改良皮質骨切開快速正畸機制的基礎研究的中期報告

改良皮質骨切開快速正畸機制的基礎研究的中期報告AbstractTheaimofthisstudyistoevaluatetheefficacyofamodifiedcorticotomytechniqueinacceleratingorthodontictreatment.Atotalof26patientsundergoingorthodontictreatmentwereincludedinthisstudy.Themodifiedcorticotomytechniqueinvolvedmakingthreeverticalcutsinthealveolarboneandcrossingthemwiththreehorizontalcuts.Thistechniquewasperformedtwice,onceatthebeginningoforthodontictreatmentandonceatthe6-weekmark.Controlgrouppatientsunderwenttraditionalorthodontictreatmentwithoutcorticotomy.Theresultsshowedthatthemodifiedcorticotomytechniquesignificantlyreducedtreatmenttime(p<0.05)andimprovedthequalityoftoothmovementcomparedtothecontrolgroup.Nosignificantdifferencewasobservedinrootresorptionbetweenthetwogroups.Furtherstudiesareneededtoevaluatethelong-termstabilityandsafetyofthistechnique.IntroductionOrthodontictreatmentisatime-consumingandoftenuncomfortableprocessforpatients.Advancesinorthodonticmaterialsandtechniqueshaveledtoshortertreatmenttimesandimprovedtreatmentoutcomes,butthedurationoforthodontictreatmentstillremainsaconcernformanypatients.Toaddressthisissue,severalacceleratedorthodontictechniqueshavebeendeveloped,includingthecorticotomytechnique.Thecorticotomytechniqueinvolvesmakingsmallincisionsinthecorticalbonesurroundingtheteeththatneedtobemoved.Thisstimulatesboneturnoverandcreatesamorefavorableenvironmentfortoothmovement.However,thetraditionalcorticotomytechniqueisoftenassociatedwithdiscomfortandswellingforpatients.Moreover,thelong-termstabilityandsafetyofthistechniquearestillunderdebate.Inthisstudy,weaimedtoevaluatetheefficacyofamodifiedcorticotomytechniqueinacceleratingorthodontictreatment,whileminimizingthedisadvantagesassociatedwiththetraditionalcorticotomytechnique.MaterialsandmethodsThisstudywasapprovedbytheInstitutionalReviewBoardofthestudyhospital,andinformedconsentwasobtainedfromallparticipants.Atotalof26patients(14females,12males)undergoingorthodontictreatmentwereincludedinthisstudy.Theinclusioncriteriawereasfollows:(1)agebetween14and25yearsold,(2)needforextractionsandorthodontictreatment,(3)healthyperiodontium,and(4)nohistoryofsystemicdiseaseormedicationthatcouldaffectbonemetabolism.Patientswererandomlyallocatedtoeithertheexperimentalgroup(n=13)orthecontrolgroup(n=13).Theexperimentalgroupreceivedthemodifiedcorticotomytechnique,whilethecontrolgroupreceivedtraditionalorthodontictreatmentwithoutcorticotomy.Allpatientsunderwentextractionsofpremolarspriortoorthodontictreatment.Themodifiedcorticotomytechniqueinvolvedmakingthreeverticalcutsinthealveolarboneandcrossingthemwiththreehorizontalcuts,creatingacheckerboardpattern(Figure1).Thistechniquewasperformedtwice,onceatthebeginningoforthodontictreatmentandonceatthe6-weekmark.Thecontrolgroupreceivedtraditionalorthodontictreatmentwithoutcorticotomy.Fig.1ModifiedcorticotomytechniqueOrthodontictreatmentwasinitiated1weekafterthefirstcorticotomyprocedure.Thesameorthodonticmechanicswereusedforbothgroupsthroughoutthetreatmentperiod.Orthodontictreatmentwascompletedwhenallteethwereproperlyalignedandthedesiredocclusionwasachieved.Clinicalphotographsweretakenatthebeginningoforthodontictreatment,beforethecorticotomyprocedure,atthe6-weekmark,beforethesecondcorticotomyprocedure,andattheendoforthodontictreatment.Thefollowingparameterswereevaluated:treatmenttime(inmonths),rateoftoothmovement(inmm/month),qualityoftoothmovement(scoredfrom1to5),androotresorption(evaluatedbyperiapicalradiographs).ResultsTherewerenosignificantdifferencesinage,gender,ortreatmentplanbetweentheexperimentalandcontrolgroups(Table1).Themeantreatmenttimefortheexperimentalgroupwas15.46±3.42months,whichwassignificantlyshorterthanthecontrolgroup(19.54±2.73months,p<0.05)(Table2).Therateoftoothmovementwassignificantlyhigherintheexperimentalgroup(0.43±0.09mm/month)thaninthecontrolgroup(0.35±0.07mm/month,p<0.05)(Table2).Themeanqualityoftoothmovementscorefortheexperimentalgroupwas4.69±0.50,whichwassignificantlyhigherthanthecontrolgroup(3.92±0.44,p<0.05)(Table2).Therewasnosignificantdifferenceinrootresorptionbetweentheexperimentalandcontrolgroups(Table2).DiscussionTheaimofthisstudywastoevaluatetheefficacyofamodifiedcorticotomytechniqueinacceleratingorthodontictreatment.Theresultsshowedthatthemodifiedcorticotomytechniquesignificantlyreducedtreatmenttimeandimprovedthequalityoftoothmovement,whilemaintainingcomparablerootresorptiontotraditionalorthodontictreatmentwithoutcorticotomy.Themodifiedcorticotomytechniqueinvolvedmakingthreeverticalcutsinthealveolarboneandcrossingthemwiththreehorizontalcuts,creatingacheckerboardpattern.Thistechniqueisthoughttocreatelargerbonydefectsthanthetraditionalcorticotomytechnique,whichstimulatesgreaterboneturnoverandresultsinfastertoothmovement.Moreover,thecheckerboardpatternallowsformoreefficientorthodonticmovementandbetteranchorage,resultinginbetterqualityoftoothmovement.Theresultsofthisstudyareconsistentwithpreviousstudiesthathaveevaluatedthecorticotomytechniqueforacceleratingorthodontictreatment.However,thelong-termstabilityandsafetyofthistechniquearestillunderdebate.Furtherstudiesareneededtoev