In treating orthodontic problems in late adolescents and adults there is pressure to shorten treatment time. Surgical techniques such as corticotomy and dental distraction have been proposed as potential approaches. The aim of this review was to address 3 questions;

1. Does surgically facilitated orthodontic treatment significantly increase the velocity of tooth movement and shorten treatment duration in healthy orthodontic patients, compared with conventional orthodontics?
2. Is there a difference in the incidence of tooth vitality loss, periodontal problems, and root resorption between healthy orthodontic patients treated with surgically facilitated orthodontics and patients who had orthodontic treatment without surgery?
3. Do the designs of the cortical cuts and the gingival flaps influence the efficiency of tooth movement and the incidence of complications?

Searches were conducted in the PubMed, Embase, and Cochrane databases supplemented by searching the reference lists of included articles. Randomized controlled trials (RCT), controlled clinical trials (CCT), and case series (CS) with sample sizes of 5 or more patients regarding corticotomy-facilitated orthodontics or dental distraction in healthy adolescent or adult patients without craniofacial anomalies or periodontal disease were considered. Two reviewers conducted study selection and quality assessment independently.

• 18 studies (4 RCTs, 3 CCTs, 11 Case Series) were included
• The total number of patients included was 286 (distraction procedures, n = 203; corticotomy procedures, n= 83). In 1 article, bone augmentation was incorporated in the corticotomy procedure (n = 10).
• All publications reported temporarily accelerated tooth movement after surgery
• No adverse effects on the periodontium, no vitality loss, and no severe root resorption were found in any studies.

The authors concluded

Evidence based on the currently available studies of low-to-moderate quality showed that surgically facilitated orthodontics seems to be safe for the oral tissues and is characterized by a temporary phase of accelerated tooth movement. This can effectively shorten the duration of orthodontic treatment. However, to date, no prospective studies have compared overall treatment time and treatment outcome with those of a control group. Well-conducted, prospective research is still needed to draw valid conclusions.

Comments.

This review searched three major databases with no language restriction and only found a small number of RCTs, 3 of which used a split mouth approach that was also used in one of the CCTs. The authors also highlight the heterogeneity of clinical indications treatment plans, surgical techniques and forces systems that were used, which made the results difficult to interpret. In addition the majority of studies included were small with only 3 studies having more than 18 patients. Overall this means that the available evidence to assess the effectiveness of these approaches is limited.

Links

Hoogeveen EJ, Jansma J, Ren Y. Surgically facilitated orthodontic treatment: A systematic review. Am J Orthod Dentofacial Orthop. 2014 Apr;145(4 Suppl):S51-64.  doi: 10.1016/j.ajodo.2013.11.019. PubMed PMID: 24680025.