Title Surgically facilitated orthodontics with corticotomy and bone grafting does result in a slight increase in horizontal and vertical bone levels for orthodontic treatment compared to traditional orthodontic treatment alone.
Clinical Question In patients who need increased labial/buccal bone thickness for orthodontic treatment, does surgically (corticotomy) facilitated orthodontics with bone grafting provide sufficient horizontal and vertical bone thickness?
Clinical Bottom Line For orthodontists seeking a way to increase bone levels in both the horizontal and vertical dimensions, bone grafting with corticotomy can be a viable treatment option. However, since these studies examine the anterior mandible only, caution should be taken by orthodontists and they are encouraged to seek future studies that show an increased bone density in all areas of the oral cavity.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
26117379Ma/201611 patients (mean age 21.4yrs)Case series
Key resultsThe purpose of the study was to introduce grafting along with corticotomy-assisted orthodontics in the lower anterior regions and to evaluate the outcomes. The investigators used a dumpling technique with subperiosteal placement of bone grafting material and suturing of the periosteum to the alveolar bone surface in a dumpling-like manner. They selected 11 patients with lower anterior defects or thin bone. Computed tomography (CT) was used to evaluate bone levels at T(0) before treatment, T(1) 1 week after treatment and T(2) 6 months post bone augmentation. The investigators found that mean alveolar bone thickness increased from T0 to T1, and decreased from T1 to T2. Overall, there was still a significant amount of horizontal bone thickness increase from T0 to T2. Vertical bone level increased from T0 to T1, and was maintained from T1 to T2. Overall both horizontal and vertical bone thickness increased for these patients; however the bottom line of the article was that a long-term follow up study is needed.
23773424Coscia/201314 patients (Class III), mean age 26.14Case series
Key resultsThe purpose of this study was to evaluate the morphologic changes in the mandibular ridge that take place with augmented corticotomy combined with accelerated orthodontic forces in Class III patients. Fourteen patients were selected, and a CT was taken at T0 before the procedure and T1 after the procedure. The mean alveolar bone increased buccally at the mid-root and apex levels. Statistically significant horizontal thickness was seen at the labial aspect of the lower incisors. There was no vertical bone loss associated with the procedure. This procedure provided its patients with adequate decompensation needed for the class III correction. The approach decreases periodontal complications associated with traditional orthodontics and gingival recession.
23210199Shoreibah/201220 adults with moderate crowding of anterior teethRandomized Controlled Trial
Key resultsThe purpose of this study was to evaluate the effect of bone grafting in corticotomy-facilitated orthodontics in adults. Twenty adults were chosen with lower moderate anterior crowding, and they were split equally into two groups: Group 1 with corticotomy facilitated orthodontics alone, and Group 2 with corticotomy facilitated orthodontics supplemented with bone augmentation. Radiographs were recorded before treatment, at the time of debracketing, and 6 months post orthodontic treatment. The net percentage of change in bone density was calculated and Group 1 showed a net decrease of 17.59% from pre-treatment to post 6 months of orthodontic treatment. Group 2 (the group with bone augmentation) showed a net increase of 25.85% in bone density. Overall, the incorporation of bone graft material significantly increased alveolar bone dentistry in adult patients, and periodontal problems associated with tooth movements were reduced.
Evidence Search Corticotomy [Mesh terms] AND/OR Surgically facilitated orthodontics [MeSH terms] AND bone graft AND bone thickness [all fields] OR bone density AND Vertical bone density [all fields] AND horizontal bone density AND increase[all fields]
Comments on
The Evidence
Validity: The study design used to research this topic were mostly case series designed to look at observations on groups of people and to report those findings based on their treatment outcomes. There was one study that utilized a randomized controlled design to split groups and deliver a different procedure to two different groups. Apart from different treatment rendered, both groups were treated equally. Only a 6 month follow-up was recorded; a longer time should be considered. Also, all treatments did focus only on the anterior region of mandible and should not be generalized to the entire mouth. Perspective: The PICO question that was asked was in the treatment category. The question is important in the field of orthodontics and periodontics. Corticotomy-facilitated orthodontics is a newer technique, and therefore more research is needed in this field. There was a significant increase in bone density with the intervention treatment as compared to the comparison. Research directed towards the usefulness of bone grafting, and the amount of increased bone thickness that it can provide orthodontists in their treatment, needs to be addressed by future studies.
Applicability The subject pool of these studies all consisted of people that needed corticotomy and bone grafting in order to increase bone levels to avoid fenestrations when moving teeth through the bone anteriorly in the mandible. All studies did show an increase in vertical and horizontal bone thickness was achieved through the corticotomy with bone grafting; however, more studies need to be done to show assessment in all areas of the oral cavity in order for this technique to take flight in orthodontics. For this technique to be successful, it requires the expertise of multiple specialists and might not be an attractive option or cost effective for many patients.
Specialty (Orthodontics) (Periodontics)
Keywords surgically facilitated orthodontic therapy, SFOT, corticotomy, bone thickness, bone grafting
ID# 3346
Date of submission 11/15/2018
E-mail patelk1@uthscsa.edu
Author Komal Patel, DMD
Co-author(s) e-mail
Faculty mentor Anthony Ravikumar
Faculty mentor e-mail ANTHONYR@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available