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The increased number of adults seeking orthodontic treatment has led to the need for faster results as social limitations arise with the use of fixed or even removable appliances. Corticotomy-assisted orthodontic treatment (CAOT) has been proposed as a technique that accelerates tooth movement and leads to a substantial reduction in treatment time. This review was conducted by searching four databases for original articles about CAOT, review articles and articles about alternative techniques and periodontal effects up to 31 December 2022. The aim of the review was to present the historical and biological background of CAOT, the description of the technique and some alternative and less invasive techniques that have been proposed. Indications, contraindications and periodontal side effects are also discussed.

  The duration of orthodontic treatment often affects patient compliance and increases the likelihood of complications. Evaluation of the clinical uses, safety, and effectiveness of corticotomy and piezocision as surgical adjuncts for accelerating orthodontic tooth movement is the goal of this narrative review. A thorough search of the literature was done for research published between January 2019 and March 2025 using PubMed, Embase, and Scopus. Information about patient demographics, dental sectors treated, length of therapy, and degree of tooth movement was extracted. Because techniques and results varied, studies were narratively summarized. The included studies showed significant variation in treatment procedures, patient ages, and sample sizes. The intervention that was examined the most was canine retraction. Piezocision and corticotomy both demonstrated efficacy in accelerating tooth movement, with treatment times ranging from two weeks to two years and movement values ranging from 0.53 mm to 6.48 mm. Despite occasional temporary postoperative swelling, piezocision was linked to lower surgical morbidity and demonstrated higher patient satisfaction.  Piezocision is a successful and minimally invasive technique for accelerating orthodontic tooth movement. Although there is evidence of its therapeutic advantages, conclusive findings are limited by the heterogeneity of study designs and outcome measures. Additional long-term, standardized research is required to improve procedures and validate its benefits over traditional corticotomy.

Introduction: The aim of this study was to evaluate the effect of corticotomy incision depth on tooth movement and stress distribution in the periodontal ligament (PDL) during orthodontic expansion using finite element analysis (FEA). The demand for accelerated and biologically safe orthodontic techniques has highlighted the importance of understanding biomechanical responses to surgical adjuncts like corticotomy. Objective: The aim of this study is to assess the effect of corticotomy depth on tooth movement and periodontal ligament stress distribution during orthodontic treatment using finite element analysis. Materials and methods: A 3D FEM model was developed based on CBCT and intraoral scans to replicate anatomical structures and simulate clinical orthodontic scenarios. Four conditions were analyzed: no corticotomy and corticotomy incisions of 1 mm, 2 mm, and 3 mm depths, applied between roots and above the apex region. Different cortical bone densities were tested using Young’s modulus values (12,500 MPa–27,500 MPa). Stress and displacement values were measured in both the crown and root regions. Results: The 3 mm corticotomy, penetrating through the cortical plate into the cancellous bone, significantly increased crown displacement (up to 26% in low-density bone) and altered root tipping patterns, reducing root movement relative to the crown. Shallower incisions (1–2 mm) had minimal effects. Despite increased movement, stress concentration in the cervical PDL region remained high across all scenarios, particularly in the premolar area, exceeding the 4.7 kPa threshold associated with tissue ischemia. Conclusions: Corticotomy depth is a critical factor for optimizing orthodontic tooth movement. Penetration into cancellous bone (3 mm) appears necessary to induce both: not only the Regional Acceleratory Phenomenon (RAP) but also to enhance displacement. However, this approach does not significantly reduce cervical PDL stress and offers limited periodontal protection. Individual planning based on bone density, morphology, and anatomical limitations is essential for balancing treatment efficiency and periodontal safety.

Objectives To assess the safety and accuracy of static computer assisted corticotomy surgery (sCACS) in comparison with freehand piezocision. Materials and methods A randomized in vitro study was conducted. A total of 260 interradicular corticotomies were performed in 20 identical printed models. sCACS was performed in half of the models, while the rest underwent freehand localized decortication. Accuracy was measured in the three spatial axes by overlapping the digital planning with a previous cone-beam computed tomography (CBCT) scan of the patient and a postoperative CBCT of the models. Safety was determined as the number of damaged root surfaces. Descriptive and bivariate analyses were performed. Results Freehand corticotomies increased the likelihood of iatrogenic root damage 2.21-fold (95%CI: 1.30 to 3.77; p  = 0.004). Both groups showed some degree of deviation compared to digital planning. Nevertheless, the accuracy of sCACS was significantly greater in sagittal (B = -0.21 mm, 95%CI: -0.29 to -0.12; p  < 0.001), axial (B = -0.32 mm, 95%CI: -0.48 to -0.18; p  < 0.001) and angular deviation (B = -2.02º; 95%CI: -2.37 to -1.66; p  < 0.001) compared to freehand surgery, with the exception of depth. Conclusions The precision and safety of sCACS are greater than the freehand technique. Clinical relevance Corticotomies are performed in crowded areas where there is usually space limitation. Clinicians should consider the systematic use of surgical guides, since minimal deviations can cause iatrogenic root damage in areas where malocclusions are present.

BackgroundTo evaluate the changes of alveolar dehiscence and fenestration after augmented corticotomy-assisted orthodontic treatment on cone-beam computed tomography (CBCT) compared with traditional pre-surgical orthodontics, both quantitatively and qualitatively.MethodsTwo hundred and four anterior teeth from 17 skeletal class III malocclusions were divided into four groups. Groups G1 (upper teeth) and G3 (lower teeth), comprising 120 teeth, accepted traditional pre-surgical orthodontics; groups G2 (upper teeth) and G4(lower teeth), comprising 84 teeth, accepted augmented corticotomy-assisted pre-surgical orthodontics. The changes of alveolar bone dehiscence and fenestration of each tooth in all groups were evaluated with the help of CBCT.ResultsQuantitative analysis for comparing both groups: For the upper teeth, d1 − d0 was different between both groups while f1 − f0 was not statistically different. For the lower teeth, d1 − d0 was statistically different between both groups while f1 − f0 was not statistically different. Qualitative analysis: For the teeth that had no dehiscence before treatment, G2 and G4 had a better transition than did G1 and G3. For those having dehiscence before treatment, G4 had a better transition than did G3. For teeth having no fenestration before treatment, there was no statistically significant difference in transition between the control and treatment groups. For those having fenestration before treatment, G4 had a better transition than did G3.ConclusionsFor skeletal class III patients, augmented corticotomy-assisted orthodontic treatment is a promising method of improving alveolar bone dehiscence and fenestration for lower anterior teeth, and it also has the potential to protect both lower and upper anterior teeth against dehiscence.

Objective To evaluate the efficacy of laser-assisted flapless corticotomy in the acceleration of canine retraction compared with the conventional technique and to evaluate patients’ pain and discomfort levels after corticotomy. Materials and methods A single-center randomized controlled trial was conducted on 18 class II division 1 patients (7 males, 11 females; age range: 16 to 24 years) who required the first-upper-premolar extraction followed by canine retraction. A split-mouth design was used in which the Er:YAG laser-assisted flapless corticotomy was randomly allocated to one side, whereas the other side served as the control side. The primary outcome measure was the canine retraction rate which was assessed immediately after laser application, 1, 2, 4, 8, and 12 weeks after laser application. Also, the levels of pain and discomfort during the first week following laser application were assessed. Paired t -tests or Wilcoxon matched-pairs signed-rank tests were used to detect significant differences. Results All of the selected eighteen patients entered the statistical analysis stage. Significant differences were observed ( P  < 0.001) in canine retraction rates between the experimental and control sides at the baseline to 1st-week, 1st- to 2nd-week, 2nd- to 4th-week, and 4th- to 8th-week intervals. No significant difference was found between the two sides at the 8th- to 12th-week interval. A significant reduction was seen in the mean score of pain during eating at all assessment times when compared to the baseline data ( P  = 0.002 at day 2, P  < 0.001 at days 5 and 7). Conclusion Er:YAG laser-assisted flapless corticotomy appears to be an effective treatment method for accelerating canine retraction and was accompanied by a mild degree of pain and discomfort. Trial registration ClinicalTrials.gov (No.: NCT04316403), retrospectively registered on the 20th of March 2020. URL: https://clinicaltrials.gov/ct2/show/NCT04316403

Background/Objectives: Surgical guides have been used in a variety of dental procedures, such as implant placement to improve clinical accuracy and reduce post-operative complications. This report presents a novel and versatile workflow for the design and fabrication of a “multi-purpose” fully-guided tooth- and bone-supported one-piece surgical guide. Methods: Briefly, intraoral and perioral anatomical features were captured by an intraoral scan and a cone-beam computed tomography scan. The data were segmented and aligned with analysis software to enable the digital design of surgical guides. The versatility of this method was demonstrated through its application in the two cases presented: the first involved a lateral sinus lift with simultaneous implant placement, and the second involved the removal of a foreign object from the alveolar bone prior to implant placement. Results: Positive clinical outcomes were confirmed at follow-up visits for up to 12 months. Conclusions: This method may be applied to a range of challenging clinical scenarios, such as apicectomy, the extraction of supernumerary or unerupted teeth, corticotomy to facilitate orthodontic movement, the precise reduction of bony spurs or exostoses, and the conservative surgical removal of pathologies.

ObjectivesImproper orthodontic force often causes root resorption or destructive bone resorption. There is evidence that T helper 17 (Th17) cells and regulatory T (Treg) cells may be actively involved in bone remodeling during tooth movement. In a combination of in vitro and in vivo studies, we investigated the effect of human periodontal ligament cells (hPDLCs) on Th17/Treg cells under different orthodontic forces and corticotomy.Material and methodshPDLCs were cultured in vitro and subjected to different mechanical forces. The expression of interleukin (IL)-6 and transforming growth factor (TGF)-β in the supernatant and the mRNA levels of hypoxia inducible factor (HIF)-1α, Notch1, and TGF-β in hPDLCs were investigated. Supernatants were collected and co-cultured with activated CD4+T cells, and the differentiation of Th17/Treg cells was analyzed by flow cytometry. We also established an animal model of tooth movement with or without corticotomy. The tooth movement distance, alveolar bone height, and root resorption were analyzed using micro-computed tomography. Expression of interleukin (IL)-17A, forkhead Box P3 (Foxp3), and IL-6 were analyzed using immunohistochemistry, while osteoclasts were evaluated by tartrate-resistant acid phosphatase (TRAP) staining. The mRNA levels of IL-17A, IL-6, Foxp3, IL-10, HIF-1α, notch1, and C-X-C motif chemokine ligand 12 (CXCL12) in alveolar bone and gingiva were investigated.ResultsHeavy force repressed cell viability and increased the mortality rate of hPDLCs; it also improved the expression of IL-6, declined the expression of TGF-β, and promoted the mRNA expression level of HIF-1α. The expression of TGF-β and Notch1 mRNA decreased and then increased. The supernatant of hPDLCs under heavy force promotes the polarization of Th17 cells. The heavy force caused root resorption and decreased alveolar bone height and increased the positive area of IL-17A immunohistochemical staining and the expression of IL-17A, IL-6, HIF-1α, and Notch1 mRNA. Corticotomy accelerated tooth movement, increased the proportion of Foxp3-positive cells, and up-regulated the expression of Foxp3, IL-10, and CXCL12 mRNA.ConclusionsDuring orthodontic tooth movement, the heavy force causes root resorption and inflammatory bone destruction, which could be associated with increased expression of Th17 cells and IL-6. Corticotomy can accelerate tooth movement without causing root resorption and periodontal bone loss, which may be related to the increased expression of Treg cells.Clinical relevanceAltogether, this report provides a new perspective on the prevention of inflammatory injury via the regulation of Th17/Treg cells in orthodontics.

Background The surgically facilitated orthodontic strategy has been a promising strategy for orthodontic treatment recently. Therefore, the present meta-analysis was conducted to assess the available scientific evidence regarding the clinical outcomes, including the potential detrimental effects associated with these surgical procedures, with the aim of providing much more evidence-based information for clinical practice. Methods An electronic search of three databases (PubMed, Cochrane, and Embase) and a manual search of relevant articles published up to May 2023 were carried out. Clinical trials (≥ 10 subjects) that utilized surgically facilitated orthodontic strategies with clinical and/or radiographic outcomes were included. Meta-analyses and sub-group analyses were performed to analyze the standardized mean difference (SMD) or weighted mean difference (WMD), and confidence interval (CI) for the recorded variables. Results Nineteen studies published from Oct 2012 to May 2023 met the inclusion criteria. Based on the analysis outcomes, corticotomy treatment significantly decreased the alignment duration (WMD: -1.08 months; 95% CI = -1.65, -0.51 months, P  = 0.0002), and accelerated the canine movement (WMD: 0.72 mm; 95% CI = 0.63, 0.81 mm, P  < 0.00001) compared to the traditional orthodontic group. The periodontally accelerated osteogenic orthodontic (PAOO) strategy markedly reduced the total treatment duration (SMD: -1.98; 95% CI = -2.59, -1.37, P  < 0.00001) and increased the bone thickness (SMD:1.07; 95% CI = 0.74, 1.41, P  < 0.00001) compared to traditional orthodontic treatment. Conclusion The present study suggests that facilitated orthodontic treatment in terms of corticotomy and PAOO strategy may represent attractive and effective therapeutic strategy for orthodontic patients.

Objectives This study aims to investigate the changes in alveolar bone following the simultaneous performance of labial and lingual augmented corticotomy (LLAC) in patients with insufficient alveolar bone thickness on both the labial and lingual sides of the mandibular anterior teeth during presurgical orthodontic treatment. Materials and methods Thirth-five surgical patients with skeletal Class III malocclusion were included: 19 (LLAC group) accepted LLAC surgery during presurgical orthodontic treatment, and 16 (non-surgery group, NS) accepted traditional presurgical orthodontic treatment. Cone-beam computed tomography (CBCT) scans were obtained before treatment (T0) and at the completion of presurgical orthodontic treatment (T1). The amount of vertical alveolar bone and contour area of the alveolar bone in the labial and lingual sides of mandibular incisors were measured. Results After presurgical orthodontic treatment, the contour area of the alveolar bone at each level on the lingual side and alveolar bone level on both sides decreased significantly in the NS group ( P  < 0.001). However, the labial and lingual bone contour area at each level and bone level increased significantly in the LLAC group ( P  < 0.001). The bone formation rate in the lingual apical region was the highest, significantly different from other sites ( P  < 0.001). Conclusions During presurgical orthodontic treatment, LLAC can significantly increase the contour area of the labio-lingual alveolar bone in the mandibular anterior teeth to facilitate safe and effective orthodontic decompensation in skeletal Class III patients. Clinical relevance : This surgery has positive clinical significance in patients lacking bone thickness (< 0.5 mm) in the labial and lingual sides of the lower incisors.