Sultana, Sharmin
(2021)
The efficacy of modified flapless corticotomy using piezocision procedure to accelerate orthodontic tooth movement in premolar extraction cases.
PhD thesis, Universiti Sains Malaysia.
Abstract
This study aimed to investigate the efficacy of modified piezocision
procedure to accelerate the levelling and alignment stage in orthodontic treatment
with first premolar extraction cases of the maxilla and mandible and evaluate its
effects on the gingival recession, periodontal pocket depth, tooth vitality, pain, and
satisfaction score. The sample comprised 16 patients with Little’s Irregularity Index
(LII) between 7-9 mm in the maxillary and mandibular incisors and require
extraction of first premolars for both jaws. The subjects were randomly allocated
into the control group, and the piezocision group and the recruited subjects were
divided into two parallel groups with a 1:1 allocation ratio. Both groups received
McLaughlin Bennett Trevisi (MBT) prescription brackets of the 0.022-inch slot.
The experimental group received piezocision surgery on the same bonding day.
Maxilla and mandibular study cast were taken at a monthly interval to assess the
overall alignment time, changes in the LII, and alignment rate. The periodontal
parameters (gingival recession and pocket depth) and pulp vitality test were
evaluated. Patient perception of the pain level and level of satisfaction with a
numeric rating scale was assessed following the piezocision procedure. A total of
13 patients (7 control and 6 piezocision) in the maxilla completed the study,
whereas, in the mandible, a total of 10 patients (7 control and 3 piezocision)
completed the study. The overall treatment time to complete the levelling and
alignment was significantly shorter in the piezocision group compared to the control
group in the maxilla (mean difference = 31.5, 95% CI: 6.5, 56.5; P = 0.018),
whereas, in the mandible, the result was non-significant. In the maxilla, changes of
LII had significantly reduced at the second month and alignment rates were
significantly faster in the first two months in the piezocision group compared to the
control group, but no significant difference in the mandible. Gingival recession,
pocket depth, and pulp vitality of the maxillary and the mandibular teeth remained
stable in both groups throughout the observation period of this study. Patients had
reported a mild to no pain score and a satisfactory score about the piezocision
procedure. Piezocision seems to be an effective method to decrease the overall
levelling and alignment time and accelerating orthodontic tooth movement.
However, the significant efficacy was found only in the maxilla and convincing
efficacy to the mandible. The piezocision procedure did not produce any adverse
effects on periodontal structure and vitality on the tooth; also, it seems a less painful
and satisfactory surgical approach.
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