NEED FOR STUDY

Orthodontic treatment often involves prolonged durations, which can cause discomfort and reduce patient compliance. Various techniques have been explored to accelerate tooth movement without compromising treatment outcomes, such as mechanical vibrations and surgical interventions, along with minimal adverse effects. Recent studies suggest that vibrational devices may influence bone remodeling, promoting faster orthodontic tooth movement.2 Additionally, minimally invasive techniques like micro- osteoperforation can enhance the biological response, facilitating accelerated tooth movement. This study investigates the combined effect of micro-osteoperforation and use of the electric toothbrush on the rate of orthodontic tooth movement and associated tissue changes, aiming to evaluate their synergistic potential to optimize orthodontic treatmentsTo evaluate the effect of micro-osteoperforation combined with electric toothbrush on the rate of orthodontic tooth movement and associated dentoalveolar changes. 

CLINICAL SIGNIFICANCE

Prolonged orthodontic treatment is associated with adverse effects such as root resorption, periodontal issues, decalcification, and temporomandibular dysfunction. Therefore, reducing treatment duration is of critical importance to both clinicians and patients.

By intentionally creating controlled, reversible bone injury, osteoclastic activity is stimulated, shifting bone metabolism into a more catabolic state. This phenomenon, known as the Regional Acceleratory

Phenomenon (RAP), forms the foundation for various accelerated orthodontic tooth movement techniques.

Assessing and comparing minimally invasive surgical approaches like Micro-osteoperforation with non-invasive techniques like vibrational frequency evaluated by electric toothbrush offers valuable insights into effective methods for speeding up orthodontic treatment while minimizing risks.

AIM: To evaluate the effect of micro-osteoperforation combined with electric toothbrush on the rate of orthodontic tooth movement and associated dentoalveolar changes.

OBJECTIVES:

• To determine and compare the rate of orthodontic tooth movement (canine retraction) under following conditions:

a. following micro-osteoperforation

b. with the application of electric toothbrush

c. combined effect of both methods

• To measure and compare gingival and periodontal status (gingival index/ pocket formation or bone loss/ mobility) between the groups.

• To measure and compare root resorption, vertical alveolar bone changes, and horizontal bone thickness at mid-root and root apex levels of the maxillary canine region pre- and post-retraction with the help of radiographs between groups.

The study will be conducted on 34 patients reporting for Orthodontic treatment at the Department of Orthodontics and Dentofacial Orthopedics at AB Shetty Memorial Institute of Dental Sciences, Mangalore.

• The patients requiring extraction of maxillary first premolar on both sides of the arch will be selected.

• It is a split mouth study where the participants will be randomly divided into two groups:

a) Group A: Conventional orthodontic treatment with bilateral micro-osteoperforation.

Participants will use an electric toothbrush on one randomly allocated side.

b) Group B: Conventional orthodontic treatment only. Participants will use an electric toothbrush on one randomly allocated side.

• The split mouth design is employed to minimize biological variability.

• Patients will be allocated to different groups using the simple randomization method to ensure an unbiased and equal distribution.

• Patients will be asked to extract the premolars prior to start of orthodontic treatment.

• Banding and bonding of both upper and lower arch will be done as per the standard method.

After initial alignment, the maxillary canine retraction will be carried out by NiTi closed coil springs at the stage of 0.017x0.025 stainless steel maxillary arch wire.

• A force of 150gm per side will be given and will be measured using a Dontrix gauge.

• Absolute anchorage using mini-implants will be used for retraction.

• Participants in Group A will undergo Micro-osteoperforation procedure bilaterally using commercially available orthodontic mini-implant screws with a diameter of 1.2mm and length of 8mm. It will be inserted to a depth of 6mm (measured from the soft tissue) using

a hand driver.

• 3 MOPs will be created distal to canine (spaced 1-3mm apart) at both buccal and palatal aspects in the extraction space, as close as possible to the roots of canine. It will be performed after the induction of local anesthesia.

All participants will receive a standardized 150 Hz electric toothbrush, ensuring uniform specifications and sourced from the same manufacturer. They will be instructed to hold the toothbrush against the mesio-labial surface of the experimental canine to apply

mechanical vibrations for at least 5 minutes, three times a day (at an interval of 6-8 hours between each use), for the duration of the study.

2 They will be advised to follow their regular cleaning routine for the rest of their teeth. A daily usage checklist will be provided, and participants will be asked to submit it during their monthly visits.

• To record the rate of canine retraction, digital impressions will be made at specific time intervals.

T0= Before start of canine retraction

T1= 45 days after the onset of canine retraction

T2= 90 days after the onset of retraction or at the completion of canine retraction, whichever is earlier.

• For measurements, following reference lines will be established:

a. Midpalatine raphe (MPR): formed from two points: one on the distal aspect of incisive papilla and the other at the posterior border of the raphe near fovea centralis

b. Rugae line (RL): formed by projection from the most medial point on the third palatal rugae.

• Then the following measurements will be recorded digitally:

1. The distance between the cusp tip of the canine and the rugae line (DC) will be used to measure the anteroposterior canine movement.

2. The distance between the mesial contact point of the first permanent molar and the rugae line (DM) will be used to measure molar movement that is the anchorage loss.

3. The angle between the median raphe and the line through the mesial and distal edges of the canine (A) will be used to measure canine rotation.

• The rate of retraction is determined by dividing distance moved in mm with time.

Gingival and periodontal health will be measured on both sides using a periodontal probe, pre and post retraction

-Gingival health: Gingival Index by Loe and Silness (1963)

- Clinical attachment loss: WHO probe

- Mobility: Millers Mobility Index

• Root resorption, along with vertical and horizontal bone thickness at the mid root and root apex levels of maxillary canine region, will be evaluated on both sides using CBCT imaging before and after the retraction phase.

• Data will be compared and analyzed using statistical analysis.