evaluation of corticotomy-facilitated orthodontics and...

ORIGINAL ARTICLE

Evaluation of corticotomy-facilitatedorthodontics and piezocision in rapid canineretraction

Noha Hussein Abbas,a Noha Ezzat Sabet,b and Islam Tarek Hassanc

Cairo, Egypt

FromCairo,aLectubProfecAssoAll auPotenAddreCity, CSubm0889-Copyrhttp:/

Introduction: The purpose of this study was to evaluate the efficiency of corticotomy-facilitated orthodontics andpiezocision in rapid canine retraction. Methods: The sample consisted of 20 patients (15-25 years old) withClass II Division 1 malocclusions. The suggested treatment plan was extraction of the maxillary first premolarswith subsequent canine retraction. The sample was divided into 2 equal groups. In the first group, 1 side of themaxillary arch was randomly chosen for treatment with corticotomy, and in the second group, piezocision treat-ment was used. The contralateral sides of both groups served as the controls. Cuts and perforations wereperformed with a piezotome, and canine retraction was initiated bilaterally in both groups with closed-coilnickel-titanium springs that applied 150 g of force on each side. The following variables were examined overa 3-month follow-up period: rate of canine crown tip, molar anchorage loss, canine rotation, canineinclination, canine root resorption, plaque index, gingival index, probing depth, attachment level, and gingivalrecession. The rate of canine crown tip was assessed every 2 weeks after the start of canine retraction at 6time points. Results: The rates of canine crown tip were greater in the experimental sides than in the controlsides in both groups. Corticotomies produced greater rates of canine movement than did piezocision at 4time points. Canine root resorption was greater in the control sides. The remaining studied variables exhibitedno differences between the control and the experimental sides. Conclusions: Corticotomy-facilitated orthodon-tics and piezocision are efficient treatment modalities for accelerating canine retraction. (Am J OrthodDentofacial Orthop 2016;149:473-80)

The long duration of orthodontic treatment is oneof the most frequent complaints of orthodonticpatients; it results from the use of traditional

mechanical forces to induce movement by stimulationof resorption modeling in the paradental tissues.Recently, it has been claimed that mechanical force isnot the only stimulus that can induce tooth movement.The use of pharmaceutical,1,2 electromagnetic,3,4 laser,5

and surgical stimuli6-8 to accelerate orthodontic toothmovement has attracted considerable scientificinterest. Over the years, several surgical techniques

the Orthodontic Department, Faculty of Dentistry, Ain Shams University,Egypt.rer.ssor.ciate professor.thors have completed and submitted the ICMJE Form for Disclosure oftial Conflicts of Interest, and none were reported.ss correspondence to: Noha Hussein Abbas, 9 Hamouda Mahmoud St, Nasrairo, Egypt; e-mail, [email protected], March 2014; revised and accepted, September 2015.5406/$36.00ight � 2016 by the American Association of Orthodontists./dx.doi.org/10.1016/j.ajodo.2015.09.029

have been developed to reduce the overall treatmenttime. Thus, the use of supplemental dentoalveolarsurgeries to accelerate tooth movement has beenrecommended.

Distal canine movement is the core time-consumingprocedure for premolar extraction patients. Conven-tional techniques result in canine retraction rates of 0.5to 1 mm per month, depending on the patient's ageand sex. Therefore, full canine retraction can require 5to 9 months. Conventional treatments with fixedappliances are likely to require 1.5 to 2 years.

For rapid canine retraction, Liou and Huang6

proposed periodontal ligament distraction. Someresearchers have reported the use of dentoalveolardistraction based on the principles of distractionosteogenesis7; others have used selective alveolardecortication and claimed that this procedure invokestransient osteopenia.8 Modified surgical techniqueshave been reported to be effective in reducing clinicalorthodontic treatment times.

Corticotomy or decortication simply refers to theintentional cutting of cortical bone. The technique hasbeen claimed to dramatically reduce the treatment

473

Delta:1_given name

Delta:1_surname

Delta:1_given name

mailto:[email protected]

http://dx.doi.org/10.1016/j.ajodo.2015.09.029

474 Abbas, Sabet, and Hassan

time because the resistance of the dense cortical bone toorthodontic tooth movement is eliminated.9-13 Thisdecreased resistance has been explained by theunderlying regional acceleratory phenomenon (RAP)that occurs after a wound; RAP involves therecruitment of osteoclasts and osteoblasts to theinjured site for wound healing, which leads to atransient localized demineralization-remineralizationphenomenon in the bony alveolar housing.14

Moreover, it has been stated that corticotomy-facilitated orthodontics decreases the undesirableadverse effects of orthodontic treatment including rootresorption and periodontal damage.11 The combinationof augmentation grafting with corticotomy increasesalveolar volume, which results in significantly moreattached gingiva and aids the repair of alveolar corticalbone fenestrations and dehiscences. The grafting in-creases the scope of orthodontic tooth movementbecause it enables greater tooth movement into stablepositions.15 The main drawback of corticotomy is itsminimal acceptance by patients because of the aggres-siveness of these procedures, which increase postopera-tive discomfort and the risk of complications.16

Corticision was introduced as a supplemental den-toalveolar surgery in orthodontic therapy to achieveaccelerated tooth movement with minimal surgicalintervention. Park et al,17 followed by Kim et al,18 intro-duced the corticision technique as a minimally invasivealternative to the creation of surgical injuries to thebone that do not involve flap reflection. In this tech-nique, the authors used a reinforced scalpel and a malletto pass through the gingiva and cortical bone withoutraising a flap.

Thereafter, a piezosurgical knife was used to sparethe patient the stressful procedure of malletting; thiscorticision procedure was termed “piezocision.” Piezoci-sion is a new minimally invasive procedure in which amicrosurgical blade is used to make gingival microinci-sions, and piezoelectric incisions of the cortical alveolarbone are then made with an ultrasonic piezosurgicalknife. This procedure has recently been reported tobe safe and effective in osseous surgeries, such as pre-prosthetic surgery, alveolar crest expansion, and sinusgrafting.19

Compared with conventional burs, the use of a piezo-electric knife enhances bone healing without causing os-teonecrotic damage and facilitates the preservation ofroot integrity because of its precise, selective cutting ac-tion.20 Furthermore, because the piezoelectric knifeworks only on mineralized tissues, it spares the soft tis-sues and their blood supplies. Hard tissue or soft tissuegrafting can be combined with piezocision via selectivetunneling, which allows for the correction of gingival

April 2016 � Vol 149 � Issue 4 American

recessions and bone deficiencies. This procedure is notfeasible with corticision. Piezocision has successfullybeen used for the rapid treatment of Class II21 and ClassIII22 patients and has been combined with lingual ortho-dontics23 and the Invisalign system24 to achieve bothesthetic and rapid treatment.

Because few studies have addressed the effects ofcorticotomy and piezocision on canine retraction, thisstudy was performed to investigate the potentials of cor-ticotomy and piezocision to accelerate canine retractionand to compare these 2 techniques to determine whethercorticotomy can be replaced with the less-invasive pie-zocision. We also aimed to determine the types of caninemovement and any adverse effects that are associatedwith these 2 techniques. The study was designed totest the null hypothesis that the rates of canine retrac-tion elicited by the conventional method, corticotomy,and piezocision are the same.

MATERIAL AND METHODS

This study had approval from the ethical committeeof the faculty of dentistry of Ain Shams University, Cairo,Egypt.

The sample consisted of 20 patients with full comple-ments of permanent teeth that necessitated maxillaryfirst premolar extractions and subsequent canine retrac-tions. All patients fulfilled the following criteria: age, 15to 25 years; Class II Division 1 malocclusion with mild orno crowding; no previous orthodontic treatment; nosystemic disease that might have affected bone forma-tion or density, such as osteoporosis, hyperparathyroid-ism, or vitamin D deficiency; adequate oral hygiene;probing depth values not exceeding 3 mm across theentire dentition; adequate thickness of the attachedgingiva (1-2 mm); and no radiographic evidence ofbone loss. The patients were equally and randomlydivided into 2 groups: a corticotomy group in which cor-ticotomy was randomly assigned to 1 side of the maxil-lary arch (experimental side), and a piezocision group inwhich piezocision was randomly assigned to 1 side of themaxillary arch (experimental side). The randomizationwas performed with coin tosses to prevent selectionbias. The sides contralateral to the procedures servedas the controls in both groups.

The initial phase of leveling and alignment was firstcompleted with a straight wire 0.022-in slot Roth appli-ance. On the day before the surgery, 1 maxillary premo-lar was randomly selected and extracted, and the otherpremolar was extracted on the day of the surgery; thisprocedure was implemented to spare the patient thestress of having 2 bleeding sites at the same time andthe discomfort of a prolonged procedure.

Journal of Orthodontics and Dentofacial Orthopedics

[F1-4/C]

[F2-4/C]

[F3-4/C]

[F4-4/C]

Fig 1. The piezotome used in this study.

Fig 2. Cortical perforations and vertical cuts in the buccalcortical plate of the bone.

Abbas, Sabet, and Hassan 475

Corticotomy entails flap reflection followed by cutsand perforations in the cortical bone. To preserve thepapillae, a submarginal flap was used, where the incisionwas performed 4 mm apical to the free gingival margin.A number 15 blade in a Bard Parker blade handle(Paragon, Sheffield, United Kingdom) was used tomake a buccal incision that followed the contours ofthe gingiva and extended from the mesial surface ofthe maxillary lateral incisor to the mesial surface of themaxillary second premolar. A vertical releasing incisionwas then made, and a full-thickness mucoperiostealflap was elevated via a mucoperiosteal elevator; thisflap was extended beyond the apex of the canine. Usinga piezotome (VarioSurg3; NSK, Tokyo, Japan) (Fig 1),bone activation was accomplished with vertical cutsand perforations. The vertical cuts were made alongthe mesial and distal aspects of the canine root starting2 to 3 mm below the alveolar crest to protect the crestalbone, and the perforations were made facially along thelength of the canine root (Fig 2). The depths of the holeswere confirmed by the drop felt when the cancellousbone was reached. The piezotome was used to removethe bundle bone from the mesial wall of the extractionsocket of the premolar to decrease the resistance totooth movement in the desired direction. Thereafter,the flap was repositioned and sutured with nonresorb-able 4-0 black silk with the interrupted technique.

Piezocision involves gingival microincisions and ver-tical cortical cuts without flap reflection. Interproximalincisions were made through the gingiva on themesiobuccal and distobuccal line angles of the caninewith a number 15 blade in a Bard Parker blade handle.The incisions were made 2 mm below the papillae topreserve the papillae. With the same piezotome, thecortical alveolar incisions were created interproximally(Fig 3). The surgical injury was made 2 mm short ofthe alveolar crest to preserve the crestal bone and wasthen extended to the entire length of the canine root.The piezotome was used to remove the bundle bonefrom the mesial wall of the extraction socket of thepremolar to decrease the resistance to tooth movementin the desired direction. The incisions were then suturedwith nonresorbable 4-0 black silk with the interruptedtechnique.

Based on the assumption that the RAP induced by thebuccal corticotomy would readily involve the noncorti-cotomized palatal side, the surgeries were performedonly on the buccal cortical plate of the bone to reducethe operation time and the patients' postoperativediscomfort.8

In both groups, a 0.016 3 0.022-in stainless steelwire was tied back immediately after the surgery, andnickel-titanium closed-coil springs that applied 150 g

American Journal of Orthodontics and Dentofacial Orthoped

of pressure on each side were used for canine retraction.Canine retraction began immediately after the surgery totake advantage of the RAP induced by bone injury. Thecoil springs were stretched between the canine and themolar band hooks where the maxillary first permanentmolar and second premolar were ligated together anddesignated as the anchor unit (Fig 4). The retractionforce was measured using a strain gauge (Dentaurum,Ispringen, Germany), and the force was calibrated forreadjustment at each visit (biweekly). The problem ofthe transient nature of the RAP was managed by adjust-ing the orthodontic appliance every 2 weeks to use thecontinuous mechanical stimulation of the teeth to pro-long the osteopenic effect induced by the procedure.

The total follow-up period after the start of thecanine retraction was 3 months. Impressions were takenevery 2 weeks, and the casts were scanned using a

ics April 2016 � Vol 149 � Issue 4

[F5-4/C]

[F6-4/C] [F7-4/C]

Fig 3. Corticision lines.

Fig 4. Closed-coil nickel-titanium spring stretched be-tween the canine and the anchor unit. A, Control side;B, piezocision side.

Fig 5. A scanned cast showing the reference lines, themidpalatine raphe (MPR) and the rugae line (RL) formedby a projection from the most medial point on the thirdright rugae. dc, The distance between the cusp tip ofthe canine and the rugae line used to measure the ante-roposterior canine movement; dm, the distance betweenthe mesial contact point of the first permanent molar andthe rugae line used to measure molar movement; a, theangle between the median raphe and the line throughthe mesial and distal edges of the canine used to mea-sure canine rotation.


flatbed scanner. The anteroposterior crown tip move-ments of the canines were assessed at 6 time points(T1-T6) with the method described by Ziegler and Inger-vall.25 The casts were also used to assess the anchorageloss of the first molars and the canine rotation (Fig 5).Cone-beam computed tomography scans taken beforeand at the end of canine retraction were used to assessthe changes in canine inclination and canine rootresorption. The angle between the palatal plane andthe long axis of the canine was measured before and af-ter canine retraction (Fig 6). Periodontal health was


assessed by evaluating the plaque index and the gingivalindex according to the method of Loe26; moreover,probing depth, attachment level, and gingival recessionwere recorded.

Statistical analysis

For the parametric variables, Student t tests wereused for comparisons between the 2 experimental sidesof the 2 studied groups, and paired t tests were usedto compare the experimental and control sides withineach group. For the nonparametric variables, Mann-Whitney U tests were used for comparisons of the 2experimental sides of the 2 groups, and Wilcoxon signedrank tests were used to compare the experimental andcontrol sides within each group. A repeated-measuresanalysis of variance test was used to study the changesin canine movement over time. Tukey post hoc testswere used for pairwise comparisons between thedifferent periods when the analysis of variance testshowed significant differences.

RESULTS

The rates of canine crown tip were greater (P\0.05)in the experimental sides than in the control sides inboth groups (Table I). The corticotomy side exhibitedsignificantly greater rates of canine crown tip than didthe piezocision side at T1, T2, T5, and T6 (Fig 7).


[F8-4/C]

Fig 6. Cone-beam computed tomography sagittal sec-tion showing the angle between the palatal plane andthe long axis of the canine that was used to assess canineinclination: A, before canine retraction; and B, aftercanine retraction.


Although canine crown tipping was observed in allsides, there were no differences between the experi-mental and control sides or the 2 experimental sides incanine inclination, canine rotation, or molar movement(Table II), and no differences in any of the periodontalreadings (P .0.05) in either the corticotomy or the pie-zocision groups, as measured before the start of canineretraction and 3 months after canine retraction.Although there was no difference between the 2 exper-imental sides in canine root resorption, in both groupsthe control side exhibited greater canine root resorptionthan did the experimental side (Fig 8).

DISCUSSION

To address the demands of orthodontic patientsto decrease treatment time, corticotomy-facilitated


orthodontics (the most commonly used technique foraccelerating tooth movement) and piezocision(a recently developed technique) were studied to assessthe advantages and disadvantages of each technique.The rate of canine crown tip was significantly greaterin the experimental side than in the control side duringthe entire follow-up period. These findings agree withthose of Wilcko et al,8 Lino et al,27 Ren et al,28 andMoon et al,29 who reported that tooth movement veloc-ity on the corticotomy side is twice as fast as that on thecontrol side.

The corticotomy group exhibited greater rates ofcanine crown tip in the first and third months than didthe piezocision group; these differences might be attrib-utable to the more extensive surgery required for thecorticotomy procedure that might have enhanced theRAP. This supposition agrees with the findings of Frost30

andWilcko et al,31 who demonstrated that the severity ofbone injury is directly correlated with the intensity ofbone healing and the rapidity of tooth movement.

The increase in the rate of canine crown tip as theretraction proceeded can be explained by the ability ofthe orthodontic force to prolong the RAP; ie, moreRAP is induced as the tooth moves, and this increasesthe rate of canine movement.32 The acceleration ofcanine retraction did not surpass the lag phase of molarmovement as occurs during periodontal distraction.Consequently, the surgical procedures seemed to haveno effect on anchorage control.

The experimental sides exhibited less root resorptionthan did the control sides; this is consistent with thefindings of Generson et al,10 Suya,13 Wilcko andWilcko,8

and Moon et al,29 who reported that teeth retain theirvitality without any evidence of resorption after cortico-tomy surgery. The increased osteoclastic activity anddecreased bone density that are associated with RAPosteopenia decrease the likelihood of hyalinization ne-crosis and root resorption.27 In contrast, Gantes et al11

reported notable apical root resorption on periapicalradiographs associated with corticotomy-facilitatedorthodontics. However, the magnification errors and2-dimensional limitations of periapical film makethis technique inappropriate for estimations of rootresorption.

The use of a 0.0163 0.022-in wire in a 0.022-in slotmight lead to uncontrolled tipping of the canines in allsides. However, this study proved that neither canineinclination nor rotation was different between the surgi-cal and the conventional sides.

In contrast to the findings of Lindhe,33 Bell andLevy,34 and Yaffe et al,14 who reported slight interdentalbone losses, decreases in attached gingiva, and peri-odontal defects, we observed no significant adverse


Fig 7. Mean canine movements of the experimental sides.

Table II. Means, standard deviations, and results of paired t tests for comparisons between molar movement, caninerotation, and canine inclination in the experimental and control sides in the groups

Side group

Experimental Control

P value*Mean SD Mean SDMolar movement (mm) Corticotomy 2.99 0.55 3.13 0.42 0.346

Piezocision 3 0.38 3.25 0.52 0.221Canine rotation (�) Piezocision 0.65 0.47 0.5 0.39 0.434

Corticision 0.7 0.35 0.58 0.41 0.38Canine inclination (�) Corticotomy 2.75 1.16 2.1 0.91 0.146

Piezocision 2.89 1.2 2.23 0.95 0.146

Measured before canine retraction and 3 months after canine retraction.*Significant at P\0.05.

Table I. Means, standard deviations, and results of paired t tests for comparisons between canine crownmovement inthe experimental and control sides in the groups at 2-week intervals (T1-T6)

Period

Corticotomy Piezocision

P value

Experimental Control Experimental Control

Mean (mm) SD Mean (mm) SD Mean (mm) SD Mean (mm) SD2 wk (T1) 0.5 0.07 0.24 0.05 0.40 0.07 0.25 0.07 \0.001*4 wk (T2) 0.6 0.07 0.34 0.08 0.50 0.07 0.30 0.08 \0.001*6 wk (T3) 0.7 0.12 0.42 0.08 0.60 0.12 0.40 0.06 \0.001*8 wk (T4) 0.78 0.1 0.46 0.11 0.70 0.12 0.45 0.09 \0.001*10 wk (T5) 0.94 0.05 0.52 0.04 0.84 0.05 0.55 0.04 \0.001*12 wk (T6) 1.22 0.08 0.58 0.04 0.99 0.10 0.60 0.04 \0.001*

*Significant at P #0.05.


effects on the periodontium after corticotomy. Ourobservations agree with those of Gantes et al,11

Wilcko et al,8 and Lino et al.27 The following factorsaugmented the preservation of the periodontium: (1)the substitution of the conventional intrasulcular flapdesign of the corticotomy surgery with the submarginal


flap; (2) the start of the vertical cuts 2 to 3 mm below thealveolar crest; (3) the manner of bone removal in whichthe bone was only perforated, and the original bonyarchitecture remained intact; and (4) no heavyorthodontic forces that might have induced extensivebone resorption.


Fig 8. Bar graph showing the comparisons between mean canine root resorptions of the experimentaland control sides of both groups.


The piezocision technique proposed here resulted inclinical outcomes that were similar to those of the classicdecortication approach, but the piezocision techniquehad the additional advantages of being minimally inva-sive, precise, and less traumatic for the patient. However,this technique was time-consuming because of thedecreased cutting efficiency of the piezotome bladesrelative to conventional burs.

CONCLUSIONS

Corticotomy-facilitated orthodontics and piezocisionare effective treatment alternatives that decrease thetime required for canine retraction and decrease rootresorption in adults. Corticotomy-facilitated orthodon-tics is 1.5 to 2 times faster than conventional orthodon-tics. Piezocision was 1.5 times faster than conventionalorthodontics.

SUPPLEMENTARY DATA

Supplementary data related to this article canbe found at http://dx.doi.org/10.1016/j.ajodo.2015.09.029.

REFERENCES

1. Leiker BJ, Nanda RS, Currier GF, Howes RI, Sinha PK. The effects ofexogenous prostaglandins on orthodontic tooth movement in rats.Am J Orthod Dentofacial Orthop 1995;108:380-8.

2. Igarashi K, Mitani H, Adachi H, Shinoda H. Anchorage andretentive effects of a bisphosphonate (AHBuBP) on toothmovements in rats. Am J Orthod Dentofacial Orthop 1994;106:279-89.

3. Davidovitch Z, Finkelson MD, Steigman S, Shanfeld JL,Montgomery PC, Korostoff E. Electric currents, bone remodeling,and orthodontic tooth movement. II. Increase in rate of toothmovement and periodontal cyclic nucleotide levels by combinedforce and electric current. Am J Orthod 1980;77:33-47.


4. Stark TM, Sinclair PM. Effect of pulsed electromagnetic fields onorthodontic tooth movement. Am J Orthod Dentofacial Orthop1987;91:91-104.

5. Kawasaki K, Shimizu N. Effects of low-energy laser irradiation onbone remodeling during experimental tooth movement in rats.Lasers Surg Med 2000;26:282-91.

6. Liou EJW, Huang CS. Rapid canine retraction through distractionof the periodontal ligament. Am J Orthod Dentofacial Orthop1998;114:372-82.

7. Iseri H, Kisnisci R, Bzizi N, Tuz H. Rapid canine retraction andorthodontic treatment with dentoalveolar distraction osteogene-sis. Am J Orthod Dentofacial Orthop 2005;127:533-41.

8. Wilcko WM, Wilcko T, Bouquot JE, Ferguson DJ. Rapid orthodon-tics with alveolar reshaping: two case reports of decrowding. Int JPeriodontics Restorative Dent 2001;21:9-19.

9. Kole H. Surgical operations on the alveolar ridge to correct occlusalabnormalities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod1959;12:515-29.

10. Generson RM, Porter JM, Zell A, Stratigos GT. Combined surgicaland orthodontic management of anterior open bite using cortico-tomy. J Oral Surg 1978;36:216-9.

11. Gantes B, Rathbun E, Anholm M. Effects on the periodontiumfollowing corticotomy-facilitated orthodontics. Case reports. J Pe-riodontol 1990;61:234-8.

12. Chung KR, Oh MY, Ko SJ. Corticotomy-assisted orthodontics. JClin Orthod 2001;35:331-9.

13. Suya H. Corticotomy in orthodontics. In: Host E, Baldauf A,editors. Mechanical and biological basics in orthodontic therapy.Heidelberg, Germany: Huthig Buch Verlag; 1991. p. 207-26.

14. Yaffe A, Fine N, Binderman I. Regional accelerated phenomenon inthe mandible following mucoperiosteal flap surgery. J Periodontol1994;65:79-83.

15. Dibart S. Periodontally accelerated osteogenic orthodontics(PAOO). In: Serge D, editor. Practical advanced periodontal sur-gery. Hoboken, NJ: Wiley-Blackwell; 2011. p. 24-5.

16. Cassetta M, Di Carlo S, Giansanti M, Pompa V, Barbato E. Theimpact of osteotomy technique for corticotomy-assisted ortho-dontic treatment (CAOT) on oral health-related quality of life.Eur Rev Med Pharmacol Sci 2012;16:1735-40.

17. Park YG, Kang SG, Kim SI. Accelerated tooth movement by corti-cision as an osseous orthodontic paradigm: Kinki Tokai KyoseiShika Gakkai Gakujyutsu Taikai. Sokai 2006;48:6.




http://refhub.elsevier.com/S0889-5406(15)01403-1/sref1























































18. Kim SJ, Park YG, Kang SG. Effects of corticision on paradental re-modeling in orthodontic tooth movement. Angle Orthod 2009;79:284-91.

19. Vercellotti T. Piezoelectric surgery in implantology: a case report—a new piezoelectric ridge expansion technique. Int J PeriodonticsRestorative Dent 2000;20:358-65.

20. Vercellotti T, Nevins ML, Kim DM, Nevins M, Wada K, Schenk RK,et al. Osseous response following respective therapy with piezosur-gery. Int J Periodontics Restorative Dent 2005;25:543-9.

21. Dibart S, Surmenian J, Sebaoun JD, Montesani L. Rapid treatmentof Class II malocclusion with piezocision: two case reports. Int JPeriodontics Restorative Dent 2010;30:487-93.

22. Keser EI, Dibart S. Sequential piezocision: a novel approach toaccelerated orthodontic treatment. Am J Orthod Dentofacial Or-thop 2013;144:879-89.

23. Brugnami F, Caiazzo A, Dibart S. Lingual orthodontics: acceleratedrealignment of the “social six” with piezocision. Compend ContinEduc Dent 2013;34:608-10.

24. Keser EI, Dibart S. Piezocision-assisted Invisalign treatment.Compend Contin Educ Dent 2011;32:46-8:50-1.

25. Ziegler P, Ingervall B. A clinical study of maxillary canine retractionwith a retraction spring and with sliding mechanics. Am J OrthodDentofacial Orthop 1989;95:99-106.


26. Loe H. The gingival index, the plaque index and the retention indexsystems. J Periodontol 1967;38(Suppl):610-6.

27. Lino S, Sakoda S, Ito G, Nishimori T, Ikeda T, Miyawaki S. Acceler-ation of orthodontic tooth movement by alveolar corticotomy inthe dog. Am J Orthod Dentofacial Orthop 2007;131:448.e1-8.

28. Ren A, Lv T, Kang N, Zhao B, Chen Y, Bai D. Rapid orthodontictooth movement aided by alveolar surgery in beagles. Am J OrthodDentofacial Orthop 2007;131:160.e1-10.

29. Moon CH, Weeb J, Lee H. Intrusion of overerupted molars by cor-ticotomy and orthodontic skeletal anchorage. Angle Orthod 2007;77:1119-25.

30. Frost HM. The regional accelerated phenomenon. Orthop ClinNorth Am 1981;12:725-6.

31. Wilcko MT, Wilcko WM, Bissada NF. An evidence-based analysis ofperiodontally accelerated orthodontic and osteogenic techniques:a synthesis of scientific perspectives. Semin Orthod 2008;14:305-16.

32. Ferguson DJ, Wilcko WM, Wilcko TM. Accelerating orthodonticsby altering alveolar bone density. Good Practice 2001;2:2-4.

33. Lindhe J. Clinical periodontology and implant dentistry. 4th ed.Copenhagen, Denmark: Blackwell Munksguaard; 2004.

34. Bell WH, Levy BM. Revascularization and bone healing after maxil-lary corticotomies. J Oral Surg 1972;30:640-8.
















































本文献由“学霸图书馆-文献云下载”收集自网络，仅供学习交流使用。

学霸图书馆（www.xuebalib.com）是一个“整合众多图书馆数据库资源，

提供一站式文献检索和下载服务”的24 小时在线不限IP

图书馆。

图书馆致力于便利、促进学习与科研，提供最强文献下载服务。

图书馆导航：

图书馆首页文献云下载图书馆入口外文数据库大全疑难文献辅助工具

http://www.xuebalib.com/cloud/

http://www.xuebalib.com/

http://www.xuebalib.com/cloud/


http://www.xuebalib.com/vip.html

http://www.xuebalib.com/db.php

http://www.xuebalib.com/zixun/2014-08-15/44.html


evaluation of corticotomy-facilitated orthodontics and...

Documents