Effect of Corticotomy on the Orthodontic Tooth Movement

This study is currently recruiting participants. (see Contacts and Locations)
Verified May 2013 by Universidad de Antioquia
Sponsor:
Information provided by (Responsible Party):
Javier Enrique Botero, Universidad de Antioquia
ClinicalTrials.gov Identifier:
NCT01630473
First received: June 24, 2012
Last updated: May 28, 2013
Last verified: May 2013

June 24, 2012
May 28, 2013
August 2011
January 2013   (final data collection date for primary outcome measure)
Changes in tooth position [ Time Frame: 0 days, 7 days, 15 days, 1st month, 2nd month, 3rd month and 4th month after surgery and conventional orthodontic ] [ Designated as safety issue: No ]
Same as current
Complete list of historical versions of study NCT01630473 on ClinicalTrials.gov Archive Site
Periodontal Clinical Parameters [ Time Frame: 0 days, 7 days, 15 days, 1st month, 2nd month, 3rd month and 4th month after surgery and conventional orthodontic ] [ Designated as safety issue: Yes ]
Same as current
Not Provided
Not Provided
 
Effect of Corticotomy on the Orthodontic Tooth Movement
Clinical Comparison Between the Corticotomy-assisted Orthodontics and Conventional Orthodontics

Orthodontic therapy allows for the treatment of dental malpositions in order to produce an adequate relationship between teeth during occlusion. Conventional orthodontic therapy applies slight forces and moves teeth slowly. It is generally performed during a 2 year minimum of time. Recent studies seem to suggest that orthodontic therapy time can be shortened by surgical assistance (corticotomy). This investigation is aimed to determine the velocity of tooth movement and changes in periodontal clinical parameters between corticotomy-assisted orthodontic therapy and conventional orthodontic therapy.

The use of surgical techniques to accelerate orthodontic tooth movement has been developed. By means of surgical burs, vertical grooves in the cortical plate (corticotomy) are produced mesial and distal to the roots of teeth that are being moved 3 mm below the marginal crest and extending beyond the apex. Animal studies showed that the rapid orthodontic tooth movement was due to increased cellular activity in the surrounding periodontal tissues, a regional acceleratory phenomenon (RAP). A high osteoclastic activity is observed in the compression side although is also observed in the tension side to a less degree. Histological analysis indicates that at day 21 the remodeling tissues are replaced by a fibrous tissue and later (60 days) by bone. Furthermore, the tissues immediately adjacent to the corticotomy are characterized by an increased width of the periodontal ligament, less calcified spongiosa bone surface and higher counts of osteoclasts. But not only the catabolic activity is increased (osteoclasts) but also the anabolic activity (osteoblasts) is increased 3-fold as well. This balances the rate of bone resorption and bone apposition. An interesting finding was the reduced rate of hyalinization at the compression site, which may be due to increased width of the periodontal ligament and thus facilitating tooth movement.

As opposed to conventional osteotomy used in alveolar distraction, the preservation of the medullar vasculature during a corticotomy procedure provides and adequate blood supply and nutrition. This accelerates the rate of tissue healing and remodeling and hence orthodontic movement can start immediately after surgery. It has been calculated that the rate of tooth movement is doubled (2.5mm to 3mm at day 25) in comparison to standard orthodontics without any detrimental effects on periodontal tissues. This surgically assisted approach for improved tooth movement is beneficial for molar intrusion, space closure, de-crowding and open bite management.

This investigation is aimed to determine the velocity of tooth movement and changes in periodontal clinical parameters between corticotomy-assisted orthodontic therapy and conventional orthodontic therapy. Periodontally and systemically healthy subjects in need of orthodontic therapy for the treatment of teeth crowding in the anterior segment. The rate of tooth movement will be assessed by radiographs and cast models and periodontal clinical parameters will be recorded at each visit during the 4 month follow-up.

Interventional
Not Provided
Allocation: Non-Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Tooth Crowding
  • Procedure: Corticotomy
    After a periodontal full flap is dissected, by using small round burs, vertical lines (2 mm depth corticotomy) parallel to each root of the teeth in the anterior segment (canines and incisors) are created 5 mm beyond the apex in the maxillary bones and interconnecting the lines at the apex by horizontal corticotomies. Marginal bone crest is not touched by the surgical procedure.
    Other Name: Osteotomy
  • Procedure: Conventional orthodontics
    Conventional orthodontic treatment
    Other Name: Orthodontic treatment
  • Experimental: Corticotomy-assisted orthodontics
    This group of patients will receive corticotomy surgical procedure at day 0. Orthodontic activation will start immediately after surgery.
    Intervention: Procedure: Corticotomy
  • Active Comparator: Conventional orthodontics
    This group of patients will receive conventional orthodontics starting at day 0.
    Intervention: Procedure: Conventional orthodontics

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
10
August 2013
January 2013   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • Voluntary participation
  • Legally adult age (>18 years old)
  • Full permanent dentition (28 teeth excluding third molars)
  • Severe anterior teeth crowding
  • Thick periodontal biotype

Exclusion Criteria:

  • Systemic diseases (i.e. diabetes, HIV)
  • cigarette smoking
  • Under medications: bisphosphonates, anti-epileptic drugs, contraceptives, corticosteroids, estrogen, antihistamine drugs, calcitonin, vitamin D
  • Previous orthodontic treatment
  • Periodontal disease
  • Severe gingival recessions
  • Pregnancy
  • Previous root resorption
Both
20 Years to 40 Years
Yes
Contact: Javier E Botero, PhD 057-4-219 6719 drjavo@yahoo.com
Colombia
 
NCT01630473
CORT2011
Yes
Javier Enrique Botero, Universidad de Antioquia
Universidad de Antioquia
Not Provided
Principal Investigator: Juan D Arango, DDS Faculty of Dentistry, Universidad de Antioquia
Study Director: Javier E Botero, PhD Faculty of Dentistry, Universidad de Antioquia
Universidad de Antioquia
May 2013

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP