Evaluation of the Accelerated Traction of Impacted Canines in Terms of Speed and Changes in the Dental Arches
Study Details
Study Description
Brief Summary
The time required for orthodontic traction of impacted canines after surgical exposure is a particularly troubling clinical problem because it prolongs the orthodontic treatment duration. During traction process, several complications could result in alveolar bone loss, root resorption of the adjacent teeth, ankylosis, discoloration, loss or vitality and gingival recession. Accordingly, and due to the lack of studies concerned with accelerating the traction movement of the impacted canines, we conducted this study to evaluate the effectiveness of some surgical interventions (corticotomy and Piezocision) in increasing the rate of orthodontic traction movement. We also aimed to evaluate dentoalveolar changes associated with the use of such accelerating procedures compared with the conventional traction method.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Detailed Description
Adult patients with unilateral palatally impacted canines will be included in this study. One of patient groups will be treated using fixed orthodontic appliances in combination with some accelerated surgical interventions, while the second patient group will be treated using the traditional treatment method. The velocity of traction movement will be assessed in the two groups. The differences between the two groups in terms of the total treatment duration and the traction duration will be evaluated.
Dentoalveolar changes associated with the use of such accelerating procedures will be assessed by several variables studied on cone-beam computed tomography (CBCT) images. In this study, two groups are going to be evaluated: (1) patients treated in the traditional manner, (2) patients will undergo corticotomy-assisted traction of the impacted canines.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Patients treated with the acceleration method Patients will be treated using fixed orthodontic appliances assisted by minimally-invasive corticotomy (osteoperforations and piezocision) to accelerate impacted canines' traction after levelling and aligning the upper dental arch and opening an appropriate distance. |
Procedure: Corticotomy
A corticotomy procedure will be applied with some osteoperforations during the surgical exposure of the impacted canine. Then this will be followed after 8 weeks with another surgical stimulation using piezosurgery.
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| Active Comparator: Patients treated with the traditional traction technique Patients will be treated using the fixed orthodontic appliances to track the palatally impacted canines after levelling and aligning the upper dental arch and opening an appropriate space to receive the impacted canine. |
Procedure: Traditional traction of the impacted canine without corticotomy
In this group of patients, the traction of the impacted canine will be performed traditionally without the involvement of additional surgical intervention.
|
Outcome Measures
Primary Outcome Measures
- Traction time [At the end of the traction stage which is expected to happen within 6 to 8 months]
The interval between the onset of orthodontic traction on the impacted canine and the emergence of half of its clinical crown.
- Total treatment time [At the end of the orthodontic treatment which is expected to happen between 15 to 24 months.]
The time between the bonding of the fixed orthodontic appliance until it is removed.
- Velocity of the traction movement [At the end of the traction stage which is expected to happen within 6 to 8 months]
Calculated by dividing the depth of impaction, which defined as the distance from the impacted canine cusp tip to the occlusal plane, by the traction duration
Secondary Outcome Measures
- Bone support ratio of the aligned canine [At the end of the orthodontic treatment which is expected to happen between 15 to 24 months.]
Alveolar bone height is the distance from the root apex of the canine to the alveolar crest (measured in mm), and canine root length is the distance from the root apex of the canine to the midpoint of a line connecting the mesial and distal points on the cementoenamel junction (measured in mm). The ratio will be calculated by dividing the alveolar bone height by the canine root length.
- Bone support ratio of the contralateral naturally erupting canine [At the end of the orthodontic treatment which is expected to happen between 15 to 24 months.]
Alveolar bone height is the distance from the root apex of the naturally erupting canine to the alveolar crest (measured in mm), and canine root length is the distance from the root apex of the naturally erupting canine to the midpoint of a line connecting the mesial and distal points on the cementoenamel junction (measured in mm). The ratio will be calculated by dividing the alveolar bone height by the canine root length.
- Bone support ratio of the adjacent lateral incisor [At the end of the orthodontic treatment which is expected to happen between 15 to 24 months.]
Alveolar bone height is the distance from the root apex of the adjacent lateral incisor to the alveolar crest (measured in mm), and the lateral incisor's root length is the distance from the root apex of the lateral incisor to the midpoint of a line connecting the mesial and distal points on the cementoenamel junction (measured in mm). The ratio will be calculated by dividing the alveolar bone height by the lateral incisor's root length.
- Bone support ratio of the adjacent first premolar [At the end of the orthodontic treatment which is expected to happen between 15 to 24 months.]
Alveolar bone height is the distance from the root apex of the adjacent first premolar to the alveolar crest (measured in mm), and the first premolar's root length is the distance from the root apex of the first premolar to the midpoint of a line connecting the mesial and distal points on the cementoenamel junction (measured in mm). The ratio will be calculated by dividing the alveolar bone height by the first premolar root length.
- Change of the root length of the adjacent lateral incisor [(1) The first assessment time is at one day before the beginning of orthodontic treatment and the (2) second assessment time is at one week following the end of the orthodontic treatment]
Resorption of adjacent lateral root will be evaluated by comparing the root length before and after treatment.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Patients aged 18 to 28.
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Unilateral palatally or mid-alveolar upper impacted canine.
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The impacted canine crown not exceeding the middle of the lateral incisor root.
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Absence of root resorption of the lateral incisors.
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No contact between the canine crown and the lateral incisor root.
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Individuals not previously receiving orthodontic treatment.
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No use of any medications that may affect the orthodontic movement.
Exclusion Criteria:
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Bilateral or buccal canine impaction cases.
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More than 45-degree angle between the canine's longitudinal axis and the vertical facial plane.
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Any medical condition that prevents oral surgery.
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Oral structural abnormality that is inherited or congenital.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Department of Orthodontics, University of Damascus Dental School | Damascus | Syrian Arab Republic | DM20AM18 |
Sponsors and Collaborators
- Damascus University
Investigators
- Principal Investigator: Mahran R. Mousa, DDS MSc, PhD student at the Department of Orthodontics
- Study Chair: Mohammad Y Hajeer, DDS MSc PhD, Professor of Orthodontics, Faculty of Dentistry, University of Damascus
- Study Chair: Omar Heshmeh, DDS MSc PhD, Professor of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Damascus
Study Documents (Full-Text)
None provided.More Information
Publications
- Al-Ibrahim HM, Hajeer MY, Alkhouri I, Zinah E. Leveling and alignment time and the periodontal status in patients with severe upper crowding treated by corticotomy-assisted self-ligating brackets in comparison with conventional or self-ligating brackets only: a 3-arm randomized controlled clinical trial. J World Fed Orthod. 2022 Feb;11(1):3-11. doi: 10.1016/j.ejwf.2021.09.002. Epub 2021 Oct 21.
- Becker A, Chaushu S. Success rate and duration of orthodontic treatment for adult patients with palatally impacted maxillary canines. Am J Orthod Dentofacial Orthop. 2003 Nov;124(5):509-14. doi: 10.1016/s0889-5406(03)00578-x.
- Becker A, Kohavi D, Zilberman Y. Periodontal status following the alignment of palatally impacted canine teeth. Am J Orthod. 1983 Oct;84(4):332-6. doi: 10.1016/s0002-9416(83)90349-4.
- Fischer TJ. Orthodontic treatment acceleration with corticotomy-assisted exposure of palatally impacted canines. Angle Orthod. 2007 May;77(3):417-20. doi: 10.2319/0003-3219(2007)077[0417:OTAWCE]2.0.CO;2.
- Mousa MR, Hajeer MY, Burhan AS, Heshmeh O. The Effectiveness of Conventional and Accelerated Methods of Orthodontic Traction and Alignment of Palatally Impacted Canines in Terms of Treatment Time, Velocity of Tooth Movement, Periodontal, and Patient-Reported Outcomes: A Systematic Review. Cureus. 2022 May 10;14(5):e24888. doi: 10.7759/cureus.24888. eCollection 2022 May.
- Parkin NA, Almutairi S, Benson PE. Surgical exposure and orthodontic alignment of palatally displaced canines: can we shorten treatment time? J Orthod. 2019 Jun;46(1_suppl):54-59. doi: 10.1177/1465312519841384. Epub 2019 Apr 1.
- Smailiene D, Kavaliauskiene A, Pacauskiene I, Zasciurinskiene E, Bjerklin K. Palatally impacted maxillary canines: choice of surgical-orthodontic treatment method does not influence post-treatment periodontal status. A controlled prospective study. Eur J Orthod. 2013 Dec;35(6):803-10. doi: 10.1093/ejo/cjs102. Epub 2013 Jan 24.
- UDDS-Ortho-10-2023