Assessment of Dimensional Bony Changes Following Laser Corticotomy (Laser)

Assessment of Dimensional Bony Changes Following Laser Corticotomy in Rapid Canine Retraction

The patient's bone morphology during orthodontic treatment is an important consideration. Therefore, during orthodontic tooth movement (OTM), an imbalance between bone resorption and deposition will cause the tooth to move out of the alveolar envelope . Unfavorable consequences like gingival recession and the dehiscence of an alveolar bone plate may arise from the movement of the teeth beyond the boundary of the bone they are housing. This happened because the dense cortical bone didn't enlarge to maintain protection for the moving root.

On the other hand, orthodontic force creates a complex loading pattern and biological response on the periodontal ligament (PDL). there was an increase in osteoclastic activity in a compression region within the PDL. In contrast, in the other tension region, there was an increase in osteoblastic activity and mineralization of the bone matrix.

Study Overview

• Status: Completed
• Conditions: Canine Retraction
• Intervention / Treatment: Procedure: Conventional tooth movement; Procedure: laser corticotomy

Detailed Description

Orthodontic tooth movement generates complex mechanical loading patterns with corresponding complex biological responses in the periodontal tissues. This will occur only if the hard tissue around the tooth can undergo proper breakdown and build-up . The primary trigger factor responsible for orthodontic tooth movement is the strain experienced by the periodontal ligament (PDL) cells and the extracellular matrix. This strain results in alteration in the gene expression within the cells, with a production of various cytokines and chemokines, capillary vasodilatation within periodontal ligament, and migration of inflammatory cells with more cytokine production and subsequent alveolar bone remodeling in response to mechanical loading .

On application of orthodontic force, the compression region within the PDL shows increased osteoclastic activity,whereas in the tension region, there is proliferation of osteoblasts and mineralization of the extracellular matrix . In general, molecules that have been linked to tensile strains and act by stimulating osteoblast progenitor cell proliferation in the periodontal ligament, with subsequent bone formation and inhibition of bone resorption similar to orthodontic tooth movement, include transforming growth factor-beta (TGF-b), various bone morphogenic proteins (BMPs), and epidermal growth factor (EGF) . On the other hand, Interleukin-1 beta (IL-1β), interleukin-6 (IL-6), CC chemokines ligand 2 (CCL2), and other inflammatory cytokines regulate osteoclastic activity through the activation of the nuclear factor kappa B (RANK) and the nuclear factor kappa B ligand (RANKL) .

Corticotomy for rapid tooth movement was introduced in 1959 by Köle to cut the alveolar bone and move a tooth. He practiced corticotomy and osteotomy on various malocclusion cases. Vertically, the cortical and marrow bone between the teeth were partially removed, and either a subapical horizontal cut with alveolar bone cutting at a distance of one cm. from the apex or only a cortical osteotomy excluding the marrow bone was performed .

Conventional treatment with fixed appliances likely requires an average of 1.5 to 2 years, resulting in a canine retraction rate of 0.5 to 1mm per month. Therefore, other modalities have been used to accelerate OTM such as pulsed electromagnetic field, corticotomy, dento-alveolar distraction, periodontal ligament distraction, and laser therapy Laser-based technology was a dream for oral surgery to find a new tool for bone cutting. Using of pulsed erbium-doped yttrium aluminium garnet (Er:YAG) lasers showed effective cutting tool with minimum degree of carbonization. Also, it can effectively accelerate canine retraction with no complications or discomfort for the patients. The Erbium laser affects the cortical bone, leading to RAP without postsurgical complications

• Study Type: Interventional
• Enrollment (Actual): 18
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Heliopolis - Cairo
    • Cairo, Heliopolis - Cairo, Egypt, 123456
      • Faculty of Dentistry , Al Azhar Univeristy For Girls

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• patients who need extraction of maxillary first premolar in orthodontic treatment and patients who need canine retraction

Exclusion Criteria:

• medically compromised patient

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: control conventional method; conventional method of canine retraction using brackets	Procedure: Conventional tooth movement; tooth movement us done using wires and brackets
Active Comparator: study laser corticotomy; an accelerated orthodontic movement using Waterlase MDTM Turbo all-tissue laser for corticotomy	Procedure: laser corticotomy; stimulation of tooth movement during orthodontics treatment using Waterlase MDTM Turbo all-tissue laser therapy

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
assessment of labial bone thickness	assessment of labial bone using CBCT	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
assessment of root length	assessment of root length using CBCT	6 months

Collaborators and Investigators

• Sponsor: Ain Shams University
• Investigators: Principal Investigator: Zainab H Abdel Rahman, Phd, lecturer

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2024
• Primary Completion (Actual): October 1, 2024
• Study Completion (Actual): October 1, 2024

Study Registration Dates

• First Submitted: November 3, 2024
• First Submitted That Met QC Criteria: November 22, 2024
• First Posted (Estimated): November 25, 2024

Study Record Updates

• Last Update Posted (Estimated): November 25, 2024
• Last Update Submitted That Met QC Criteria: November 22, 2024
• Last Verified: October 1, 2024

More Information

Terms related to this study

• Keywords: laser; CBCT; canine retraction; bony changes
• Other Study ID Numbers: Assessment of bony changes

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No