Introduction: Surgically Facilitated Orthodontic Therapy (SFOT) has been utilized for years to overcome the limitations encountered with traditional orthodontic treatment of dentoalveolar and alveoloskeletal malocclusions. The procedure, which consists of full flap corticotomies and bone grafting, has many proposed benefits including increased speed and range of tooth movement. The purpose of this study is to evaluate arch expansion in patients treated with SFOT and clear aligners. Materials and Methods: A retrospective cohort study design was used to evaluate 51 consecutive adult patients that were treatment planned for significant arch expansion with corticotomies, bone grafting, and clear aligners. 17 of the 51 patients refused the surgical procedure and served as controls. Eight transverse arch width measurements were obtained at three different time points (Initial, ClinCheck, Refinement). Five calculations were performed to determine the magnitude, predictability, and efficiency of arch expansion. Results: The difference in treatment time between the two groups was statistically significant at 5.2 months (P < .0001). On average, corticotomies reduced the length of treatment by 46% and increased the rate of expansion 2.4x. Patients that received SFOT achieved a greater magnitude (+28%) of expansion at a significantly higher rate (P< 0.002) than controls for all eight interarch measurements. The SFOT group displayed higher predictability (% goal achieved) and a smaller difference between predicted and achieved tooth movements for all measures obtained. The mean age for the entire sample was 42.81 (+12.51 years). Conclusion: Arch expansion with corticotomy-assisted clear aligner therapy is significantly more effective, efficient, and predictable than with clear aligners alone. The predictability of expansion with aligners appears to have a higher range than initially thought, even in patients that do not receive corticotomies.

Corticotomies have been used to assist orthodontic treatment since the late 18th century. This review describes and compares different surgical techniques available to accelerate tooth movement: PAOO™, Corticision, Piezocision™ and Propel. All of the approaches described accelerate orthodontic tooth movement and may protect against root resorption. PAOO™ and Piezocision™ offer the option of bone and soft tissue grafting at time of surgery. Corticision, Piezocision™ and Propel are considered minimally invasive procedures thanks to the flapless approach, but the use of the mallet in Corticision could constitute a trauma for the patient. The piezoelectric knife creates a more intense Regional Accelleratory Phenomenon (RAP) at the site of injury due to the effect of high frequency vibrations. This suggests that Piezocision™ could create a greater effect on bone remodeling, hence producing faster tooth movement and extended RAP. The lack of randomized controlled clinical trials makes an effective comparison between these techniques difficult and future studies are needed to better evaluate the outcomes of each of these.

BACKGROUND: The ultrasonic vibrations from the piezoelectric knife may amplify the natural response to surgical injury. This may lead to different clinical and biological outcomes when using the piezoelectric knife versus a surgical bur to create selective cortical penetrations for alveolar ridge augmentation surgeries. The first aim of this study was to analyze the differences in bone graft healing when selective cortical penetrations are created with a surgical bur and with a piezoelectric knife. The second aim of this pilot study was to see if enhanced new bone formation during bone regeneration procedures can be achieved with the use of a piezoelectric knife versus the conventional bur or onlay grafting techniques utilizing deep learning, a subset of machine learning. MATERIALS & METHODS: he project was approved by the Boston University Medical Center Institutional Animal Care and Use Committee (IACUC). Twenty, 9-10 week male Sprague Dawley rats, weighing approximately 300g, were used in this study. The rats were randomly divided into three groups: Xenograft, Alloplast, and Collagen. These groups were further divided by surgical technique: Bur, Piezo, and Onlay. For the Bur and Piezo groups, four equally-spaced selective cortical penetrations were made prior to bone graft stabilization. Three rats served as controls (Control group). Microcomputed tomography scans (µCT) were acquired for each sample, containing approximately 1,000 slices of data each. After 28 days of healing the volumes of and density of the newly formed bone were extracted and analyzed for each group. This was achieved with an innovative deep learning algorithm designed for multi-level segmentation and regional feature detection utilizing convolutional neural networks (CNN). RESULTS: Microcomputed tomography (µCT) of our samples yielded very localized, high-resolution scans of our surgical samples. The innovative deep learning algorithm was able to reliably produce highly accurate, unbiased segmentations of our samples. This study demonstrated that new bone formation was possible with all nine of the tested surgical techniques, however the differences were not statistically significant. Selective cortical penetrations with a piezoelectric knife (PIEZO) resulted in significantly more “cortical-like” new bone formation at 28 days. CONCLUSION: Within the limitations of this preliminary study, it is possible to conclude that the piezoelectric knife is a valid alternative to conventional carbide burs when making selective cortical penetrations prior to bone grafting surgery. Additionally, our deep learning algorithm successfully segmented thousands of slices of data and allowed for the calculation of porosity and new bone volume in our samples.

Submitted by MARCELO LELIS ZUPPARDO (ortodontiazuppardo@hotmail.com) on 2018-08-01T23:43:51Z No. of bitstreams: 1 Versão FINAL 01.08.2018.pdf: 1738428 bytes, checksum: ea89ecbcd914fe55c572f405cd81df64 (MD5) / Approved for entry into archive by Silvana Alvarez null (silvana@ict.unesp.br) on 2018-08-03T12:52:56Z (GMT) No. of bitstreams: 1 zuppardo_ml_dr_sjc.pdf: 1738428 bytes, checksum: ea89ecbcd914fe55c572f405cd81df64 (MD5) / Made available in DSpace on 2018-08-03T12:52:56Z (GMT). No. of bitstreams: 1 zuppardo_ml_dr_sjc.pdf: 1738428 bytes, checksum: ea89ecbcd914fe55c572f405cd81df64 (MD5) Previous issue date: 2018-06-06 / Este estudo comparou dois protocolos cirúrgicos, corticotomia e corticotomia com decorticalização, em ratos para verificar alteração na movimentação ortodôntica convencional. 60 animais foram divididos aleatoriamente: Grupo controle (GC) - movimentação ortodôntica convencional; Grupo 1 (G1) -movimentação ortodôntica e corticotomia; Grupo 2 (G2) - movimentação ortodôntica com corticotomia e decorticalização. Os animais foram eutanasiados após 7 e 14 dias. No G1 e G2 houve uma maior movimentação ortodôntica comparado aos animais do GC aos 14 dias (p = 0,009 e 0,016) com uma maior área radiográfica interradicular, menor volume ósseo/volume total, menor área final e menor porcentagem de osso. Aos 7 dias os animais do G2 apresentaram menor volume de osso/volume total comparado com GC e aos 14 dias os animais do G2 apresentaram uma menor medida linear da crista óssea comparado com o GC. Os animais do GC aos 14 dias apresentaram uma maior área final comparado aos 7 dias, enquanto o G2 apresentou maior número de células TRAP positivas tanto aos 7 quanto aos 14 dias comparado com o G1. Na análise histológica aos 7 dias houve frequente reabsorção radicular inicial geralmente associada às áreas de hialinização e aos 14 dias, presença do infiltrado inflamatório e com menor ocorrência de áreas hialinas. O padrão de reabsorção radicular iniciado no 7º dia de movimento e consolidado no 14º dia. Concluímos que a corticotomia acelera a movimentação ortodôntica em 14 dias independente da magnitude da injúria cirúrgica / This study compared two surgical protocols, corticotomy and decorticalization corticotomy, in rats to verify alteration in conventional orthodontic movement. 60 animals were randomly divided: Group 1 (G1) orthodontic movement and corticotomy, and Group 2 (G2) orthodontic movement with corticotomy and decorticalization. The animals were euthanized after 7 and 14 days. In G1 and G2, there was a greater orthodontic movement compared to CG animals at 14 days (p = 0.009 and 0.016) with a higher interradicular radiographic area, lower bone volume / total volume, lower final area and lower percentage of bone. At 7 days the G2 animals presented lower bone volume / total volume compared to CG and at 14 days G2 animals presented a smaller linear measure of bone crest compared to CG. GC animals at 14 days presented a larger final area compared to 7 days, while G2 presented a higher number of TRAP cells positive at 7 and 14 days compared to G1. In the histological analysis at 7 days, there was frequent initial root resorption generally associated with hyalinization areas and at 14 days, presence of inflammatory infiltrate and less occurrence of hyaline areas. The root resorption pattern started on day 7 of movement and was consolidated on the 14th day. We conclude that corticotomy accelerates orthodontic movement in 14 days regardless of the magnitude of the surgical injury.