OBJECTIVE: To evaluate the effectiveness of micro-osteoperforation (MOP) over a 56-day period and to determine the influence of number of perforations on the rate of canine retraction. In addition, the amount of pain and discomfort caused by the MOP was evaluated.
METHODS: A single-center, split-mouth, triple-blind, randomized, controlled trial.
METHODS: 22 patients (18-30 years) who need fixed orthodontic treatment were recruited and randomly assigned to MOP1 and MOP2 groups. The recruited patients were divided into two groups with 1:1 allocation ratio. Randomization for the determination of experimental side and number of perforations was done using sealed envelopes. On each patient, the other side of mouth worked as control side with no MOPs. 4 months after first premolar extraction, patients in MOP1 received 3MOPs on the buccal surface of alveolar bone, whereas patients in MOP2 received three buccal and three palatal MOPs in the experimental side. The amount of canine retraction was measured every 28 days at two intervals on both sides of mouth. Pain perception was measured after 1 hr, 24 hr, 72 hr, 7 days, and 28 days of procedure.
RESULTS: Result of the intra-examiner reliability using ICC is more than 0.97 (P < 0.001), indicating excellent repeatability and reliability of the measurements. The baseline characteristics between groups were similar (P > 0.05). A statistically significant difference in the rate of canine retraction on the MOP side was observed at the end of 56 days, amounting to two folds more than that of the control side. No significant difference was seen between MOP1 and MOP2 groups (P > 0.05). Mild-to-moderate pain was experienced only in first 72 hours of procedure.
CONCLUSIONS: The study recommends that MOP procedure has substantial potential to be used as an adjunct to the routine mechanotherapy for accelerating tooth movement, as it may reduce treatment time by half in the first four weeks after the MOP procedure.
BACKGROUND: Clinical trial registry of India (CTRI/2022/12/048181).

OBJECTIVE: The aim was to compare and evaluate the variation in the mandible\'s posterior anatomic limits (MPAL) stratified by different third molar impaction patterns utilizing cone-beam CT (CBCT) in individuals with skeletal Class III malocclusion.
METHODS: The sample consisted of CBCT records of 80 samples of Class III patients categorized based on the pattern of their third molar impaction. The shortest linear distances from the distal root of the second mandibular molar to the inner cortex of the mandibular body were measured at the crown level, at the cementoenamel junction (CEJ), and at the depths of 4, 6, and 8mm from the CEJ, all parallel to the posterior occlusal line. The MPAL of the four groups were compared. The Shapiro-Wilk test for normality was performed. The Kruskal-Wallis test was performed to compare the MPAL distances between the groups.
RESULTS: Significant differences were noted between the four groups at every level. MPAL distances decreased towards apex in all the groups and was least at the 8mm root level. The greatest MPAL distances were noted in the no-impaction group followed by the horizontal. At 8mm, the MPAL were 4.2+/-1.3 in Group 3 (Control), 3.3+/-0.9 in Group 1 and 2.7+/-0.05 mm in Group 2. Though the amount of space available for distalization was greatest for the mesioangular group at the crown level, it was least at the 8mm level compared to other groups.
CONCLUSIONS: MPAL distances were shortest at the root level in Class III patients who had mesioangularly impacted third molars and care should be taken before attempting distalization in them.

Wilckodontics is the periodontally accelerated orthodontic treatment, which is a clinical procedure that combines orthodontic tooth movement with corticotomy and bone grafting. Corticotomy is the surgical procedure that involves cutting the bone, perforating the bone and mechanically altering it. This procedure makes tooth movement easy and rapid with the help of orthodontic force application. This procedure is based on the regional acceleratory phenomenon that increases the bone width, shortens the treatment time from years to months and increases the treatment stability. This procedure also reduces the need for extraction and also increases bone support for teeth and soft tissues. This review article describes the surgical procedure, advantages, disadvantages, indications, and contraindications of Wilckodontics and the current advances in this technique.

BACKGROUND: The purpose of this study was to evaluate the amount of root resorption with mini implant-aided anchorage, with and without inducing the regional acceleratory phenomenon (RAP) in en masse retraction cases using cone-beam computed tomography (CBCT).
METHODS: Thirty patients requiring therapeutic extraction of all first premolars were included in the study and randomly divided into two groups of fifteen patients each (groups I and II). Patients of both groups underwent retraction using mini implants. In patients of group II, the RAP was initiated before starting retraction. For each patient, CBCT of the maxillary and mandibular anterior region was taken before treatment and after retraction to evaluate root length changes.
RESULTS: The amount of root resorption post-retraction was lesser in group II as compared to group I for the maxillary canine, mandibular canines, and mandibular lateral incisors. When the amount of root resorption was scored according to the Malmgren index, a greater percentage of teeth in group I (17.8%) showed root resorption of score of 3 as compared to group II (6.1%).
CONCLUSIONS: The results of the study show that the RAP caused reduced root resorption, but its effect was localized to the area where it was induced. When mini implants are used for absolute anchorage during en masse retraction, the RAP can be induced to reduce the root resorption that results from increased treatment time associated with implant-aided retraction.

UNASSIGNED: The objective of the study was to evaluate the rate of orthodontic tooth movement assisted by piezocision and discission in extraction cases.
UNASSIGNED: Twelve adults (20-35 years) requiring upper premolar extraction for orthodontic treatment were included in this preliminary parallel-arm clinical study. Participants (randomly allocated) in Groups A and B received piezocision and discision-assisted corticotomy cuts at the premolar extraction site, respectively, contralateral side served as the control. Canine retraction was started bilaterally using closed coil NiTi (Nickel titanium) springs. A schedule of fortnightly activation was followed for 3 months. Stage models were made monthly (M0, M1, M2, M3). Models were scanned using a 3-shape intraoral scanner, and the displacement of the canine was measured bilaterally in the stage models. A self-designed questionnaire was used to assess patients pain and satisfaction levels on a visual analogue scale.
UNASSIGNED: The rate of canine retraction at the piezocision site was twice that at the control site in group A (p=0.007). The rate of canine retraction at the dissection site was twice that at the control site in group B (p=0.012). However, there was no significant difference in the rate of retraction between the two surgical techniques. Pain and disturbance were noticed in the discission group at 50 and 67% respectively.
UNASSIGNED: Discision is comparable to piezocision for accelerating orthodontic tooth movement. Although dissection can speed orthodontic treatment, it should be used with caution as it could pose technical and clinical difficulties, particularly in the posterior buccal region of the oral cavity.

Surgery-mediated acceleration of orthodontic tooth movement (SAOTM) has been proven effective for decades. Research has confirmed that surgical approaches play an important role in adult patients with a short orthodontic treatment time. The mechanism of SAOTM involves short-term acceleration of localized hard and soft tissue remodeling, known as the regional acceleratory phenomenon. However, no relevant review on the biological mechanism of SAOTM has been performed to date. The proposed biological mechanism of acceleration of OTM involves the participation of various cells, cytokines, and signaling pathways. We herein review the relevant literature and summarize the biological mechanism of SAOTM to provide new insights for further research on acceleration of OTM.

OBJECTIVE: To evaluate the effect of micro-osteoperforations (MOPs) on the rate of orthodontic tooth movement (OTM) during en masse anterior retraction.
METHODS: Twenty patients were randomly allocated into experimental and control group of 10 each. In the control group, en masse retraction was performed with sliding mechanics with a coil spring. In the experimental group after alignment and levelling, MOPs were performed mesially and distally to all six anterior teeth in the interdental cortical region on the labial aspect of both arches. MOPs were performed at the beginning of space closure (T0) and 1 month after beginning of space closure (T1). En masse retraction was performed with sliding mechanics with a coil spring. Measurements were recorded on digital models made from scanned plaster casts at the beginning of space closure (T0) and monthly at each follow-up visit for the next 4 months (T1, T2, T3, T4). The monthly rate of OTM, the overall rate of OTM, and the difference between OTM in the MOP period (T0-T2) and post-MOP (T2-T4) period in the experimental and control group were evaluated. A visual analogue scale (VAS) was used to evaluate patients\' pain experience.
RESULTS: The overall rate of OTM was significantly greater in the experimental group for both arches in the MOP period (T0-T2) and also in the post-MOP period (T2-T4) as compared to the control group. Within the experimental group, the rate of OTM in the MOP period was significantly greater than in the post-MOP period, which in turn was greater than that of the control group. The patients reported only mild discomfort for 24 h after performing the MOPs, which then gradually decreased.
CONCLUSIONS: The use of MOPs is effective in increasing the rate of en masse tooth retraction in both the maxillary and the mandibular arch. The rate of tooth movement was greater even in the post-MOP period as compared to the control group.
UNASSIGNED: ZIELSETZUNG: Untersucht werden sollten die Auswirkungen von Mikro-Osteoperforationen (MOPs) auf die Geschwindigkeit der kieferorthopädischen Zahnbewegung (OTM) während einer En-masse-Retraktion im Frontzahnbereich.
METHODS: Zwanzig Patienten wurden randomisiert in eine Versuchs- und eine Kontrollgruppe mit jeweils 10 Patienten eingeteilt. In der Kontrollgruppe wurde die En-masse-Retraktion mit einer Gleitmechanik und einer Zugfeder durchgeführt. In der Versuchsgruppe wurden nach der Ausrichtung und Nivellierung MOPs mesial und distal an allen 6 Frontzähnen in der interdentalen Kortikalregion auf der labialen Seite beider Zahnbögen durchgeführt. Die MOPs wurden zu Beginn des Lückenschlusses (T0) und einen Monat nach Beginn des Lückenschlusses (T1) durchgeführt. Die En-masse-Retraktion wurde mit einer Gleitmechanik und einer Zugfeder durchgeführt. Die Messungen wurden auf digitalen Modellen aufgezeichnet, die aus eingescannten Gipsabdrücken zu Beginn des Lückenschlusses (T0) und monatlich bei jeder Nachuntersuchung in den nächsten 4 Monaten (T1, T2, T3, T4) erstellt wurden. Die monatliche OTM-Rate, die Gesamtrate der OTM und der Unterschied zwischen der OTM in der MOP-Periode (T0-T2) und in der Post-MOP-Periode (T2-T4) in der Versuchs- und in der Kontrollgruppe wurden bewertet. Zur Einschätzung des Schmerzempfindens der Patienten wurde eine visuelle Analogskala (VAS) verwendet.
UNASSIGNED: Die Gesamtrate der OTM war in der Versuchsgruppe für beide Zahnbögen in der MOP-Periode (T0-T2) und auch in der Post-MOP-Periode (T2-T4) im Vergleich zur Kontrollgruppe signifikant höher. In der Versuchsgruppe war die OTM-Rate in der MOP-Periode signifikant höher als in der Post-MOP-Periode, die wiederum höher war als die der Kontrollgruppe. Die Patienten berichteten über 24 h lang nach Durchführung der MOP andauernde, nur geringe, dann allmählich abnehmende Beschwerden.
UNASSIGNED: Die Anwendung von MOPs ist effektiv, um die Geschwindigkeit einer En-masse-Retraktion von Zähnen sowohl im Ober- als auch im Unterkiefer zu erhöhen. Die Geschwindigkeit der Zahnbewegung war sogar in der Zeit nach der MOP höher als in der Kontrollgruppe.

This case report introduces digital surgery-first approach orthognathic surgery assisted by three-dimensional virtual planning and combined with invisible orthodontic treatment for a 21-year-old female patient with a skeletal Class III high-angle gummy smile malocclusion. We explored the clinical significance of the widespread application of digital technology for rapid development of the orthodontic/orthognathic field. The regional acceleratory phenomenon and clear aligners were used to achieve fast and aesthetic tooth movement after surgery. The treatment lasted only 8 months, and the patient was satisfied with the aesthetic results. The results remained stable after 1 year of follow-up. This case report highlights the advantages of combining a digital design and a surgery-first approach to produce accurate, rapid, safe, stable, and fulfilling cosmetic results. The combination of the surgery-first approach and clear aligners can facilitate patient-oriented surgical orthodontic treatment.

OBJECTIVE: The mechanisms of regional acceleratory phenomenon (RAP) induced by orthognathic osteotomy are unclear. It was not known if locally hypoxic microenvironment changes were involved in this phenomenon.
METHODS: Hypoxia-induced factor-1α knockout mice harboring Cathepsin K (CTSK) Cre were used to investigate the effect of hypoxia-driven osteoclasts on alveolar bone remodeling. RAW264.7 cells were induced by CoCl2 to observe the effects of dendritic cell-specific transmembrane protein (DC-STAMP) on the fusion and differentiation of osteoclasts.
RESULTS: We found mandibular osteotomy of C57 mice induced active alveolar osteoclasts and increased hypoxia-induced factor-1α (HIF-1α) positive staining areas. Alveolar bone density of the 10-week-old HIF-1α conditional knockout (CKO) mouse was increased at 10 and 14 days after bilateral mandibular osteotomy. Moreover, decreased numbers of osteoclasts and matrix metalloproteinase 9 (MMP-9)-positive cells were observed on the surface of bone resorption lacunae in the CKO group. HIF-1α could increase the expression level of DC-STAMP to enhance osteoclastogenesis and cell fusion in active RAW264.7 cells.
CONCLUSIONS: Our data considered hypoxia-driven osteoclasts resorption to be an adaptive mechanism to permit alveolar bone loss after bilateral mandibular osteotomy of mice.

To evaluate the effect of a second-stage piezocision on the biological response.
60 rats were randomly allocated to 6 experimental groups of 10 rats. Rats undergoing a one-stage piezocision were sacrified on day 7, 28 and 42 (groups 1-3) while rats undergoing a two-satge piezocision were sacrified on day 42, 63 and 90 (groups 4-6), respectively. The biological response was investigated in 3D at the tissue level using Nano-computed tomography (Nano-CT) and, at the molecular level using the qRT-PCR technique. Bone Volume Fraction (BVF) loss was the primary endpoint.
Similar loss of BVF were observed both after the first and second piezocisions. The change in BVF loss between 7 and 28 days after each piezocision were 25.1 ± 13.0 (SE)% and 11.2 ± 11.6 (SE)% respectively and did not differ from each other (p = 0.43). Changes in BVF loss from 7 to 42 days were also comparable in one-stage and two-stage piezocision (4.9 ± 12.3 (SE) vs. -19.9 ± 13.4 (SE), p = 0.19). At the molecular level, all parameters except Translating Ribosome Affinity Purification (TRAP) protein had identical patterns.
Within the limits of the present study, a second piezocision allowed to re-induce the Regional Acceleratory Phenomenon (RAP) effect. Nevertheless, the relevance of the findings to the clinical effect has not been tested.