Alveolar Bone Remodeling After Micro-Osteoperforations Vs. Flapless Corticotomy: A Randomized CBCT Study
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Abstract
Background: Orthodontic treatment often entails prolonged durations, a significant concern for many patients. To address this, accelerated orthodontic techniques, such as micro-osteoperforations (MOPs) and flapless corticotomy, have emerged. These methods aim to stimulate alveolar bone remodeling, primarily by inducing the Regional Acceleratory Phenomenon (RAP), thereby expediting tooth movement. Despite their increasing popularity, the precise and comparative effects of these interventions on quantitative alveolar bone morphology and density remain inconsistently reported in the existing literature.
Objective: This randomized controlled trial aimed to quantitatively compare the effects of micro-osteoperforations versus flapless piezocision on alveolar bone remodeling, specifically assessing changes in buccal alveolar bone thickness, bone density, and the incidence of dehiscence and fenestration, using Cone-Beam Computed Tomography (CBCT) in adult orthodontic patients.
Methods: This study was designed as a prospective, parallel-group, single-center randomized controlled clinical trial. Twenty-four adult participants requiring fixed orthodontic treatment with premolar extractions were randomly allocated to either the MOP group (n=12) or the flapless piezocision (FP) group (n=12). In the MOP group, three perforations (1.5 mm width, 3 mm depth) were created using a Propel device. In the FP group, vertical buccal incisions were made with a piezosurgical knife, followed by a 3 mm depth corticotomy. CBCT scans were acquired at baseline (T0) and 6 months post-intervention (T1). Specialized 3D imaging software (Mimics®) was used for quantitative assessment of buccal alveolar bone thickness (at coronal, mid-root, and apical levels), alveolar bone density (in Hounsfield Units), and the presence of dehiscence and fenestration. Statistical analysis included paired and independent samples t-tests, and Chi-square tests.
Results: Both interventions significantly accelerated tooth movement. In terms of buccal alveolar bone thickness, both groups showed a statistically significant increase at the coronal and mid-root levels (P < 0.05), with the flapless piezocision group demonstrating a significantly greater increase at the coronal level compared to the MOP group (P = 0.009). Alveolar bone density showed a non-significant reduction in the MOP group and a non-significant change in the FP group, with no statistically significant difference observed between the two groups (P = 0.15). No new cases of alveolar dehiscence or fenestration were observed in either group at 6 months post-intervention.
Conclusion: Both micro-osteoperforations and flapless piezocision are effective in promoting favorable alveolar bone remodeling, characterized by an increase in buccal alveolar bone thickness, without significantly compromising bone density or increasing the incidence of dehiscence and fenestration. Flapless piezocision demonstrated a quantitatively superior effect on coronal bone thickness. These minimally invasive techniques serve as valuable adjuncts to accelerate orthodontic treatment while maintaining periodontal health.
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References
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