ORIGINAL ARTICLE

Acceleration of orthodontic tooth movement by alveolar corticotomy in the dog
Shoichiro Iino,a Sumio Sakoda,b Gakuji Ito,c Toshikazu Nishimori,d Tetsuya Ikeda,e and Shouichi Miyawakif Kagoshima and Miyazaki, Japan Introduction: Tooth movement and alveolar bone reaction after corticotomies have not been thoroughly examined. In this study, the effects of corticotomies on orthodontic tooth movement and alveolar bone reaction were investigated in dogs. Methods: Corticotomies were performed on the cortical bone of the mandibular left third premolar region in 12 male adult beagles. The third premolars on the left experimental side and on the right sham side were moved mesially with a continuous force of 0.5 N. Results: Tooth movement velocities from 0 to 1 week and from 1 to 2 weeks after the corticotomies were significantly faster on the experimental side than on the sham side. Hyalinization of the periodontal ligament appeared only at 1 week after the corticotomies on the experimental sides, whereas it was observed from 1 to 4 weeks after the corticotomies on the sham sides. Tartrate-resistant-acid-phosphatase positive cells of the experimental side tended to work vigorously at an early time on the alveolar wall and in the bone marrow cavities. Conclusions: Orthodontic tooth movement increased for at least 2 weeks after the corticotomies. This might be brought about by rapid alveolar bone reaction in the bone marrow cavities, which leads to less hyalinization of the periodontal ligament on the alveolar wall. (Am J Orthod Dentofacial Orthop 2007;131: 448.e1-448.e8)

corticotomy on the alveolar bone makes orthodontic tooth movement faster than in conventional orthodontic treatment; this leads to shorter orthodontic treatment times.1-8 According to Hajji,3 the active orthodontic treatment periods in patients with corticotomies were 3 to 4 times more rapid compared with patients without corticotomies. It was believed that a corticotomy makes tooth movement faster because the bone block moves with the tooth.6-8 However, tooth movement after a corticotomy should be considered a combination of classical orthodontic tooth movement and the movement of bone blocks
a

A

Assistant professor, Department of Orthodontics, Center of Developmental Dentistry, Medical and Dental Hospital, Kagoshima University, Kagoshima, Japan. b Professor and chair, Department of Oral and Maxillofacial Surgery, Miyazaki Medical College, University of Miyazaki, Miyazaki, Japan. c Professor emeritus, Kagoshima University, Kagoshima, Japan. d Professor and chair, Division of Biology, Miyazaki Medical College, University of Miyazaki, Miyazaki, Japan. e Assistant professor, Division of Biology, Miyazaki Medical College, University of Miyazaki, Miyazaki, Japan. f Professor and chair, Department of Orthodontics, Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan. Partially supported by grants-in-aid for scientific research for the first and sixth authors from the Japan Society for the Promotion of Science. Reprint requests to: Shouichi Miyawaki, Department of Orthodontics, Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; e-mail, miyawaki@denta.hal.kagoshima-u.ac.jp. Submitted, May 2006; revised and accepted, August 2006. 0889-5406/$32.00 Copyright © 2007 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2006.08.014

containing a tooth, because the force applied to a tooth is transmitted into the osteotomy gap through the periodontal ligament (PDL). Bone turnover is well known to be accelerated after bone fracture, osteotomy, or bone grafting.9 This could be explained by a regional acceleratory phenomenon (RAP); ie, osteoclasts and osteoblasts increase by local multicellular mediator mechanisms containing precursors, supporting cells, blood capillaries, and lymph. RAP also occurs in the mandible.10 Similarly, bone turnover is increased by RAP after a corticotomy. The velocity of orthodontic tooth movement is influenced by bone turnover,11,12 bone density,13 and hyalinization of the PDL.14 Wilcko et al4,5 mentioned, in cases of rapid orthodontics with corticotomies, that corticotomies could increase tooth movement by increasing bone turnover and decreasing bone density. However, the increase of tooth movement after a corticotomy was not always examined histologically. In our study, we intended to elucidate the mechanism of rapid tooth movement associated with corticotomies by investigating the amount of tooth movement and the alveolar bone reaction on the periodontal tissue of the compression side after corticotomies in beagle dogs.
MATERIAL AND METHODS

The experimental animals were 12 male adult beagles. They were caged individually with regulated light and temperature, and fed soft dog food
448.e1

6 mm. by the formation and mineralization of callus. The experimental conditions and procedures were approved by the Animal Ethics Committee of Miyazaki University. teeth. tic bands of the P3. usually requires 4 to 16 weeks after bone injury. respectively. The mandibular second premolars were extracted on both sides to prepare the space for mesial movement of the P3. P4. Tracing and superimposition on the mandibular fourth premolar were carried out. The horizontal cut line of the corticotomy was made under the apices of the P3 on the lingual side and at the level of mental foramen on the buccal side (Fig 1). Standardized dental radiographs were taken at a constant distance and angle by setting the film holder with an attachment on the mandibular fourth premolar (Fig 4) before the corticotomy (T0) and at 1 (T1). The appliance. Japan) were soldered to the orthodon- Fig 2.14 mm. P3. 1. Schematic drawing of orthodontic appliance.9 Therefore. Same incision was made on lingual side. Orthodontic bands were cemented on the mandibular canines and P3 teeth. Healing. and the other side was fixed to the metal tube with a ligature wire. length. was measured with a caliper and strain gauge. The bands were cemented to the teeth with glass ionomer cement.5 N. Dentsply-Sankin. 2 (T2). and the force delivery was measured once a week. Orthodontic wires (diameter. Immediately after the corticotomies. Metal tubes (diameter. Canine. The mandibular left and right third premolars (P3) were the experimental and sham sides. Tokyo. Photograph of corticotomy on alveolar buccal surface on experimental side.448. The vertical cut lines were made from the alveolar crests of the P3 to the horizontal cut lines on the buccal and lingual sides. Tomy International. and other side ran freely through the 1.0 mm) was soldered to orthodontic band of mandibular canine. The error of the method was calculated for the distance of tooth movement based on double measurements on 10 randomly selected distances of tooth . vertical cut line was made from alveolar crest to horizontal cut line. One end of the spring was fixed to the bent loop of the orthodontic wire on the canine site with a ligature wire.02% chlorhexidine in water. Japan) were soldered to the mandibular canine bands and inserted through the metal tubes on the bands of the P3. the alveolar bone on the experimental side was corticotomized as follows: the gingival mucoperiosteal flaps were raised to expose cortical bone on both the buccal and the lingual sides of the P3. 1. Tokyo. White arrowhead. The corticotomy process was performed with a #009 fissure bur under saline-solution irrigation. third premolar. the P3 teeth of the experimental and sham sides were moved mesially along the orthodontic wire with a continuous force of 0.e2 Iino et al American Journal of Orthodontics and Dentofacial Orthopedics April 2007 Fig 1.14 mm metal tube (internal diameter) on mandibular third premolar. at 16 weeks after extraction. black arrowhead. and the depth was carefully adjusted to reach the bone marrow by confirming bleeding through the cut lines. and the activation of the spring was set at that length. and gingiva were checked once a day and cleaned with a toothbrush and gauze with 0.5 N by using nickel-titanium closed coil springs (Tomy International). All experimental procedures were performed under intravenous anesthesia with sodium pentobarbital (25-30 mg per kilogram of body weight). The width of bone cuts was approximately 1 mm. The length of each spring. C. Mandibular third premolars on both sides were moved mesially with nickel-titanium coil springs. One side of wire (external diameter 1. horizontal cut line was made beyond apices. which corresponded to a contractile force of 0. 4 (T4). 4. The distance of tooth movement was measured between the tip of protocone of the P3 at the various time points with a caliper on the tracing. The mucoperiosteal flaps were sutured with absorbable surgical sutures. and water to prevent any damage to the experimental orthodontic appliance.0 mm. fourth premolar. Orthodontic appliances were constructed on both sides on the dental casts before the corticotomies (Figs 2 and 3). and 8 (T8) weeks after the corticotomy.

***P . T2. Number 4 Iino et al 448. and T8 for histologic examinations. pH 7. Subsequently.4) at 4°C for 30 days. T2.American Journal of Orthodontics and Dentofacial Orthopedics Volume 131. T1. and T2 to T4 (T2-4) were calculated. . 6. T1-2. The mean values of the distance and velocity of the tooth movement were estimated with the Mann-Whitney U test. and T8. The error of the method for measurement of tooth movement was 0. T4. Fig 5.05. according to a conventional technique.1 mol phosphate buffer (pH 7.02 mm. Comparison of tooth movement velocity between experimental and sham groups with Mann-Whitney U test. Photographs of orthodontic appliances used for tooth movement: A. 1 week. B. where n number of paired measurements and d deviations between the 2 measurements.4) under deep anesthesia. we observed only osteoclasts to study the tendency of bone turnover on the periodontal tissue and simplify our experiment. Comparison of distance of tooth movement between experimental and sham sides with MannWhitney U test. *P .001.05. respectively. period from 2 to 4 weeks after corticotomy. Therefore. *P . closed-mouth view. 2 weeks. Fig 4. period from 1 to 2 weeks. 9. open-mouth view.001. serial mesiodistal paraffin sections of 8 m thickness were made and stained with haematoxylin and eosin or tartrate-resistant-acid-phosphatase (TRAP) with methylene blue as counterstaining for detection of the osteoclasts. ***P . the numbers of dogs were 12. oclasts and osteoblasts are generally observed to assess bone turnover. movement measurements and was estimated as S (d)2/2n. The animals were perfused through the carotid artery with 1% paraformaldehyde and 1% glutaraldehyde in 0. and 3 at T1. 4 weeks after corticotomy. T1 to T2 (T1-2). The tooth movement velocities (millimeters per week) from T0 to T1 (T0-1).01. Period from 0 to 1 week. Standardized dental radiograph taken by setting film holder with attachment on mandibular fourth premolar. The blocks of mandibular bone were dissected and refixed in the same solution at 4°C for 24 hours. T0-1. T2. T4. Although oste- Fig 6. **P . T2-4. Three dogs were killed at T1.e3 Fig 3. The blocks were trimmed and decalcified in 10% ethylenediaminetetraacetic acid (EDTA-2Na. T4.

The numbers of TRAP positive (TRAP ) cells were counted on the mesial surface of the mesial root (alveolar wall) and in the bone marrow cavities immediately adjacent to the alveolar wall according to the method of Noxon et al. T8 means 8 weeks after corticotomy. hyalinization. All P3 teeth of the experimental and sham sides were moved mesially with slight tipping. Remarkably. Alveolar bone. TR. movement was 2 and 5 times faster on the experimental side. and T4 (Fig 9). RESULTS The distances of the tooth movement on the experimental side were significantly greater than those on the sham sides at T1. Root resorption was observed around the area of hyalinization at T4. H. the velocity at T1-2 was significantly slower than that at T0-1 and T2-4. and T8. periodontal ligament. Hyalinization of PDL was observed only at T1. Undermining resorption disappeared. On the sham side. in the bone marrow cavities.448. and T4. T2. On the sham sides. AB. undermining resorption was significant at T1. On the experimental side. undermining resorption with hyalinization of the PDL was observed on the alveolar wall only at T1 (Figs 7 and 8). Tooth movement increased almost linearly from T0 to T4 on the experimental side. Other abbreviations are shown in Fig 5. T2. and T8. There was no significant difference in movement velocity between T1-2 and T2-4 on the experimental side. On the alveolar wall. and direct bone resorption progressed at T8. and direct resorption progressed at T2. T4. There was a significant difference between the experimental and sham sides at T0-1 and T1-2. Light microscopic observation was carried out on the compression side of the P3 mesial root in the experimental and sham sides at T1. . tooth root. respectively. undermining resorption with hyalinization of the PDL also occurred on the alveolar wall at T1. The movement velocity on the experimental side was also faster than that on the sham side throughout the experiment (Fig 6). and it was more striking at T8 (arrows in Fig 8). T2. PDL. Undermining resorption disappeared. All photographs are at same scale. tooth movement stopped from T1 to T2. Framed areas of T1 are magnified in Fig 8. approximately double those on the sham side. and T4 (Fig 5). Microphotographs of periodontal tissue on experimental side with haematoxylin and eosin stain. On the sham side. T4. the numbers of TRAP cells increased from T1 on the experimental side (Fig 10). undermining resorption was found at T2. but the distances increased from T0 to T1 and from T2 to T4.e4 Iino et al American Journal of Orthodontics and Dentofacial Orthopedics April 2007 Fig 7.15 Their numbers were counted from 3 midsagittal sections per case in the experimental and sham sides at T1. T2. so histological observations were performed from the alveolar crest to halfway apically at the compression side. The timing of TRAP cell increase (increasing bone turnover) and decrease (decreasing bone turnover) was observed on the alveolar wall and in the bone marrow cavities. No root resorption was observed at any time point after corticotomy. In the bone marrow cavities.

acceleration. and the lag . Arrowheads show root resorption. Microphotographs of periodontal tissue on sham side with haematoxylin and eosin stain. Microphotographs of A. DISCUSSION The average distance of tooth movement by an orthodontic force of 0. and this value is similar to that in a previous dog study. All photographs are at same scale. Therefore.5 N on the sham side in this study was 1 mm in 4 weeks. the numbers increased at T2 and decreased at T4 on the sham side. it is suggested that orthodontic tooth movement increased especially in the early stage after the corticotomies. Number 4 Iino et al 448. and T4 compared with the sham side. and its duration is never longer than 7 days. lag. tooth movement velocity on the experimental side was significantly faster than on the sham side at T0-1 and T1-2: 2 and 5 times faster on the experimental side. TRAP cells seemed to work vigorously at an early time on the experimental side (Figs 10 and 11).e5 Fig 8. and constant linear phases. T2. Thus. the numbers of TRAP cells decreased at T2 on the experimental side (Fig 9). Fig 9. hyalinization of PDL and B.16. Hyalinization of PDL was observed at T1. and T4. Photographs are at same scale. respectively. In the bone marrow cavities.16 The distance was approximately double on the experimental side at T1. Abbreviations are shown in Fig 7. Time-displacement curves of orthodontic tooth movement are divided and sequenced into 4 phases: initial. undermining resorption in Fig 7 at T1.17 The initial phase (rate of tooth movement: about the distance of PDL thickness) lasts 3 to 4 days or less.American Journal of Orthodontics and Dentofacial Orthopedics Volume 131. Moreover. T2. the numbers increased gradually during the experiment on the sham side. Timing of increase and decrease of TRAP cells seemed to be hastened on the experimental side.

Timing of increase and decrease of numbers of TRAP cells on alveolar wall and in bone marrow cavities. Abbreviations are shown in Fig 5.) and sham sides with TRAP stain at 1 week after corticotomy.e6 Iino et al American Journal of Orthodontics and Dentofacial Orthopedics April 2007 Fig 10. .448. Photographs are at same scale. Microphotographs of periodontal tissue on experimental (Exp. . Fig 11. There are many TRAP cells (arrowheads) in experimental side. Abbreviations are shown in Fig 7. ●. Number of TRAP cells in each tooth. mean value of number of TRAP cells at each time point.

Therefore. we considered that orthodontic tooth movement after the corticotomy increased by an acceleration of bone turnover accompanied by the surgery of the corticotomy and raising of the gingival mucoperiosteal flaps. but it was observed on the sham side at T4 and T8. on the compression side. 3. tooth movement velocity was also quite slow at T1-2 (mean. therefore.21. osteoclasts appear in the adjacent bone marrow cavities and begin attacking the underside of the bone adjacent to the area of hyalinization. the side without a corticotomy in this study might not be really a sham for the corticotomy in a strict sense. tooth movement velocity at T0-1 was still faster than that at T1-2 and T2-4 on the experimental side. However. root resorption was not observed on the experimental side. hyalinization of the PDL was eliminated at an early stage on the experimental side.26 Also.1. However. The surgical orthodontic approach to the treatment of dentofacial deformities.10 Therefore.18.American Journal of Orthodontics and Dentofacial Orthopedics Volume 131. In our study. 2000. It would have been interesting to investigate the alveolar bone reaction in the osteotomy gaps.1 mm per week).e7 phase (rate: quite small) lasts for an average of about 7 days. Converse JM. We thank Masanori Uemura and Tetsuya Matsuguchi for their generous guidance and Abdullah Al-Kalaly for his help with the English language. whereas it was found at T1. Horwitz SL. there was no observable lag phase on the experimental side. and that the efficiency of tooth movement might be improved by preventing hyalinization.23 Tooth movement in juveniles was faster than that in adults at an early phase. Thus. Köle H. Almost no TRAP cells were found on the alveolar bone of sections from dogs examined in our other previous study (data not shown). hyalinization of the PDL at the compression side was observed only at T1 on the experimental side.16-20 Hyalinization of the PDL precedes the root resorption process during orthodontic tooth movement and can often be observed adjacent to this process. The initial phase was interpreted as the initial movement of a tooth in its socket. Perhaps the effects of simple surgeries on orthodontic tooth movement and dysfunction after corticotomy should be studied.6. REFERENCES 1. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1959. possibly by acceleration of the bone turnover mechanism at an early stage after a corticotomy. a more simple surgery such as gingival mucoperiosteal incision or bone perforation4. 0. T1-2 could be considered the lag phase.7 However.5 might be used instead of a corticotomy.16 On the sham side. TRAP cells of the experimental side seemed to work vigorously at an early time on the alveolar wall and in the bone marrow cavities. the alveolar bone reaction increased simultaneously with orthodontic tooth movement near the corticotomy by RAP at an early stage. Number 4 Iino et al 448. by the orthodontic force. The influence of accelerated osteogenic response on mandibular decrowding (thesis).55: 217-43. because no significant difference existed in tooth movement velocity between T1-2 and T2-4. Surgical operation on the alveolar ridge to correct occlusal abnormalities. This process might be brought about by the rapid alveolar bone reaction in the bone marrow cavities. and this might be due to the disappearance of the lag phase as evident by less hyalinization of the PDL in the early stage.25 Bone healing is accelerated by RAP after surgery. Several authors proposed that the lag phase is associated with hyalinization in the PDL. Wilcko et al4 mentioned that bleeding of the corticotomy site is more important than creating blocks of bone for rapid tooth movement. it is generally believed that a heavier orthodontic force is needed for the en-masse movement of the bone block with the tooth after a corticotomy. a problem that could arise from the surgical procedure might be dysfunction accompanied by pain or swelling immediately after the corticotomy. These results suggested that tooth movement after corticotomy increased without root resorption. and T4 on the sham side. leading to less hyalinization of the PDL on the alveolar wall.12:515-29. our results suggest that conventional orthodontic force would increase the velocity of orthodontic tooth movement. St Louis: St Louis University. no alveolar bone reaction in the osteotomy gaps was observed in this study. Am J Orthod 1969. . When hyalinization of the PDL occurs. CONCLUSIONS The alveolar corticotomy procedure increases orthodontic tooth movement for at least 2 weeks after the corticotomy and decreases the risk of root resorption. T2. Alveolar bone turnover of the mandible is accelerated by the raising of the gingival mucoperiosteal flap per se. However. On the other hand. because the thickness of the PDL is reduced on the compression side by the orthodontic force. Furthermore. Furthermore.7 New bone formed in the trabecular bone adjacent to the incision site was caused by increasing bone turnover in rabbits.2. after the corticotomies in our study.24 because mediator levels in juveniles were more responsive than those in adults in early tooth movement. Hajji SS. 2. Clinically.22 In our study.16 The increase of tooth movement velocity at T0-1 on the experimental side would be due to compression of the PDL and bare spongiose bone and.

Pilion JJGM. Am J Orthod 1984. In: Rudolph P. Eur J Orthod 1993.6:155-63. Time-dependent mechanical behavior of the periodontal ligament. King GJ.4:197-205.Part I: regulation of bone volume and the regional acceleratory phenomenon in normal bone.120:466-76. 8. Brudvik P. Rygh P. 12. Int J Periodontics Restorative Dent 2001. 10. 21.15:249-63. 16. In: Hosl E.29:757-62. Suya H.21:9-19. J Periodontol 1994. Wilcko WM. Bouquot JE. Corticotomy-assisted orthodontics. 22. KuijpersJagtman AM. Rapid orthodontics with alveolar reshaping: two case reports of decrowding. Hwang HS. J Orthop Res 1993. Age effect on orthodontic tooth movement in rats. Owman-Moll P. Baldauf A. Gu G. Leeuwen EJ. Part I. J Dent Res 2003.35:331-9. Maltha JC. 6.68:161-5. 20. King GJ. 25. Ren Y. Osteoclast clearance from periodontal tissues during orthodontic tooth movement. Von den Hoff JW.92:334-43. Hyalinization and root resorption during early orthodontic tooth movement in adolescents. 19. Verna C. Ren Y. World J Orthod 2003. J Clin Periodontol 2002. Maltha JC. Wilcko MT. Lee KH. Biomechanics and mechanics. . Kurol J. Gschwend N. 296-361. Am J Orthod Dentofacial Orthop 2004. 18. An overview for clinicians. Rapid orthodontic decrowding with alveolar augmentation: case report. Maltha JC.110:16-23.85:424-30. editor. Wilcko WM. 1991. Rahn B. Bogoch E. Angle Orthod 1998. Focal hyalinization during experimental tooth movement in beagle dogs. 11. The initial phase of orthodontic root resorption incident to local compression of periodontal ligament.11:285-91. Acta Odont Scand 1947. Leeuwen EJ. and lactating rats.248:283-93. Goldie RS.6:115-44.214:497-504. Intrusion of overerupted molars by corticotomy and magnets.65:79-83.107:468-74. Reitan K. Root resorption and tooth movement in orthodontically treated. Von den Hoff JW. 15. Ferguson DJ. Kuijpers-Jagtman AM. Binderman I. editors. Ko SJ. St Louis: Mosby. Continuous bodily tooth movement and its histological significance. Kuijpers-Jagtman AM. Am J Orthod Dentofacial Orthop 2001. Wilcko MT. Corticotomy in orthodontics. Melsen B. Hoff JW. Verna C. J Clin Orthod 2001. 9. Kuijpers-Jagtman AM. Bohl MV. p. Tissue reaction to orthodontic tooth movement in different bone turnover conditions. 13. Chung KR. Melsen B. calcium-deficient. Cytokine levels in crevicular fluid are less responsive to orthodontic force in adults than in juveniles. 5. Eur J Oral Sci 1999.82:38-42. Von den Hoff JW. Proc Inst Mech Eng 2000. Ferguson DJ. Maltha JC. Heidelberg. Am J Orthod Dentofacial Orthop 2001. p. Moran E.125: 615-23. Bohl MV. 14. Driel WD. Lilja E. 17. Maltha JC. Proffit WR. Frost HM. Eur J Orthod 2000. Oh MY. Noxon SJ.448. 2000. Kuijpers-Jagtman AM. 26. Contemporary orthodontics. Scand J Dent Res 1984. Orthod Craniofac Res 2003. Am J Orthod Dentofacial Orthop 1996. Bouquot JE. Kuijpers-Jagtman AM.e8 Iino et al American Journal of Orthodontics and Dentofacial Orthopedics April 2007 4. 7. Regional accelerated phenomenon in the mandible following mucoperiosteal flap surgery. Huang G. 207-26. Clin Orthop Related Res 1989. Scanning electron microscopic study of orthodontically induced injuries to the periodontal membrane. Yaffe A. Maltha JC. Fine N. Dalstra M. Perren S. Mechanical and biological basics in orthodontic therapy. 120:209-15. The rate and the type of orthodontic tooth movement is influenced by bone turnover in a rat model. Lindskog S.22:343-52. Magnitude of orthodontic forces and rate of bodily tooth movement: an experimental study in beagle dogs. Healing of cancellous bone osteotomy in rabbits . Germany: Huthig Buch Verlag. 24. 23. Ding Z. The biology of fracture healing. Tooth movement with light continuous and discontinuous forces in beagle dogs.