The effects of micro-osteoperforations on orthodontic root resorption and tooth movement - A pilot study

A primary objective of orthodontic treatment is to achieve a functional and aesthetic outcome efficiently and with minimum root resorption. Preliminary research has shown promising results with micro-osteoperforations and accelerated orthodontic tooth movement. Being a relatively recent adjunct to orthodontic treatment, further research is required to gain insight into the effects of micro-osteoperforation on tooth movement as well as on root resorption. The aim of the proposed investigation is twofold. The first part consists of applying buccally directed orthodontic forces to the upper 1st premolars to compare the amount of root resorption that occurs with normal orthodontic tooth movement, with that which occurs with orthodontic tooth movement in areas treated with micro-osteoperforations. The micro-osteoperforations will be applied using a disposable appliance designed for this purpose by Propel Orthodontics. The Propel device is a TGA approved, FDA registered medical device specifically designed to create micro-osteoperforations. The second part consists of quantitatively measuring the rate of bodily canine retraction with normal orthodontic tooth movement, and orthodontic tooth movement associated with micro-osteoperforations. The hypothesis of this research project is that micro-osteoperforations will minimise orthodontic root resorption while allowing accelerated rates of orthodontic tooth movement. The proposed investigation will be a Prospective Cohort study involving 12-14 subjects. The first part of the project involves placing orthodontic braces only on the upper posterior teeth. Using a split-mouth design, one side will be randomly made control, while the other will be the experimental side in which micro-osteoperforations will be placed. Three perforations in a vertical alignment will be placed on both the mesial and distal aspects of the upper first premolar. Orthodontic force will be applied to the first premolars bilaterally for 4 weeks, after which the teeth will be extracted as part of the patient’s ongoing orthodontic treatment. These extracted teeth will then be scanned with a MicroCT scanner and the extent of resorption measured. Patients will also be asked to record their level of discomfort on the experimental and control side following the placement of braces and micro-osteoperforations. The second part of the study involves placing full braces on the subjects with 24 weeks of aligning and levelling teeth. After this period, another three perforations in a vertical alignment will be placed distal to the upper canine on the experimental side and the rate of canine retraction will be compared to the control side. Patients will be assessed and tooth movement measured off study models every 2-4 weeks, over an 8-week period. Conclusion: Root resorption is a significant consequence of orthodontic treatment. As micro-osteoperforations is a new adjunctive treatment to orthodontics, further research is needed to assess its effect on root resorption and to confirm its association with accelerated orthodontic tooth movement.