A novel surgical technique for augmented corticotomy-assisted orthodontics: dumpling grafting with periosteum

Abstract

Abstract: PURPOSE : To introduce the dumpling grafting with periosteum (dumpling technique) as an alternative surgical approach for augmented corticotomy-assisted orthodontics in the lower anterior region and evaluate the preliminary outcomes. METHODS : From March to August in 2014, eight patients (2 men, 6 women) with dehiscence/fenestration in the lower anterior region underwent an innovated augmented corticotomy using the dumpling technique. In this new technique, an initial split-thickness dissection was performed and then the periosteal layer was carefully elevated from the alveolar bone，facilitating subperiosteal placement of bone graft material. Then the periosteum was fixed by sutures to the alveolar bone surface in a dumpling-like fashion so as to protect the grafting materials from displacement and leakage. Cone-beam computerized tomography (CBCT) was used to evaluate morphologic changes of the lower anterior ridge before treatment (T0), and 1 week after bone-augmentation procedure (T1). Quantitative measurements of the vertical alveolar bone changes and horizontal bone thickness at the middle levels of the coronal, middle and apical thirds of the lower anterior teeth were evaluated at T0 and T1. Paired t test was performed using SPSS 16.0 software package for data analysis. RESULTS : No serious complications occurred after surgery. Augmented bone morphology was well maintained after surgery on CBCT. Alveolar bone thickness from T0 to T1 increased by (0.65±0.89) mm at the coronal third, (3.30±1.09) mm at the middle third, and (3.96±1.35) mm at the apical third on labial side. Significant horizontal bone augmentation was found in the lower anterior teeth (P < 0.01). Furthermore, vertical alveolar bone increased by (5.35 mm±1.90 mm), which also showed significant change (P<0.01). CONCLUSIONS : Augmented corticotomy-assisted surgical orthodontics using the dumpling technique could prevent bone graft material from shifting, well maintain primary augmented bone morphology, and facilitate bone regeneration at the desired position. However, long-term follow-up is necessary. Supported by Research Fund for Young College and University Teachers of Shanghai Municipal Education Commission (jdy11027), Research Fund of Shanghai Municipal Health Bureau (20134Y061) and Scientific Research Fund of Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine (2012-12).

Key words: Dehiscence, Fenestration, Periodontal accelerated osteogenic orthodontics, Cone-beam CT

CLC Number:

R782.1

MA Zhi-gui, YANG Chi, XIE Qian-yang, YE Zhou-xi, PAN Lu-lu, SHEN Pei, CHEN Zhuo-zhi.. A novel surgical technique for augmented corticotomy-assisted orthodontics: dumpling grafting with periosteum[J]. China Journal of Oral and Maxillofacial Surgery, 2015, 13(6): 515-520.

References

[1] Handelman CS. The anterior alveolus: its importance in limiting orthodontic treatment and its influence on the occurrence of iatrogenic sequelae [J]. Angle Orthod, 1996, 66(2): 95-109.
[2] Wehrbein H, Bauer W, Diedrich P. Mandibular incisors, alveolar bone, and symphysis after orthodontic treatment. A retrospective study [J]. Am J Orthod Dentofacial Orthop, 1996, 110(3): 239-246.
[3] Kim Y, Park JU, Kook YA. Alveolar bone loss around incisors in surgical skeletal Class Ⅲ patients [J]. Angle Orthod, 2009, 79(4): 676-682.
[4] Yared KF, Zenobio EG, Pacheco W. Periodontal status of mandibular central incisors after orthodontic proclination in adults [J]. Am J Orthod Dentofac Orthop, 2006, 130(1): 6.e1- 8.
[5] Kim SH, Kim I, Jeong DM, et al. Corticotomy-assisted decompensation for augmentation of the mandibular anterior ridge [J]. Am J Orthod Dentofacial Orthop, 2011, 140(5): 720-731.
[6] Ahn HW, Lee DY, Park YG, et al. Accelerated decompensation of mandibular incisors in surgical skeletal class Ⅲ patients by using augmented corticotomy: a preliminary study [J]. Am J Orthod Dentofacial Orthop, 2012, 142(2): 199-206.
[7] Wilcko WM, Wilcko T, Bouquot JE, et al. Rapid orthodontics with alveolar reshaping: two case reports of decrowding [J]. Int J Periodontics Restorative Dent, 2001, 21(1): 9-19.
[8] Coscia G, Coscia V, Peluso V, et al. Augmented corticotomy combined with accelerated orthodontic forces in class Ⅲ orthognathic patients: morphologic aspects of the mandibular anterior ridge with cone-beam computed tomography [J]. J Oral Maxillofac Surg, 2013, 71(10): 1760.e1-9.
[9] Wang B, Shen G, Fang B, et al. Augmented corticotomy-assisted surgical orthodontics decompensates lower incisors in Class Ⅲ malocclusion patients [J]. J Oral Maxillofac Surg, 2014, 72(3): 596-602.
[10] Murphy KG, Wilcko MT, Wilcko WM, et al. Periodontal accelerated osteogenic orthodontics: a description of the surgical technique [J]. J Oral Maxillofac Surg, 2009, 67(10): 2160-2166.
[11] Kreisler M, Gockel R, Schmidt I, et al. Clinical evaluation of a modified marginal sulcular incision technique in endodontic surgery [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 108(6): e22-28.
[12] Evangelista K, Vasconcelos Kde F, Bumann A, et al. Dehiscence and fenestration in patients with Class I and Class Ⅱ Division 1 malocclusion assessed with cone-beam computed tomography [J]. Am J Orthod Dentofacial Orthop, 2010, 138(2): 133.e1-7.
[13] Yagci A, Veli I, Uysal T, et al. Dehiscence and fenestration in skeletal Class I, Ⅱ, and Ⅲ malocclusions assessed with cone-beam computed tomography[J]. Angle Orthod,2012,82(1):67-74.
[14] Germe? D, Giray B, Kocadereli I, et al. Lower incisor retraction with a modified corticotomy[J]. Angle Orthod,2006,76(5):882-890.
[15] Mostafa YA, Mohamed Salah Fayed M, Mehanni S, et al. Comparison of corticotomy-facilitated vs standard tooth-movement techniques in dogs with miniscrews as anchor units [J]. Am J Orthod Dentofacial Orthop, 2009, 136(4): 570-577.
[16] Lee KM, Kim YI, Park SB, et al. Alveolar bone loss around lower incisors during surgical orthodontic treatment in mandibular prognathism [J]. Angle Orthod, 2012, 82(4): 637-644.
[17] Nimigean VR, Nimigean V, Bencze MA, et al. Alveolar bone dehiscences and fenestrations: an anatomical study and review[J]. Rom J Morphol Embryol, 2009, 50(3): 391-397.
[18] Augustin G, Antabak A, Davila S. The periosteum. Part 1: anatomy, histology and molecular biology[J]. Injury, 2007, 38(10): 1115-1130.
[19] Heberer S, Rühe B, Krekeler L, et al. A prospective randomized split-mouth study comparing iliac onlay grafts in atrophied edentulous patients: covered with periosteum or a bioresorbable membrane [J]. Clin Oral Implants Res, 2009, 20(3): 319-326.
[20] Reilly TM, Seldes R, Luchetti W, et al. Similarities in the phenotypic expression of pericytes and bone cells [J]. Clin Orthop Relat Res, 1998, (346): 95-103.
[21] Burstein FD, Ariyan S, Chicarilli Z, et al. The effect of periosteal preservation on osteogenesis in a canine rib autograft model: tetracycline fluorescence incident photometry [J]. J Craniofac Surg, 1994, 5(3): 161-171.
[22] Dibart S, Sebaoun JD, Surmenian J. Piezocision: a minimally invasive, periodontally accelerated orthodontic tooth movement procedure [J]. Compend Contin Educ Dent, 2009, 30(6): 342-344, 346, 348-350.