READERS' FORUM
Letter to the editor
Osseous evidence behind micro-
osteoperforation
W e read the article reporting osseous evidence
behind micro-osteoperforation (MOP) when it
was first published online ahead of print (Asif MK, Ibra-
him N, Sivarajan S, Heng Khiang Teh N, Chek Wey M.
Osseous evidence behind micro-osteoperforation tech-
nique in accelerating orthodontic tooth movement: a
3-month study. Am J Orthod Dentofacial Orthop
2020;158:579-86.e1). The study highlighted important
aspects related to the acceleration of orthodontic tooth
movement. We have some questions regarding the trial
and would like the authors to enlighten us regarding
the same.
It was mentioned that scans were performed before
the MOP for the 12th week for groups 1 and 3, but it
was not clear when the scans were done for group 2.
In the inclusion criteria, it was mentioned that pa-
tients with less than one half unit Class II molar relation-
ship, requiring the extraction of all first premolars,
treated using absolute anchorage were included in the
trial. The rate of tooth movement was assessed in a
canine retraction model only in the mandibular arch.
The retraction of canines in the mandibular arch in a
Class II dentition using absolute anchorage may not be
a good treatment option. Was any other therapy, such
as molar protraction, performed in conjunction with
canine retraction?
No details regarding the Frankfort-mandibular plane
angle of the respective treatment group was mentioned.
It is well known that different vertical skeletal patterns
have differing rates of tooth movement and thus may
have a bearing on the study results.1
Why was a paired-samples t test done to compare the
MOP side with the control side, as they represent 2
different clinical scenarios albeit in the same patient?
Would an independent t test be a more appropriate
test in this case? In addition, because there are clearly
3 groups, we wonder why the analysis of variance test
was not used for an intergroup comparison because it
would yield very useful information. Finally, we saw a
varying number of dropouts in this trial. We wish to
ask whether an intention-to-treat analysis was done,
and if not, were the final numbers analyzed on a “as
treated” protocol basis. If so, this clearly diminishes the
original assumptions for sample and power calculations.
It is established that the regional acceleratory phe-
nomenon for MOPs is viable only for a period of 4 weeks,
and MOPs need to be repeated after every 4 weeks to
maintain the regional acceleratory phenomenon for
the acceleration of orthodontic tooth movement.2 As a
result, most of the studies evaluating MOPs have
repeated them at an interval of 4 weeks. Why were inter-
vals of 8 and 12 weeks taken?
Karan Sharma
Sreevatsan Raghavan
Puneet Batra
Modinagar, Uttar Pradesh, India
Am J Orthod Dentofacial Orthop 2021;159:e81
0889-5406/$36.00
Ó 2020 by the American Association of Orthodontists. All rights reserved.
https://doi.org/10.1016/j.ajodo.2020.11.008
REFERENCES
1. Pepicelli A, Woods M, Briggs C. The mandibular muscles and their
importance in orthodontics: a contemporary review. Am J Orthod
Dentofacial Orthop 2005;128:774-80.
2. Teixeira CC, Khoo E, Tran J, Chartres I, Liu Y, Thant LM, et al. Cyto-
kine expression and accelerated tooth movement. J Dent Res 2010;
89:1135-41.
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