The Effect Of Micro-osteoperations In Accelerating Orthodontic Tooth Movement

Background:Many patients are concerned about the physical and social discomfort caused by fixed appliances.In order to reduce possible dental and periodontal complications,including root apex absorption and increased dental caries.Doctors are actively exploring ways to shorten the time for orthodontic treatment in order to reduce orthodontic post-gingivitis and periodontitis.Although the best treatment plan that is developed through detailed examination and definite diagnosis and the patient’s cooperation can shorten the treatment time.However,the most important factor determining the treatment time is the organism’s biological response to orthodontic force.It is now generally believed that the speed of tooth movement is determined by the absorption rate of the alveolar bone,and the rate of alveolar bone resorption is controlled by the activity of osteoclasts.Many accelerated dental movement techniques based on regional acceleratory phenomenon(RAP)are invasive and involve surgery,requiring the simultaneous treatment of periodontists and orthodontists.Local regeneration leads to RAP when the tissue is subjected to noxious stimuli,including osteoclasts during the remodeling process,and the activity of markers and inflammatory markers of osteoblasts increases.Wilckodontics is the first technology that utilizes RAP and has been shown to be effective in accelerating tooth movement.However,this technique requires a corticotomy that removes the bone by peeling through a full-thickness flap and stripping it with a round drill bit.Although later invasive corticotomys have been developed,such as using a mallet hammer to strike a scalpel into the alveolar bone and using pressure puncture to penetrate the buccal cortex,the patient’s acceptance of these methods is still low.Recently,a new method of accelerating tooth movement using micro-osteoperations(MOPs)has been introduced into the field of orthodontics to stimulate alveolar bone remodeling without surgical trauma.The technique was developed based on previous animal studies and showed that small,shallow perforations in the alveolar bone increase the rate of tooth movement without the need for flaps,bone grafts or sutures.Alveolar bone perforation activates the cytokine cascade and subsequently increases osteoclast activity and can enhance bone remodeling after orthodontic force.A follow-up clinical study involving 20 adults showed that after removing the maxillary first premolar,the maxillary cuspids were moved distally and the distance moved by the canine was measured for one month.The MOP group was found to be the control group’s canine movement distance 2.3.Times.However,by accelerating the movement of teeth through surgery,the rate of movement of teeth decreases with time,which may be related to the short duration of local acceleration.When the micro-perforation stimulates the maxillary bone on one side,the stimulation does not cause significant discomfort to the patient and can make the tooth move faster than traditional orthodontic treatment.Due to the clinical nature of these studies,the effect of accelerating tooth movement using MOP has not been histologically observed.It is relatively easy to move the canine in clinical practice,and the long-distance movement of the molars is relatively difficult to achieve.The main purpose of this study was to study the role of micro-osteoperations in accelerating orthodontic tooth movement and explore the application of micro-osteoperations in clinical practice.ObjectiveMicro-osteoperations is the minimal trauma method to accelerate tooth movement in orthodontics through surgical methods.In the clinical,orthodontists can carry out independently and have broad application prospects.The purpose of this study was to evaluate the role of micro-osteoperations in accelerating orthodontic treatment and assess the advantages and clinical outcomes of micro-osteoperations.Content(1)To study the role of micro-osteoperations in rat maxillary expansion.(2)To study the role of minimal invasive surgery in accelerating orthodontic tooth movement.(3)To compare the diffference between MOP and traditional orthodontics of the second molars movement rate and related indicators in the process of mandibular second molars moving into the missing first molars space,.MethodResearch methods(1)32 female Sprague-Dawley rats,6 weeks old,were selected to expand the maxillary bone of the rat using a widening device.The rats were divided into 4 groups,8 in each group,blank control group,expanded bow group,MOP group,MOP+expansion group.At the beginning of the experiment,on the 7th and 14th day,the rat maxillary width was measured.On the 7th day,4 rats from each group were killed and the maxilla was isolated for HE staining and TRAP staining.The remaining rats were killed on the 14th day and the maxilla was isolated for HE staining and TRAP staining.The maxillary bone volume was measured and histological examinations were performed in the four groups of rats.The differences in bone metabolism between the four groups were analyzed by the number of various types of cells.Evaluate the effect of MOP on bone metabolism.(2)Systematic analysis of minimally invasive surgery accelerated orthodontic tooth movement.Use"piezocision","corticision","piez*","mop","micro-osteoperforation","minimally invasive","micro-osteoperations"and"ultrasonotomy"as key words to search by computer,respectively.The search was conducted through the search database CNKI,Weipu,Wanfang Database,Pubmed,EMBASE,Cochrane Central Register of Controlled Trials(CENTRAL),Scopus,Web of Science,Sciencedirect.Through review of the literature review,clinical randomized controlled trials were screened.All aspects of the experiment were evaluated and the conclusion was drawn that the minimally invasive surgery can help to accelerate tooth movement.(3)To study the role of micro-osteoperations in accelerating the mandibular second molar to replace the missing mandibular first molar.After aligning and leveling,20 cases of mandibular first molar missing samples were randomly divided into two groups.The experimental group was injected with 4%etanerceptin 1:100000 epinephrine 0.5ml at the base of the mandibular second molars near the middle vestibule to local anesthesia.No flaps,no other analgesic or anti-inflammatory drugs was used to eliminate the possible effects on the teeth movement.Using the PROPEL special handle,three micro-holes with a depth of 2 mm were made in the edentulous region of the mandibular first molar near the second molar.Patients in the control group did not use micro-perforated bone stimuli and were treated with traditional orthodontics.Both groups of patients used 200g nickel-titanium springs to pull the mandibular second molars to move into edentulous.If necessary,implanted nail anchorage was used.Visits are repeated every 4 weeks.At the time of referral,check the force generated by the tension spring and check for any deformation caused by chewing.At the time of referral,the experimental group was given the same perforation of micro-osteoperations,and the control group was routinely referred back.At the end of the 24th week,the experiment was named T2.The stage model was taken and the CBCT was taken.At the end of the experiment,patients in the experimental and control groups continued to undergo orthodontic treatment.By measuring the rate of movement of the mandibular second molar.The changes in the length of the second molar root and the amount of alveolar bone were measured by CBCT.Result(1)The rat’s maxillary dental arch width increases more with micro-perforation.The perforation of micro-bone can promote the bone metabolism at the sutures of the iliac crest.The MOP at the sacral suture can promote local osteoclast activation and bone formation.(2)Using minimally invasive surgical stimuli,the cuspid movement distance was greater after 1 month,which was 0.70 mm more than that of conventional orthodontics.The difference was statistically significant(WMD=0.70;95%confidence interval was(0.57,0.82).);p<0.001).The heterogeneity was low(χ~2=0.07,p=0.97,I~2=0%).The amount of distal movement of cuspids accumulated at 2 months,and the movement of orthodontic teeth stimulated by minimally invasive surgery was increased by 1.31 mm.The difference was statistically significant(WMD=1.31;95%confidence interval was(0.69,1.92);p<0.001).The heterogeneity was low(χ~2=0.69,p=0.41,I~2=0%).Use of minimally invasive stimulation without pain,periodontal injury and other obvious complications.(3)Under the stimulation of micro-bone perforation,the movement rate of the second molar in the experimental group was 1.14 mm/mon,1.08 mm/mon,and 1.02 mm/mon from the he,middle,and neck positions,respectively,and the control group second molars.The movement rates were 0.87 mm/mon,0.83 mm/mon,and 0.79 mm/mon from the he,middle,and neck positions,respectively.The moving speed of the experimental group was significantly higher than that of the control group(p=0.01),the average monthly movement was 0.27 mm,and the movement rate was increased by 31%.By using the micro-bone perforation method,the movement rate of the second molar increased by 0.27mm/mon,an increase of 0.31%.Through the comparison of CBCT before and after the experiment,it was found that there was no obvious root resorption and loss of alveolar bone in the experimental group and the control group(P>0.05).Conclusion(1)Micro-osteoperations can effectively promote rat maxillary dental arch enlargement,and promote bone metabolism in palatal suture(2)Systematic review shows that minimally invasive surgery can effectively accelerate tooth movement(3)The micro-osteoperations can accelerate the replacement of the missing first molars with the mandibular second molars.The height and width of the alveolar bones during the near-term movement have no significant changes.