Corticotomy facilitated correction of skeletal class II malocclusion

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1 Open Access Journl of Orl Helth nd Crniofcil Science Cse Report ISSN Corticotomy fcilitted correction of skeletl clss II mlocclusion Arif Yezdni A* Deprtment of Orthodontics nd Dentofcil Orthopedics, Professor nd Director, Bhrth University, Sree Blji Dentl College nd Hospitl, Nrynpurm, Pllikrni, Chenni , Tmilndu, Indi *Address for Correspondence: Arif Yezdni A, Deprtment of Orthodontics nd Dentofcil Orthopedics, Professor nd Director, Bhrth University, Sree Blji Dentl College nd Hospitl, Nrynpurm, Pllikrni, Chenni , Tmilndu, Indi, Emil: Sumitted: 10 Octoer 2017 Approved: 25 Octoer 2017 Pulished: 26 Octoer 2017 Copyright: 2017 Yezdni AA. This is n open ccess rticle distriuted under the Cretive Commons Attriution License, which permits unrestricted use, distriution, nd reproduction in ny medium, provided the originl work is properly cited. Keywords: Supernumerry premolrs; Decortiction; Bone grft; Rpid orthodontics Astrct Selective lveolr decortiction nd periodontl ugmenttion with one grft were the two procedures used for the correction of the skeletl clss II mlocclusion in the cse reported. A 25-yer-old mle ptient presented with skeletl clss II mlocclusion with incresed i-mxillry dento-lveolr protrusion, incresed overjet, deep ite nd imricted nd rotted mndiulr incisors with ilterl presence of supernumerry teeth in the mxillry right nd left premolr regions. Extrction of supernumerry in the mxillry right nd left premolr region, nd impcted UL5 ws done. Pre-djusted edgewise pplince, Roth s prescription (0.022x0.028-inch slot), ws onded nd week lter full thickness lil nd lingul flps were reflected in the mxillry nd mndiulr rches. Circumscried corticotomy cuts ws done nd susequently ugmented with one grft. Orthodontic tretment ws commenced immeditely fter surgery nd orthodontic djustments were performed every 2 weeks. The entire orthodontic tretment ws completed in 9 months. Regionl ccelertory phenomenon, triggered y the lveolr decortiction, ws responsile for the rpid correction of the mlocclusion nd the ugmenttion with the one grft provided dequte one volume for housing the teeth, therey decresing the possiility of susequent relpse. Introduction Adult or lte dolescent ptients requiring orthodontic correction of mlocclusion desire short tretment periods due to socil nd psychologicl resons which is fesily possile only in conjunction with surgicl procedures [1,2]. Orthopedist Hrold Frost termed the cscde of physiologic heling events following surgicl wounding of corticl one the Regionl Accelertory Phenomenon (RAP) [3,4]. This phenomen is tken dvntge of in ringing out rpid orthodontic tooth movement which together with periodontl ugmenttion with one grft increses the lveolr one housing s lso corrects lveolr one dehiscences nd fenestrtions [5]. The one grft provides dditionl one support, resulting in less tendency for relpse [6]. It lso improves the posture of the lip in certin conditions. Animl experiments too hve demonstrted n increse in pposition nd resorption of lveolr spongios djcent to corticotomy cuts [7]. Hence, circumscried corticotomy cuts nd ugmenttion with one grft ws found to increse the rte of orthodontic tooth movement nd shorten the period of orthodontic tretment in the cse reported. Cse Report A mle ptient ged 25 yers presented with forwrd plcement of mxillry nteriors nd crowded mndiulr nteriors with ilterl supernumerry premolr teeth in mxillry dentl rch. Extr-orl ssessment The ptient hd mesoprosopic fce, convex pro ile, posterior divergence, How to cite this rticle: Yezdni AA. Corticotomy fcilitted correction of skeletl clss II mlocclusion. J Orl Helth Crniofc Sci. 2017; 2:

2 incompetent lips, clinicl low mndiulr plne ngle nd excessive mxillry incisor disply on smiling, with no signs of temporomndiulr joint dysfunction (Figure 1c). Intr-orl ssessment Orl hygiene ws stisfctory. Mxillry rch ws U-shped, symmetricl with supernumerry premolr present ilterlly in the premolr region, impcted UL5 nd proclined mxillry incisors. Mndiulr rch ws U-shped, symmetricl with proclined, rotted nd imricted mndiulr incisors. In occlusion, incresed overjet nd deep ite ws oserved. The mxillry dentl midline ws shifted to the left y 1mm,nd on left side the molr reltion ws clss II nd on the right it ws clss I while the cnine reltion ws end-on ilterlly with UL5 nd UL6 in mild pltl cross-ite (Figure 1d-h). c Figure 1: ). Pre tretment extrorl Frontl; ). Pre tretment extrorl Profile; c). Pre tretment extrorl Smiling. d e c f g h Figure 1 D-H: d). Pre tretment introrl - Frontl e). Pre tretment introrl Right; f). Pre tretment introrl Left; g). Pre tretment introrl - Upper occlusl; h). Pre tretment introrl - Lower occlusl. Pulished: Octoer 26, /103

3 Rdiogrphic ssessment The pnormic rdiogrph con irmed the presence of ll permnent teeth, nd norml lveolr one levels except round impcted UL5, with impcted LR7 nd LL8 with prtilly erupted UR8 nd UL8 (Figure 2). Cephlometric nlysis reveled skeletl Clss II pttern with n orthognthic mxill nd retrognthic mndile, with low mndiulr plne ngle, severely proclined mxillry incisors nd modertely proclined mndiulr incisors (Figure 3). Aims nd ojectives 1. Improve orl hygiene. 2. Improve fcil pro ile nd chieve lip competence. 3. Correction of protruded mxillry nd mndiulr teeth. 4. Correction of imricted nd rotted mndiulr teeth. 5. Correction of end-on cnine reltionships. Figure 2: Pre tretment pnormic rdiogrph. Figure 3: Pre tretment lterl cephlometric rdiogrph. Pulished: Octoer 26, /103

4 The ptient opted for the corticotomy procedure s he preferred the orthodontic tretment to e completed within short period of time. Extrction of supernumerry in the mxillry right nd left premolr region nd impcted UL5 ws done. Roth s prescription Pre Adjusted Edgewise Applince Therpy (0.022x0.028-inch slot), (3M Unitek, Monrovi, CA, USA) with upper nd lower inch nickel titnium rchwires long with trnspltl nchorge ws strpped week prior to the surgicl procedure. The ptient underwent decortiction of the lveolr one nd grfting with Grio Glscer one grft. (DORTHOM TM MEDI DENTS PVT. LTD., Coimtore, Tmil Ndu, Indi). Grio Glscer (GG) re ioctive, cermic, composite, porous grnules mde up of:- 50% Bioctive Glss (BG) nd 50% Hydroxyptite (HA) mixture ville in prticle size of mm. Orthodontic djustments were mde t 2 week intervls. Surgicl procedure Under locl nesthesi, lil nd lingul sulculr incisions were mde nd full thickness mucoperiostel lps were elevted without disturing the neurovsculr undles nd the genioglossus ttchment. A long shnk surgicl issure ur ws used to mke the corticotomy cuts rely into the medullry one on lil nd lingul spects of mxillry nd mndiulr nterior teeth longside the roots with sclloped cut slightly ove the pices of the teeth. One to two ml of pltelet rich plsm from the ptient s lood ws mixed with GG grnules nd plced over the decorticted re. The lps were then returned to their originl position nd sutured with one interrupted loop 3/0 suture, interproximlly (Figure 4-, Figure 5-, Figure 6-c). Amoxycillin 500mg t.id./week nd nti-in lmmtory drugs t.i.d/week were prescried. An ntiseptic mouthwsh ws dvised. Two weeks lter the sutures were removed nd non-steroidl nti-in lmmtory drugs were sked to e discontinued s they would interfere with orthodontic tooth movement. Figure 4: ). Circumsciing corticotomy cuts-mxillry lil view; ). Circumsciing corticotomy cuts - mxillry pltl view. Figure 5: ). Alveolr ugmenttion with Grio Glscer one grft - mxillry nterior view; ). Suturing. Pulished: Octoer 26, /103

5 c Figure 6: ) Circumsciing corticotomy cuts - mndiulr nterior view; ). Alveolr ugmenttion with Grio Glscer grft - mndiulr nterior view; c). Suturing. Orthodontic procedure The orthodontic tretment ws commenced immeditely fter suture removl. Initil ligning nd levelling ws done with upper nd lower inch nickel titnium rchwires, upgrded to inch nickel titnium rchwires. Extrction spce closure for the mxillry dentl rch ws done with 9mm nickel titnium closed coil springs ttched to crimple hooks on 0.017x0.025-inch stinless steel rchwires. Detiling nd inishing ws done with upper nd lower 0.019x0.025-inch stinless steel rchwires (Figure 7-). Discussion The ptient showed remrkle improvement in his soft tissue pro ile nd smile esthetics (Figure 8-c). The i-mxillry dentolveolr protrusion, incresed overjet, rotted nd imricted mndiulr incisors ws corrected in nine months (Figure 9-e, Figures 10,11). The rpid correction of the mlocclusion ws most proly ttriuted to the RAP phenomen triggered y the corticotomy procedure which cused n increse in the osteoclstic ctivity of the one. The resultnt osteopeni ws responsile for the rpid tooth movement tht ws oserved. Corticotomy with one ugmenttion incresed the volume of the one nd mximized the metolic response during orthodontic tretment in concert with wht hs een reported in literture [8]. Cre ws lso tken to thin the one on the distl spect of the cnine roots during the corticotomy procedure. Full thickness mucoperiostel lps hve een used in the cse reported. However, conservtive lpless corticotomy techniques hve lso een recently proposed to mitigte the invsiveness of the full mucoperiostel lps [9]. No loss of tooth vitlity, discolortion or pin ws oserved in tune with wht hs een reported in literture [10-12]. In conventionl orthodontics, due to prolonged tretment durtion or indvertent ppliction of hevy forces root resorption is oserved [13]. In the cse reported no root resorption ws oserved ecuse of one mtrix trnsporttion nd reduced density of the one due to osteopeni creted y the corticotomy procedure. The ptient ws seen every 2 weeks, throughout the phses of ligning, levelling, spce closure, inishing nd detiling to tke dvntge of RAP. The periodontl lveolr ugmenttion with the GG one grft incresed the one volume therey reducing the incidence of relpse thing often oserved when orthodontic tretment is done without one grfting. This procedure is lso useful Pulished: Octoer 26, /103

6 Figure 7: ). Orthodontic tretment - Frontl view; ). Orthodontic tretment - Left view. c Figure 8: ). Post tretment extrorl Frontl; ). Post tretment extrorl - Profile; c). Post tretment extrorl Smiling. c d e Figure 9: ). Post tretment introrl Frontl; ). Post tretment introrl Right; c). Post tretment introrl Left; d). Post tretment intr-orl - Upper occlusl; e). Post tretment intr-orl - Lower occlusl. Pulished: Octoer 26, /103

7 Figure 10: Post tretment pnormic rdiogrph. Figure 11: Post tretment lterl cephlometric rdiogrph. for thinner mndiulr cortices which re t incresed risk for relpse susequent to dentl de-crowding [14]. Fixed lingul retiners were given for oth mxillry nd mndiulr dentl rches. The rpid correction of the mlocclusion hd een mde possile ecuse of the cortiocotomy fcilitted procedure, which lso reinforces clim mde in literture tht results re more stle with miniml risk of complictions with fster orthodontic tretment fter corticotomy procedure [15]. Corticotomy fcilitted orthodontics gretly contriuted to the completion of the correction of the mlocclusion in one-third to three-fourth the time required for conventionl orthodontics. Conclusion The corticotomy fcilitted orthodontics speedied up the correction of the mlocclusion in just out nine months nd the lveolr ugmenttion with the one grft provided n incresed one volume to house the dentition. This creted stle nd conducive environment to mitigte the occurrence of the tell-tle relpse. References 1. Rolee RD, Bolding SL, Lnders JM. Surgiclly fcilitted orthodontic therpy: new tool for optiml interdisciplinry results. Compend Contin Educ Dent. 2009; 30: Ref.: 2. Dirt S, Seoun JD, Surmenin J. Piezocision: minimlly invsive, periodontlly ccelerted orthodontic tooth movement procedure. Compend Contin Educ Dent. 2009; 30: , 346, Ref.: 3. Frost HM. The iology of frcture heling: An overview for clinicins. Prt I. Clin Orthop Relt Res. 1989; 248: Ref.: Pulished: Octoer 26, /103

8 4. Frost HM. The iology of frcture heling: An overview for clinicins. Prt II. Clin Orthop Relt Res 1989; 248: Ref.: 5. Wilcko MW, Wilcko T, Bouquot JE, Ferguson DJ. Rpid orthodontics with lveolr reshping: two cse reports of decrowding. Int J Periodontics Restortive Dent. 2001; 21: Ref.: 6. Wilcko MW, Ferguson DJ, Bouquot JE, Wilcko MT. Rpid Orthodontic De-crowding with Alveolr Augmenttion: Cse Report. World J Orthod. 2003; 4: Ref.: 7. Seoun JD, Ferguson DJ, Wilcko MT, Willim WM. Corticotomie lveolire et tritements orthodontiques rpides. Orthod Fr. 2007; 78: Ref.: 8. Wilcko MT, Wilcko WM, Bissd NF. An evidence-sed nlysis of periodontlly ccelerted orthodontic nd osteogenic techniques: synthesis of scientific perspectives. Semin Orthod. 2008; 14: Ref.: 9. Suy H. Corticotomy in orthodontics. In: Hosl E, Blduf A, editors. Mechnicl nd iologicl sics in orthodontic therpy. Heidelerg, Germny: Huthig Buch Verlg: 1991; Liou EJ, Hung CS. Rpid cnine retrction through distrction of the periodontl ligment. Am J Orthod Dentofcil Orthop. 1998; 114: Ref.: Sukuric Y, Krmn A, Gurel HG, Dolnmz D. Rpid cnine distliztion through segmentl lveolr distrction osteogenesis. Angle Orthod. 2007; 77: Ref.: Iseri H, Kisnisci R, Bzizi N, Tuz H. Rpid cnine retrction nd orthodontic tretment with dentolveolr distrction osteogenesis. Am J Orthod Dentofcil Orthop. 2005; 127: Ref.: Rygh R, Brudvik P. The histologicl responses of the periodontl ligment to horizontl orthodontic lods.in:berkovitz BKB,Moxhm BJ,Newmn HN(eds).The Periodontl ligment in Helth nd Disese.London:Mosy-Wolfe.1995: Rothe LE, Bollen RM, Herring SW, Herring SW, Chison JB, et l. Treculr nd corticl one s risk fctors for orthodontic relpse. Am J Orthod Dentofcil Orthop. 2006; 130: Ref.: Kole H. Surgicl opertions on the lveolr ridge to correct occlusl normlities. Orl Surg Orl Med Orl Pthol. 1959; 12: Ref.: Pulished: Octoer 26, /103