Title	Corticotomy Is an Effective Adjunctive Procedure to Accelerate Tooth Movement in Adults Undergoing Orthodontic Treatment
Clinical Question	In adult patients undergoing orthodontic treatment, does corticotomy assisted treatment accelerate tooth movement as compared to non-surgery assisted tooth movement?
Clinical Bottom Line	Adult patients undergoing orthodontic treatment with corticotomy experience accelerated tooth movement compared to adult patients undergoing traditional orthodontic treatment without surgical assistance. This is supported by a systematic review and randomized clinical trials that demonstrate accelerated tooth movement and statistically significant decrease in treatment time of the corticotomy-assisted orthodontic treatment. More long term randomized clinical trials are still needed to allow more definitive conclusions on its validity in orthodontic treatment due to presence of heterogeneity in intervention, risk of bias in the included articles in systematic reviews and lack of long-term follow up. The risk of bias came from lack of randomization in some of the studies included, lack of allocation concealment in all of the studies included, and the absence of blinding of outcomes assessment in some of the studies.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 26608454 Patterson, 2016 Adults (13 studies, age range from 15-33), Children (1 study, age range from 11-13) Systematic review of randomized trials Key results Corticotomy procedures produced a statistically significant increase in the rate of orthodontic tooth movements when compared to controls. All studies included in the systematic review concluded that corticotomy procedures could accelerate the rate of tooth movement 1.5x-4x that of conventional orthodontic therapy. In one study, rate of space closure with corticotomy was assessed via duration of treatment — the corticotomy group had their treatment time decreased by about 8.65 +/- 2.67 months compared to the control group. Other studies concluded that treatment time decreased by about 28%-50% in the corticotomy group. Only 2 studies examined the rate of tooth movements at specific time intervals and concluded that accelerated tooth movement occurs at a higher rate in the first few months post-corticotomy. Fischer/2007 was the only study in which the study participants were children (age 11-13). This Fischer study focused on retraction of canines into the edentulous space. Corticotomy canines moved at a rate of 1.06 mm/mo while the control canines moved at a rate of 0.75 mm/mo, thus decreasing the treatment time 28-33%. In addition to evaluating rate of tooth movement, 9 articles concluded that the corticotomy procedures did not appear to have adverse effects on the periodontal health of the participants. 33876339 Jaber, 2022 18 Class II Division I pts, (age range from 16-24) Randomized Controlled Trial Key results A split-mouth randomized control study was performed in 18 patients (7 males, 11 females; age range from 16-24) that had upper first premolar extractions and underwent Er: YAG laser-assisted flapless corticotomy performed only on one side of the mouth. Canine retraction rates were assessed at five different time intervals and compared to the control side. There was a statistically significant difference (p-value < 0.001) in the rate of canine retraction at the first time point (from baseline to 1st week) and a 2.5x higher retraction rate of the experimental side compared to the control side. On average, there was an increase in canine retraction velocity of 1.8x on the experimental side from each time interval from week 1 to week 8. However, from the 8th week to the 12 week interval, there was no significant difference in velocity between the two sides (p-value: 0.427). 25128922 Al-Naoum, 2014 Adolescents and Adults (mean age: 20.04 ± 3.63 years, range 15-24) Randomized Controlled Trial Key results A split-mouth design randomized control study included 30 patients (15 males and 15 females) with a mean age of 20.04 ± 3.63. Total of 60 upper canines were retracted using 2 methods: corticotomy accelerated canine retraction (experimental), and conventional retraction with traditional fixed appliances (control). The tooth movement on the corticotomy side was significantly faster than on the control side throughout the experiment. A significant difference (p<.001) was found between the experimental and control sides at baseline to 1-week interval (0.74 mm/wk vs 0.20 mm/wk) and 1-2 week interval (0.46 mm/wk vs 0.10 mm/wk), and the tooth movement velocity was approximately 4 times faster on the experimental side. Moreover, a significant difference (p<.001) was found between the two groups at 2-4 week interval (0.31 mm/wk vs 0.10 mm/wk) and 8-12 week interval (0.24 mm/wk vs 0.08 mm/wk): approximately 3 times faster on the experimental side.
Evidence Search	“Corticotomy” AND “Orthodontics”, “Corticotomy” AND “Tooth movements”, “Corticotomy-assisted orthodontics”, “Accelerated tooth movement”
Comments on The Evidence	While Patterson’s systematic review directly addresses tooth movement via corticotomy and concludes that while corticotomies do accelerate tooth movement, there is a high risk of bias in this review, including sequence generation, allocation concealment, and blinding of outcomes. Bias risk was assessed using the Cochrane Risk of Bias Assessment Tool and the Cochrane Quality Study Guide. Only 6 of the 14 articles within this systematic review were RCTs. Only 2 of the 6 included RCT studies adequately addressed sequence generation (randomization); the other 4 RCTs did not provide any information about the randomization process. None of the articles adequately addressed allocation concealment. Only the blinding of outcomes (detection bias) was possible in these studies because the participants and operators could not be blinded from the corticotomy surgical intervention. Most studies sufficiently addressed incomplete data outcome (only 2 studies had attrition of subjects but had low risk of incomplete data reporting). Selective outcome reporting was generally not an issue. Other biases, such as methodology inconsistencies, were present in some of the studies. PRIMSA guidelines were followed during this study to minimize bias. Overall, the quality of the body of evidence was regarded as low, and this should be taken into consideration when evaluating this systematic review. In Jaber’s RCT, 18 participants were selected to participate in a split-mouth randomized controlled trial comparing corticotomy assisted retraction of the canine to traditional orthodontic movement. Jaber concluded that there are statically significant differences in canine retraction between the control and experimental group, and a higher rate of tooth movement is observed immediately following the corticotomy procedure. Patients were selected following the inclusion criteria, and 18 participants were selected according to the sample size calculation. Blinding could only be performed on the assessor since the patient served as both the control and experimental group. Paired sample t-tests indicated that there were small and insignificant systemic errors in assessors measuring the tooth movements, meaning there was high reliability in the measurements done by the accessors. This study did not evaluate for posterior teeth changes and anchorage loss during retraction of the canines. In addition, whether there was pure translation of the canines or other movements remains unaddressed. Slight pain and discomfort with the corticotomy procedure was a secondary outcome of this study. A split-mouth design randomized controlled trial was conducted by Fadi Al-Naoum at the Department of Orthodontics at University of Al-Baath Dental School to evaluate the efficacy and validity of alveolar corticotomy on acceleration of orthodontic tooth movement when retracting upper canines. 15 males and 15 females were included, and they were mostly adults needing retraction of upper canines. The follow-up period for the tooth movement was at baseline (immediately after corticotomy) and at 1,2,4,8, and 12 weeks after corticotomy, and average velocity for space closure was measured by a digital gauge and documented. Although the acceleration of tooth movement was statistically significant, patients in the study reported pain and discomfort ranging from mild to severe. Shortcomings of this randomized controlled study were lack of long term follow-up and the reference plane to accurately assess the tooth movement without unwanted forward drift of posterior teeth.
Applicability	At the moment, current literature includes mostly low-level evidence supporting corticotomy-facilitated orthodontic treatments. These articles conclude that there are statistically significant differences in utilizing corticotomies to increase and accelerate tooth movement; however, statistical significance and clinical significance can differ. Many studies conclude that the rate of tooth movement is increased right after the corticotomy is performed, but this rate slowly decreases back to control values. At the expense of patient comfort, corticotomy-facilitated orthodontic treatments can provide immediate changes to tooth movement rates, and can potentially decrease the time the patient is in treatment.
Specialty	(Orthodontics)
Keywords	Corticotomy, Orthodontics, Accelerated tooth movements
ID#	3563
Date of submission	10/17/2024
E-mail	chenj19@livemail.uthscsa.edu
Author	Jordan Chen
Co-author(s)	David Jeong
Co-author(s) e-mail	jeongd1@livemail.uthscsa.edu
Faculty mentor	Maria Karakousoglou
Faculty mentor e-mail	karakousoglo@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 (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available