Indian Journal of Dental ResearchIndian Journal of Dental ResearchIndian Journal of Dental Research
HOME | ABOUT US | EDITORIAL BOARD | AHEAD OF PRINT | CURRENT ISSUE | ARCHIVES | INSTRUCTIONS | SUBSCRIBE | ADVERTISE | CONTACT
Indian Journal of Dental Research   Login   |  Users online: 687

Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size         

 


 
Table of Contents   
ORIGINAL RESEARCH  
Year : 2014  |  Volume : 25  |  Issue : 6  |  Page : 748-754
Corticotomy-assisted retraction: An outcome assessment


1 Department of Orthodontics, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
2 Department of Oral and Maxillofacial Surgery, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India

Click here for correspondence address and email

Date of Submission02-Oct-2014
Date of Decision24-Oct-2014
Date of Acceptance27-Jan-2015
Date of Web Publication02-Mar-2015
 

   Abstract 

Background: To assess the efficiency and treatment outcome of patients treated with corticotomy-assisted en-masse orthodontic retraction as compared with the en-masse retraction without corticotomy.
Materials and Methods: Forty adult patients with bimaxillary protrusion requiring correction of bidental proclination constituted the sample. The study group consisted of 22 patients (male 11, female 11) willing to undergo surgery to reduce the duration of their orthodontic treatment and 18 patients (male 9, female 9) desirous of undergoing conventional orthodontic treatment without surgical intervention constituted the control group. Comparison of rate of retraction and anchor loss between the study and the control group was assessed.
Results: Average rate of space closure of 1.8 mm/month in the maxilla and 1.57 mm/month in the mandible was observed in the study group compared to 1.02 mm/month in the maxilla and 0.87 mm/month in the mandible in the control group. The rate of retraction accelerated during the first 2 months of retraction. Molar anchor loss of approximately 0.6 mm occurred in the study group, and 1.8 mm occurred in the control group during the 4 months.
Conclusion: The rate of retraction with study group was twice as faster when compared to the control group, accelerating during the first 2 months of retraction. There was better anchorage control with the undecorticated molar segment during the retraction period but was found to increase as time advanced.

Keywords: Adult orthodontics, corticotomy, orthodontic retraction, regional acceleratory phenomenon

How to cite this article:
Sakthi S V, Vikraman B, Shobana V R, Iyer S K, Krishnaswamy N R. Corticotomy-assisted retraction: An outcome assessment. Indian J Dent Res 2014;25:748-54

How to cite this URL:
Sakthi S V, Vikraman B, Shobana V R, Iyer S K, Krishnaswamy N R. Corticotomy-assisted retraction: An outcome assessment. Indian J Dent Res [serial online] 2014 [cited 2019 Nov 12];25:748-54. Available from: http://www.ijdr.in/text.asp?2014/25/6/748/152191
Patients with bimaxillary protrusion seek orthodontic treatment to decrease the procumbency of the lips. [1] Extracting the first four premolars and retracting the anterior segments with maximum anchorage is the most common way to straighten the profile.

The anatomic limits set by the cortical plates of the alveolus at the level of the incisor apices act as barriers to incisor retraction. Orthodontic treatment requiring closure of the extraction space, has side effects such as bone loss, [2],[3],[4] root resorption, [2],[3] gingival recession, [3] root dehiscence, [5] and fenestration. [6]

Adult patients who seek orthodontic treatment often desire that their treatment be completed in as short a period as possible. [7] In 1959, Köle [8] introduced a technique called selective alveolar decortications to enable movement of the bone segment. In 2001, Wilcko et al. [9] developed a new method of combining corticotomy, alveolar augmentation, and orthodontic treatment. They have observed that orthodontic tooth movement is accelerated by the increase of bone turnover and decrease of bone density because osteoclasts and osteoblasts are increased due to a regional acceleratory phenomenon (RAP). [10],[11]

One possible method for completing treatment in a shorter period is through orthodontic treatment combined with corticotomy. [12],[13],[14] This period of accelerated tooth movement usually lasts for 4-6 months. [14],[15]

Due to the limited studies of corticotomy facilitated orthodontics in bimax cases, the aim of the present study was to assess the efficiency of treatment outcome of patients treated with corticotomy-assisted en-masse orthodontic retraction with a modified protocol as compared with the en-masse retraction without corticotomy.


   Materials and methods Top


Twenty-two patients (male 11, female 11), willing to undergo surgery to reduce the duration of their orthodontic treatment were selected as sample for the study and 18 patients (male 9, female 9), reluctant to undergo any surgical interventions desirous of undergoing conventional orthodontic treatment constituted the control group. The group allocation was not blinded. It was based on the willingness of the patient to opt for an additional minor surgical procedure that may influence the duration of orthodontic treatment

Inclusion criteria

Cases with bimaxillary protrusion, angles class I malocclusion, interincisal angle <125°, crowding ≤3 mm. Requiring first premolar extraction in all the four quadrants. Adult patients between the age of 18-25 years. Patients with satisfactory periodontal health and good oral hygiene. Not under any systemic medication.

Exclusion criteria

Patients with severe skeletal dysplasia in all three dimensions. Nonconsenting adults. Severe crowding. Symptoms of temperomandibular disorders. Patients on medication for systemic disorders, pregnancy or steroid therapy.

Methodology

All patients included in the study required extraction of all first premolars and were treated with 0.022' slot Roth appliance. In the study group, leveling and aligning were carried out until 0.019" × 0.025" stainless steel archwire could be fully engaged in the bracket slot, the first premolars were not extracted till the time of retraction stage. Whereas in the control group, the first premolars were extracted prior to aligning stage of treatment (as traditional). The surgery was carried out under local anesthesia (Lignox 2%A). Surgical procedure was handled by the same maxillofacial surgeon. Lower arch procedure preceded 2 weeks ahead of the upper arch. First premolars were extracted at the time of the surgery and a stainless steel 0.019" × 0.025" archwire with soldered brass hooks was placed before flap elevation in the study group. Sulcular incisions from the distal aspect of one canine to the contralateral canine were placed, and full thickness flap was elevated, 3 mm above the apical region of the tooth. 701 fissure bur and number 2 size round bur mounted on a micromotor handpiece under copious irrigation was used for decortications (only cortical surface scoring and not through and through penetration). If there was a good amount of inter-root distance between two adjacent teeth vertical interdental cortical surface scoring was done otherwise only surface punch hole were placed in the area, stopping 2 mm short of the alveolar crest, occlusally. Horizontal decortications connected the vertical 2 mm beyond root apex. Selective alveolar decortication from the mesial aspect of one canine to the mesial surface of the contralateral canine involving the anteriors was performed. Similarly, a palatal flap incision was raised immediately for decortications of the superficial surface of the palatal bone for RAP to occur.

The graft was placed only in cases with Evidence of bone loss (dehiscence and fenestration) on flap elevation with demineralized freeze-dried allograft (demineralized freeze-dried bone allograft - Rocky Mountain Tissue Bank) wetted with sterile saline and maintained in the desired position by the full thickness flap, sutured with an interrupted loop, nonresorbable 4-0 black silk suture material, left in place for 1-2 weeks. Initiation of orthodontic force was done within 5-7 days after the surgery with the help of closed NiTi coil spring which was engaged from the first molar tube to the soldered hook on the archwire delivering a force of 250 g for en-masse retraction using sliding mechanics, similarly in the control group.

A case treated with corticotomy-assisted retraction is depicted from [Figure 1] [Figure 2] [Figure 3] [Figure 4] [Figure 5] [Figure 6].
Figure 1: (a) Pretreatment extraoral photographs (b) Posttreatment extraoral photograph

Click here to view
Figure 2: (a) Pretreatment intraoral photograph (b) Posttreatment intraoral photograph

Click here to view
Figure 3: (a and b) Right and left reference molar jigs

Click here to view
Figure 4: Maxillary and mandibular corticotomy

Click here to view
Figure 5: (a) Pretreatment lateral cephalogram (b) Posttreatment lateral cephalogram

Click here to view
Figure 6: (a) Pretreatment orthopantamogram (b) Posttreatment orthopantamogram

Click here to view


Study models at monthly intervals and the lateral cephalometric radiographic records every 2 months were taken for assessment.

Methodology for evaluation of extraction space closure in the dental cast

Following extractions, space closure was measured using a digital vernier caliper at the maximum contour of the mesial point of second premolar and the distal maximum contour of the canine on the study model and was repeated every month.

Methodology for evaluation of retraction and anchor loss

Maxilla and Mandible: Using lateral cephalograms

Linear measurements were taken from pterygoid vertical along the Frankfort horizontal plane, horizontal distance from pterygoid vertical to the jig on the molar [Figure 3]a and b] and incisor bracket was used in the maxilla. Whereas, linear measurements were taken from sella vertical along the SN plane, horizontal distance from the sella vertical to the jig on the molar [Figure 3]a and b], and incisor bracket to assess anchor loss and retraction, respectively [Figure 9].

Comparison with the conventional group for the en-masse retraction

The space closure was compared in both the groups before the start of retraction. The time taken for space closure in the corticotomy group was compared with the space closure in the conventional group.

Statistical analysis

All statistical analyses were performed using SPSS software package (SPSS for Windows XP, version 17.0, Chicago, IL, USA). For each variable measured on the lateral cephalogram, the mean and the standard deviation were calculated.

Paired t-test was used to determine statistical significance of the difference between left and right side variables within maxilla and mandible.

Independent t-test was used to determine statistical significance of the difference between the rate of retraction, molar anchor loss before retraction (T1) and after retraction (T2) between the study group and the control group.

One-way ANOVA followed by Tukey's HSD test was done to evaluate and compare the rate of space closure and anchor loss between the studied monthly time intervals.

P < 0.05 was considered statistically significant. Power of the sample is 0.95.


   Results Top


Rate of retraction in the maxilla and mandible compared during monthly intervals in study and control group [Table 1].
Table 1: Rate of retraction in the maxilla and mandible compared during monthly intervals in study and control group

Click here to view


Duration and rate of retraction

There was no significant difference in the quantum of extraction spaces in the maxilla and the mandible between the study group and the control group [Figure 8]a].

Maxilla

  • Extraction space closure of 92.8% in the study group and 54.5% in the control group was achieved during the 4-month period
  • Average rate of space closure of 1.8 mm/month and 1.02 mm/month was achieved in the in the study group and control group, respectively, during the 4-month period.
Mandible

  • Extraction space closure of 91.6% in the study group and 51.5% in the control group was achieved during the 4-month period
  • Average rate of space closure of 1.57 mm/month in the study group and 0.87 mm/month was achieved in the control group during the 4-month period.
Comparison of rate of space closure in the maxilla and mandible at monthly intervals

  • Acceleration of rate of space closure was statistically significant during the first 2 months of retraction in the study group
  • No significant rate of acceleration and rate of space closure were found in the maxilla and/or the mandible during the monthly intervals in the control group.
Anchor loss

Molar anchor loss in the maxilla and mandible compared between the study and the control group (mm) [Table 2].
Table 2: Molar anchor loss in the maxilla and mandible compared between the study and the control group (mm)

Click here to view


In the 4-month period during which the space closure was assessed, the following changes were observed [Figure 8]b].

Maxilla

  • Molar anchor loss of approximately 0.86 mm occurred in the study group, and 1.8 mm occurred in the control group.


Mandible

  • Molar anchor loss of approximately 0.51 mm occurred in the study group, and 1.6 mm occurred in the control group.


Comparison of anchor loss

  • Statistically significant difference was present between the study group and the control group
  • The amount of anchor loss increased as time advanced in the study group.

   Discussion Top


In the treatment of bimaxillary protrusion, two important factors for consideration are: Esthetic improvement of the dentofacial area and the establishment of a stable dental relationship. Because of the protrusive dentition and lips many patients with bimaxillary protrusion seek orthodontic care to decrease this procumbency. [9] The treatment approach usually consists of extracting the four first premolars and retracting the anterior teeth with maximum anchorage. Time is an important factor during the course of orthodontic treatment. [16]

Mavreas [16] in a systematic review indicated that the duration of treatment for four premolar extraction cases was approximately 18.6 months (retraction of anteriors alone took 8 months). Long [17] evaluated the effectiveness of interventions on accelerating orthodontic tooth movement found, corticotomy to be effective and safe procedure to accelerate orthodontic tooth movement. Therefore, the procedure employed in the current study can be considered to be an effective and mode of intervention.

There is sufficient evidence in the literature by Wilcko et al., [9] Spena et al., [18] Fischer, [19] Moon et al., [20] Yaffe et al., [21] Mostafa et al., [22] Generson et al., [23] Chung et al., [2],[24] Hassan et al., [25] Ahn et al., [26] Newman [27] and many others suggesting that corticotomy is a viable option for accelerating orthodontic treatment. The RAP exists probably for about 4 months. [28],[29] Anecdotal evidence shows that when the teeth are extracted just before commencing space closure, then space closure tends to be faster, owing to the reduced bony resistance offered by freshly healed extraction site to tooth movement. [30]

Thus to take advantage of the maximum RAP response which exists for 4 months, delayed extraction of the first bicuspid would be advantageous in accelerating tooth movement. Further, the undecorticated molar segment acts as an anchorage module during the period of retraction. This protocol has been used effectively to enhance the en-masse retraction of the anterior segment compared with the conventional en-masse retraction in bimaxillary protrusion patients.

The teeth were stabilized with stainless steel wire (0.019" × 0.025") to minimize torque loss and to bring about bodily/controlled tipping movements during retraction. The posterior segment (second premolar, first and second molar) was not decorticated to enable them to serve as an anchorage module.

In Wilcko's et al. protocol, [15] corticotomy was performed prior to aligning and an additional procedure viz.; ostectomy (surgical removal of cortical plate) in the extraction space was recommended, which would be a cumbersome and expensive method. Thus rather than removing a large amount of cortical bone around the first bicuspid, delayed extraction of the first bicuspid without removal of the cortical bone was carried out further cases selected had very minimal crowding and delaying extraction did not prolong the treatment. Nevertheless, minor inconvenience as a result of transient inflammation was seen following the procedure. [31]

In our study, 701 tapering fissure bur for interdental scoring and number 2 round bur for punch hole perforation were used which is an acceptable method for decortications. [22],[32]

A few case reports Germeη et al., [13] Kim et al., [11] Aboul-Ela et al., [33] Lino et al., [34] suggest corticotomy can be beneficial in bimaxillary protrusion cases. Most of these studies employ either an implant or involves independent canine retraction.

The technique for alveolar decortication is based upon cortical bone thickness than upon any particular preconceived pattern of bone injury with a surgical bur, such as cuts or dots or a combination of cuts and dots. The surgical scarring barely penetrates the cortical bone into the medullary space on both the labial and lingual surfaces. [11]

Molar anchor loss has not been documented convincingly in the literature for corticotomy assisted retraction. Therefore, our study aimed to evaluate the rate of retraction and the amount of molar anchor loss that occurred during the retraction period compared to the control group for the same period.

Anchor loss was assessed with the help of lateral cephalogram similar to the method proposed by Badri Thiruvengadachari [35] with modified jigs placed on the upper and lower, right and left first molar [Figure 3]a and b] to differentiate the right from the left molar [Figure 9]. Anchor loss was correlated with the space closure and effective retraction in the Study group was assessed and compared with the control group (approximately 4-5 months). Case report superimposition refers [Figure 7].
Figure 7: Pre- and post-treatment superimposition

Click here to view
Figure 8: (a) Graph of amount of incisor retraction in mm (b) Graph of amount of anchor loss in mm

Click here to view
Figure 9: Reference point for measurement on lateral cephalogram

Click here to view


In our study, there was no significant difference in the extraction space in the study and the control group which accounted to be on an average of 7.63 mm in the maxilla and 6.77 mm in the mandible in spite of early extraction in the control group when compared with the study group which could be due to the fact that the cases selected for the study had minimal crowding. Thus, the study and the control group can be effectively compared.

About 92.8% (7.05 mm) of extraction space closure in the study group and 54.5% (4.15 mm) of extraction space closure in the control group were achieved by the end of 4 th month in the maxilla. 91.6% (6.3 mm) of extraction space closure in the study group (corticotomy group) and 51.7% (3.5 mm) of extraction space closure was achieved in the control group for the same period of time in the mandible.

The average rate of space closure was 1.8 mm/month in the maxilla and 1.6 mm/month in the mandible of the study group. This correlates with the studies of Aboul-Ela et al., [33] who reported the mean rate of individual maxillary canine retraction, was on an average about 1.42 mm/month.

There was a peak increase in the rate of retraction during the first 2 months of retraction in the maxilla (2.01 mm/month) and in the mandible (1.89 mm/month) which started to decline by the end of 4 th month. This finding is in concurrence with that of Aboul-Ela et al. [33] who reported that the rate of space closure peaked during the end of 1 st and 2 nd month and reduced by the end of the 4 th month. This could be biologically co-related with the transient RAP phenomenon as mentioned by Frost [10] which remains active for 4 months. Thus, the time period of assessment of retraction for the first 4-month period after corticotomy can be substantiated.

An average anchor loss of 0.6 mm occurred in maxilla and mandible for a period of 4-6 months. There is no pertinent literature to substantiate molar anchor loss in corticotomy-assisted retraction as most of the study used temporary anchorage devices to bolster anchorage. To the best of our knowledge, this study would probably be the first to correlate pure anchor loss and the efficiency of the undecorticated posterior segment to act as an efficient anchorage source. Similarly, in a previous study on a conventional en-masse retraction by Wook Heo, approximately 4 mm of retraction of upper incisal edge resulted in 1 mm of anchor loss in the upper molar. Since the complete space closure in the control group was not assessed in the current study, there could be further anchor loss at the end of the retraction.


   Summary and conclusion Top


Based on the outcome of this study, it is reasonable to conclude that corticotomy-assisted retraction drastically reduces the overall duration of orthodontic treatment. It is particularly useful in maximum anchorage cases by using selective decortications the anchorage segment can be made virtually stationary, thereby eliminating the need for other anchorage boosters.

 
   References Top

1.
Lewis SJ. Bimaxillary protrusion. Angle Orthod 1943;13:51-9.  Back to cited text no. 1
    
2.
Chung KR, Kim SH, Baek SL. Speedy surgical-orthodontic treatment with temporary anchorage devices as an alternative to orthognathic surgery. Am J Orthod Dentofacial Orthop 2009;135:787.  Back to cited text no. 2
    
3.
Handelman CS. The anterior alveolus: Its importance in limiting orthodontic treatment and its influence on the occurrence of iatrogenic sequelae. Angle Orthod 1996;66:95-109.  Back to cited text no. 3
    
4.
Wehrbein H, Bauer W, Diedrich P. Mandibular incisors, alveolar bone, and symphysis after orthodontic treatment. A retrospective study. Am J Orthod Dentofacial Orthop 1996;110:239-46.  Back to cited text no. 4
    
5.
Suya H. Corticotomy in orthodontics. In: Hosl E, Baldauf A, editors. Mechanical and Biological Basics in Orthodontic Therapy. Heidelberg, Germany: Huthig Buch Verlag; 1991. p. 207-26.  Back to cited text no. 5
    
6.
Baek SH, Kim BH. Determinants of successful treatment of bimaxillary protrusion: Orthodontic treatment versus anterior segmental osteotomy. J Craniofac Surg 2005;16:234-46.  Back to cited text no. 6
    
7.
Miyawaki S, Koh Y, Kim R, Kobayasi M, Sugimura M. Survey of young adults women regarding men's orofacial features. J Clin Orthod 2000;34:367-70.  Back to cited text no. 7
    
8.
Köle H: Surgical operations of the alveolar ridge to correct occlusal abnormalities. Oral Surg Oral Med Oral Pathol. 1959; 12:515-529.  Back to cited text no. 8
    
9.
Wilcko WM, Wilcko MT, Bouquot JE, Ferguson DJ. Rapid orthodontics with alveolar reshaping: Two case reports of decrowding. Int J Periodontics Restorative Dent 2001;21:9-19.  Back to cited text no. 9
    
10.
Frost HM. Biology of fracture healing - An overview for clinicians Part I and II. Clini Orthop Relat Res 1989;248:283.  Back to cited text no. 10
    
11.
Kim SJ, Park YG. Kang SG. Effects of Corticision on paradental remodeling in orthodontic tooth movement. Angle Orthod 2009;79:284-91.  Back to cited text no. 11
    
12.
Iino S, Sakoda S, Miyawaki S. An adult bimaxillary protrusion treated with corticotomy-facilitated orthodontics and titanium miniplates. Angle Orthod 2006;76:1074-82.  Back to cited text no. 12
    
13.
Germeç D, Giray B, Kocadereli I, Enacar A. Lower incisor retraction with a modified corticotomy. Angle Orthod 2006;76:882-90.  Back to cited text no. 13
    
14.
Hajji SS. The Influence of Accelerated Osteogenic Response on Mandibular Decrowding [Master's Thesis]. St. Louis, Mo: St. Louis University; 2000.  Back to cited text no. 14
    
15.
Wilcko MT, Wilcko WM, Bissada NF. An evidence-based analysis of periodontally accelerated orthodontic and osteogenic techniques: A synthesis of scientific perspectives. Semin Orthod 2008;14:305-16.  Back to cited text no. 15
    
16.
Mavreas D, Athanasiou AE. Factors affecting the duration of orthodontic treatment: A systematic review. Eur J Orthod 2008;30:386-95.  Back to cited text no. 16
    
17.
Long H, Pyakurel U, Wang Y, Liao L, Zhou Y, Lai W. Interventions for accelerating orthodontic tooth movement: A systematic review. Angle Orthod 2013;83:164-71.  Back to cited text no. 17
    
18.
Spena R, Caiazzo A, Gracco A, Siciliani G. The use of segmental corticotomy to enhance molar distalization. J Clin Orthod 2007;41:693-9.  Back to cited text no. 18
    
19.
Fischer TJ. Orthodontic treatment acceleration with corticotomy-assisted exposure of palatally impacted canines. Angle Orthod 2007;77:417-20.  Back to cited text no. 19
    
20.
Moon CH, Wee JU, Lee HS. Intrusion of overerupted molars by corticotomy and orthodontic skeletal anchorage. Angle Orthod 2007;77:1119-25.  Back to cited text no. 20
    
21.
Yaffe A, Fine N, Binderman I. Regional accelerated phenomenon in the mandible following mucoperiosteal flap surgery. J Periodontol 1994;65:79-83.  Back to cited text no. 21
    
22.
Mostafa YA, Tawfik KM, El-Mangoury NH. Surgical-orthodontic treatment for overerupted maxillary molars. J Clin Orthod 1985;19:350-1.  Back to cited text no. 22
[PUBMED]    
23.
Generson RM, Porter JM, Zell A, Stratigos GT. Combined surgical and orthodontic management of anterior open bite using corticotomy. J Oral Surg 1978;36:216-9.  Back to cited text no. 23
[PUBMED]    
24.
Chung KR, Oh MY, Ko SJ. Corticotomy-assisted orthodontics. J Clin Orthod 2001;35:331-9.  Back to cited text no. 24
    
25.
Hassan AH, AlGhamdi AT, Al-Fraidi AA, Al-Hubail A, Hajrassy MK. Unilateral cross bite treated by corticotomy-assisted expansion: Two case reports. Head Face Med 2010;6:6.  Back to cited text no. 25
    
26.
Ahn HW, Lee DY, Park YG, Kim SH, Chung KR, Nelsonf G. Accelerated decompensation of mandibular incisors in surgical skeletal Class III patients by using augmented corticotomy: A preliminary study. Am J Orthod Dentofacial Orthop 2012;142:199-206.  Back to cited text no. 26
    
27.
Newman WG. Possible etiologic factors in external root resorption. Am J Orthod 1975;67:522-39.  Back to cited text no. 27
[PUBMED]    
28.
Häsler R, Schmid G, Ingervall B, Gebauer U. A clinical comparison of the rate of maxillary canine retraction into healed and recent extraction sites - a pilot study. Eur J Orthod 1997;19:711-9.  Back to cited text no. 28
    
29.
Wilcko W, Wilcko MT. Accelerating tooth movement: The case for corticotomy-induced orthodontics. Am J Orthod Dentofacial Orthop 2013;144:4-12.  Back to cited text no. 29
    
30.
Wilcko WM, Wilcko T, Bouquot JE, Ferguson DJ. Rapid orthodontics with alveolar reshaping: Two case reports of decrowding. Int J Periodontics Restorative Dent 2001;21:9-19.  Back to cited text no. 30
    
31.
Lanigan DT, Hey JH, West RA. Aseptic necrosis following maxillary osteotomies: Report of 36 cases. J Oral Maxillofac Surg 1990;48:142-56.  Back to cited text no. 31
    
32.
Goldson L, Reck VJ. Surgical-orthodontic treatment of malpositioned cuspids. J Clin Orthod 1987;21:847-51.  Back to cited text no. 32
    
33.
Aboul-Ela SMB, Beialy AR, El-Sayed KMF, Selim EMN, EL-Mangoury NH, Mostafad YA. Miniscrew implant-supported maxillary canine retraction with and without corticotomy-facilitated orthodontics 2011. Am J Orthodontics and Dentofacial Orthopedics 2011;139:2  Back to cited text no. 33
    
34.
Lino S, Sakoda S, Miyawaki S. An adult bimaxillary protrusion treated with corticotomy-facilitated orthodontics and titanium miniplate. Angle Orthod 2006;76:1074-82.  Back to cited text no. 34
    
35.
Thiruvenkatachari B, Pavithranand A, Rajasigamani K, Moon HK. Comparison and measurement of the amount of anchorage loss of the molars with and without the use of implant anchorage during canine retraction. Am J Orthod Dentofacial Orthop 2006;129:4.  Back to cited text no. 35
    

Top
Correspondence Address:
N R Krishnaswamy
Department of Orthodontics, Ragas Dental College and Hospital, Chennai, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.152191

Rights and Permissions


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


    Abstract
    Materials and me...
   Results
   Discussion
    Summary and conc...
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed3624    
    Printed122    
    Emailed4    
    PDF Downloaded237    
    Comments [Add]    

Recommend this journal