Acceleration of orthodontic tooth movement using two different distraction techniques

Neetu Dabla; Arjun Vedvyas; Geetanjali Gandhi

doi:10.4103/jdmimsu.jdmimsu_243_21

CASE REPORT

Year : 2022 | Volume : 17 | Issue : 1 | Page : 114-117

Acceleration of orthodontic tooth movement using two different distraction techniques

Neetu Dabla¹, Arjun Vedvyas², Geetanjali Gandhi¹
¹ Department of Orthodontics and Dentofacial Orthopaedics, Maharishi Markandeshwar College of Dental Sciences, Ambala, Haryana, India
² Department Of Orthodontics and Dentofacial Orthopaedics, Seema Dental College and Hospital, Rishikesh, Uttarakhand, India

Date of Submission	25-Jun-2021
Date of Decision	08-Oct-2021
Date of Acceptance	06-Jan-2022
Date of Web Publication	25-Jul-2022

Correspondence Address:
Dr. Neetu Dabla
582-GF,Happy Homes, Omaxe city 2, sector 26, Rohtak-124001, Haryana
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jdmimsu.jdmimsu_243_21

Abstract

A shortened orthodontic treatment period is the demand of the modern era. Various methods, namely corticotomy, micro-osteoperforation, distraction, etc., have been implored to achieve a quicker tooth movement. Our report presents a comparison of periodontal and dentoalveolar distraction techniques done using a modified HYRAX as distractor in contralateral arches of the same patient. Results showed that the canine was retracted in 13 days on the periodontal distraction side and in 16 days on the side of dentoalveolar distraction. Hence, it can be concluded that the distraction technique significantly reduces the treatment time duration.

Keywords: Accelerated orthodontics, dentoalveolar distraction, periodontal distraction

How to cite this article:
Dabla N, Vedvyas A, Gandhi G. Acceleration of orthodontic tooth movement using two different distraction techniques. J Datta Meghe Inst Med Sci Univ 2022;17:114-7

How to cite this URL:
Dabla N, Vedvyas A, Gandhi G. Acceleration of orthodontic tooth movement using two different distraction techniques. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2022 Aug 18];17:114-7. Available from: http://www.journaldmims.com/text.asp?2022/17/1/114/352221

Introduction

Orthodontic treatment time is a major concern for both orthodontists and the patient. To limit anchorage requirements, the retraction is preferably carried out in two separate phases of canine and incisor retraction. The canine tooth retraction into an extraction site usually takes about 6 to 8 months, and under normal conditions, conventional treatment with fixed appliances is likely to last about 20–24 months. Many attempts have been made to shorten the duration of orthodontic tooth movement using techniques such as corticotomy, micro-osteoperforation, and distraction.^[1],[2] In the past decade, a greater stress has been emphasized on distraction osteogenesis (DO) principle, as a method to shorten the time period of canine retraction. It is a method of inducing new bone formation by applying mechanical strains on pre-existing bone using distraction devices in osteotomy/corticotomy sites.^[3],[4] It has been applied in two ways to achieve quicker results as periodontal and dentoalveolar distraction.

Periodontal ligament (PDL) distraction (for the purpose of effecting rapid tooth movement) was achieved first by Liou and Huang.^[5] In 2001, Iseri et al. introduced a new technique named Dentoalveolar Distraction (DAD), which also achieved rapid tooth movement using the same principle.^[6] In this technique, the canine segment is transported rapidly as a bone block without stretching of the PDL.

Studies done previously have shown that:^{[6],[7],[8],[9]}

The rapid canine retraction achieved by either of the techniques reduces the overall treatment time appreciably
The anchorage demands are reduced considerably
Pulp vitality is preserved clinically.

Therefore, the aforementioned techniques can be used successfully to quicken the orthodontic treatment.

In this case report, we have used the DAD technique in the maxillary left quadrant and periodontal distraction on the right side.

Case Report

A 25-year-old female patient with a chief complaint of forwardly placed front teeth reported for the treatment. She was diagnosed as a class I bimaxillary protrusion case having convex profile. Intraorally, she presented with 2-mm overjet, 3-mm overbite, and mild crowding of 3.5 mm in the mandibular arch [Figure 1]. Treatment plan was to extract all the first premolars to reduce the protrusion and eliminate the crowding. The treatment protocol was explained to the patient, and an informed consent was taken for the same.

Figure 1: Pretreatment intraoral photographs of the patient

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On the left side, DAD was performed, whereas on the right side, periodontal distraction was done. 13, 23, 16, and 26 were banded, and bands were transferred via an alginate maxillary impression to pour dental casts. Custom-built intraoral distractors were fabricated for maxillary left and right sides using the HYRAX expander screw [Figure 2]. For the mandibular arch, accelerating mechanics were not used, and conventional method of retraction was planned.

Figure 2: Intraoral distractor made using HYRAX expander screw

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Surgical procedure

Periodontal distraction

After the first premolar extraction, vertical grooves were made inside the extraction socket, along the buccal and lingual sides, extending obliquely toward the base of the interseptal bone. Distractor was then cemented in place.

Dentoalveolar distraction

The periosteal flap was raised from the canine to the second premolar. Cortical holes were drilled from the canine to the premolar on both sides extending 3–5 mm above the apex. A thin tapered bur was used to connect these holes, and fine osteotomes were advanced in the coronal direction. The first premolar was then extracted and buccal bone was removed between the outlined bone cut anteriorly at the distal canine region and posteriorly at the second premolar region. The alveolar segment that included the canine was fully mobilized by fracturing the surrounding bone using larger osteotomes. The apical and buccal bones through the extraction socket as well as any bony interferences were smoothened between the canine and second premolar. The transport segment included the canine, buccal cortex, and spongy bone enveloping the canine root, leaving intact palatal cortical plate, and the bone around the apex of the canine [Figure 3].

Figure 3: Surgical procedure

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The angular changes of canines were recorded using reference points cited by Ursi et al.^[9] In their article, authors had established two reference lines, namely: upper – passing through inferior most points of the left and right orbits and the lower – passing through the right and left mental foramen. The long axis of single-rooted tooth was taken from the image of the root canal to its longest extent.

Distraction protocol

The distraction procedure was initiated immediately on the side of periodontal distraction and after 3 days of latency period on the side of DAD
Activation of the hyrax screw (distractor) was carried out and taught to the patient/parents. The distraction device was activated twice a day at a rate of 0.8 mm/day. The treatment was carried out using conventional fixed mechanotherapy postcompletion of distraction.

Treatment progress and result

The distraction procedure was completed in 13 days on the side of periodontal distraction, whereas DAD took 16 days [Figure 4] and [Figure 5]. In measurement, canine angulation on the dentoalveolar side changed from 92° to 86°, i.e., 6° of tipping was observed, and in the periodontal distraction side, it changed from 91° to 83°, i.e., 8° of tipping was evident [Figure 6].

Figure 4: Progress of treatment after 1 week

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Figure 5: Progress of treatment after 2 weeks

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Figure 6: Pretreatment and postdistraction OPGs of the patient. OPG: Orthopantomograph

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Discussion

Orthodontic tooth movement is a process, in which the application of a force induces bone apposition on the tension side and bone resorption on the side experiencing pressure. The rate of biological tooth movement with optimum mechanical force is approximately 1–1.5 mm in 4–5 weeks. Therefore, in maximum anchorage cases, canine retraction approximately takes 6–9 months, thus adding to an overall treatment time of 1.5–2 years. The duration of orthodontic treatment is one of the issues that patients, especially adult patients, complain the most.^[6],[7]

Different approaches have been suggested to shorten the treatment time, which includes Distraction Osteogenesis (DO) also, a technique that had been used initially in the correction of craniofacial anomalies and dentoalveolar discrepancies. Both the initially mentioned methods of distraction are efficient in achieving desired results. Various studies have reported complete retraction of canine in 12–28 days using dentoalveolar distraction and approximately 3 weeks for periodontal distraction.^{[5],[7],[8],[10]}

In the present case, the canines were retracted in 16 days on the left side and 13 days on the right side without using any extraoral anchorage appliances. The change in distal inclination of canine was found to be 6° and 8°, respectively, in dentoalveolar and periodontal distraction.

Conclusion

Thus, it can be concluded that the distraction technique reduces orthodontic treatment duration by a significant amount in patients who need extractions, eliminating the need for an extraoral or intraoral anchorage device (s) and this, in turn, caters to the demands of patients in terms of opting for orthodontic treatment and reduces compliance requirement during the treatment itself. Furthermore, there are no reported unfavorable effects on periodontal and surrounding tissues. The periodontal distraction was achieved faster than the DAD in our patient. Hence, despite the surgical aspects involved in the distraction technique, it is an effective method of accelerating orthodontic tooth movement.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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