymptomsoftemporomandibular joint dysfunction were observed. Thepatient had dolichocephalic head, leptoprosopic facial form with aconvexprofile, and7mmof lip incompetency.Thepatientpresented with Class I molar relation, Class I canine relation, andClassI incisorrelationbilaterally.Cephalometricanalysisrevealed orthognathic maxilla and mandible with proclinedupperandloweranteriorteethonskeletalClassIjawbaseswithhorizontal growth pattern. The patient was diagnosed as Angle’s ClassImalocclusionwithbidentalprotrusiononskeletalClassIjawbaseswithhorizontalgrowthpattern.Theoverjetwas5mmandtheoverbitewas3mm.Lowermidlinewasshiftedtotherightsideby2mm.Carey’sandarchperimeteranalysisshowed3mmoftoothmaterialexcess inmaxillaryarchand2mmoftoothmaterialexcessinlowerarch.

• Treatment plan advised for the patient was extraction of14, 24, 34, and 44 with maximum anchorage using fixed

Chandra, et al. Faster orthodontic tooth movement using piezosurgery – A case report

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orthodontic treatment utilizing preadjusted edgewiseappliance mechanotherapy with Mclaughlin Bennet Trevisi (MBT)prescriptionfollowedbyfrenectomywithrespecttohigh frenal attachments.

Treatment progress

• MBTappliancewith0.022×0.028˝slot(Ormco,Glendora,CA, USA) was used.

• Alignment and leveling both dentitions were accomplishedwith following sequence of archwires in a time period of 5 months: 0.016˝ heat-activated nickel–titanium archwires,0.016˝stainlesssteelarchwires,0.016×0.022”heat-activatednickel–titanium archwires, 0.017 × 0.025” stainless steelarchwires,and0.019×0.025”stainlesssteelarchwires.Afteralignmentandlevelingphase,thesecondphaseofextractionspace closure had to be started. At this stage, the patientdemandedthetreatmenttogetoverfasterthantheexpectedtreatment time of traditional approach. Hence, the patient was given an option of an additional procedure of Wilckodontics for the acceleration of orthodontic tooth movement. After explainingtheprocedureindetail,heagreedforthesamewitha view of faster orthodontic results without any complications [Figure 1].

Periodontally accelerated osteogenic orthodontics (PAOO)/Wilckodontics procedure performed

• Theareatobeoperatedwasanesthetizedbylocalanesthesia(4% Articaine).

• Crevicularincisionextendingfrommandibularleftfirstmolarto mandibular right first molar (36–46), with no verticalreleasetopreservethebloodsupply,wasgiven.

• Theenvelopeflapwasreflectedextending4mmbeyondtherootapex.

• The ultrasonic piezoelectric bone surgery unit (NSKVariosurg 3) was used to carry out corticotomy [Figure 2].

• Boththehorizontalandverticalcorticotomieswereperformedinterdentally. Horizontal grooves with the depth of 1.5 mm into cortical bone and vertical depth grooves connectinghorizontalgrooveina“U”-shapedfashion2mmbeyondtherootapexwereplaced[Figure 3].

• Atthe1stpremolarextractionspace,corticotomyfollowedbyinterdentaldepthgroovesusingpiezoroundburstoenhanceregional acceleratory phenomena (RAP) was performed.

• Attheendoftheprocedure,allthecorticotomieswerecoveredwithablendofautogenousboneharvestduringcorticotomiesanddemineralizedfreeze-driedboneallograft[Figure 4].

• Theareawassuturedusingaresorbable5-0vicrylsuture.Anexternal ice pack on the first post-surgical day tominimizepost-operative swelling was advised.

• Postsurgically,Ultracet-P(acombinationoftramadol-opiateanalgesicandparacetamol)wasprescribedtocontrolpainandinflammation.Non-steroidalanti-inflammatorydrugsarenotindicatedasitinhibitsprostaglandinsynthesiswhich,inturn,slowsdownboneturnoverrate.

• Thesameprocedurewasrepeatedinthemaxillaryarchafter15 days.

• Thepatientwasrecalledafter2weeks.Orthodonticactivationwas carried out at every 2 weeks interval until the retraction wascompleted.Theclosureofextractionspacewasobserved

Figure 1: Pre-operative occlusal view of mandibular arch

Figure 2: Corticotomy performed using ultrasonic piezoelectric bone surgery unit (NSK Variosurg 3)

Figure 3: Horizontal and vertical corticotomy performed interdentally and 2 mm beyond root apex, depth groove of 1.5 mm into cortical bone

Faster orthodontic tooth movement using piezosurgery – A case report Chandra, et al.

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in all the four quadrants after 4–5 months [Figure 5]. There were no complications such as root resorption, fenestration, and dehiscence observed radiographically. Finishing of the casewascompletedinanother3monthsoftimewith0.021×0.025titanium–molybdenumalloyarchwirefollowedby0.021×0.025braidedNiTiinmaxillaryandmandibulararcheswithsettling of the occlusion. The full treatment duration for this particular case was 13 months. The patient was happy with the overall treatment results as well as the time duration in which it had got completed.

Discussion

• The PAOO also termed as Wilckodontics involves full-thickness labial and lingual periosteal flap reflectionaccompanied by selective corticotomy in the interdentalareas both labial and lingual.The corticotomy segment canbemovedfasterinone-thirdtoone-fourththetimerequiredfortraditionalorthodonticsalone.Thisisaphysiologic-basedtreatment consistent with RAP and maintaining an adequate

blood supply is essential. PAOO is an effective treatmentapproach in adults to decrease treatment time and reduce the risk of root resorption. Selected corticotomy limited to the buccalandlabialaspectsalsosignificantlyreducestreatmenttime.[8]

• The use of conventional instruments such as chisel andmalletor surgicalburs,microsawswithexternal irrigants,ortrephineburshaslongbeenusedtraditionallyinperformingcorticotomyprocedures.However,themajordisadvantageisthattheconventionalinstrumentsrequiregreaterexposureofthe surgical site, greater frictional heat generatedbymotor-driven instruments which may also hinder the healing process, andfinallydifficult tocontrol inareaswhich requireprecisecut and are densely mineralized.

• To overcome these disadvantages, the piezoelectricdevice (Piezosurgery®) has been introduced. Ultrasonicpiezoelectric bone surgery works on microvibrationsgeneratedbythepiezoelectricdevicecanbeusedtogivefineprecise incisions required to give corticotomy cuts causing less discomfort to the patient when compared to traditional surgical instruments. The Piezosurgery® device is also very gentle on the hard tissues since it does not require the use of manual force, thus improving the handling with greater intraoperative control, particularly in anatomically difficultareas.[10]

• All the extraction spaceswere closed in 4monthsof timewith the mean rate of 1.9 mm per month. Conventional technique would have taken 7–9 months of time for the closure of premolar extraction spaces with normal rateof 1–1.2 mm per month. The full treatment duration for this particular case was 13 months which is lesser than the minimum treatment time of 18–20 months for anyorthodonticextractioncase.

Conclusion

This case report shows that PAOO or Wilckodontics can besmartly and effectively used in contemporary orthodonticpractice to meet the increased demand of shorter orthodontic treatment time. However, one must not fail to realize that we are dealingwithabiologicsystemandthateachindividualrespondsinavariablefashion,regardlessofthetype,andtechniquebeingused. In essence, thebody andhow it responds toorthodonticoranyexternalmanipulationstillgovernsoveralltreatmenttime.

References

1. Bosio JA, Liu D. Moving teeth faster, better and painless. Dental Press J Orthod 2010;15:14-7.

2. Wilcko WM, Wilcko T, Bissada NF. An evidence-based analysis of periodontally accelarated orthodontic and osteogenic techniques: A synthesis of scientific perspectives. Semin Orthod 2008;14:305-16.

3. Vaidya M, Jyothikiran H, Raghunath N. Accelerated orthodontics: An answer to fast paced life. Int J Adv Res 2017;5:75-81.

Figure 4: Autogenous bone harvest during corticotomy and demineralized freeze-dried bone allograft were mixed and placed in the corticotomy site

Figure 5: Post-operative occlusal view 4 months after periodontally accelerated osteogenic orthodontics, showing complete closure of extraction space

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4. Kalemaj Z, DebernardI CL, Buti J. Efficacy of surgical and nonsurgical interventions on accelerating orthodontic tooth movement: A  systematic review. Eur J Oral Implantol 2015;8:9-24.

5. Aboul-Ela SM, El-Beialy AR, El-Sayed KM, Selim EM, El-Mangoury NH, Mostafa YA. Miniscrew implant-supported maxillary canine retraction with and without corticotomy-facilitated orthodontics. Am J Orthod Dentofacial Orthop 2011;139:252-9.

6. Mrudul V, Nehal A, Saikrishna D, Jyothikiran H, Raghunath N. Evolution of corticotomy: An insight. Int J Oral Health Med Res 2017;4:61-4.

7. Wilcko WM, Wilcko T, Bouquot JE, Ferguson DJ. Rapid orthodontics with alveolar reshaping: Two case reports of decrowding. Int J Periodontics Restorative Dent 2001;21:9-19.

8. Vaidya M, Chandra S, Jyothikiran H, Shashikumar P, Raghunath  N. Wilckodontics: How and why? Int J Adv Res 2018;5:623-5.

9. Keser EI, Dibart S. Sequential piezocision: A  novel approach to accelerated orthodontic treatment. Am J Orthod Dentofac Orthop 2013;144:879-89.

10. Torrella F, Pitarch J, Cabanes G, Anitua E. Ultrasonic ostectomy for the surgical approach of the maxillary sinus: A  technical note. Int J Oral Maxillofac Implants 1998;13:697-700.

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