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Dental Research Journal

Original Article
The effect of buccal corticotomy on accelerating orthodontic tooth
movement of maxillary canine
Mohammad Reza Jahanbakhshi1, Ali Mohammad Kalantar Motamedi1, Masoud Feizbakhsh1, Ahmad Mogharehabed2
Department of Orthodontics, School of Dentistry, Islamic Azad University, Isfahan (Khorasgan) Branch, 2Dental Implant Research Center and
1

Department of Periodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran

ABSTRACT
Background: Selective alveolar corticotomy is defined as an intentional injury to cortical bone.
This technique is an effective means of accelerating orthodontic tooth movement. The aim of this
study is to evaluate the effect of buccal corticotomy in accelerating maxillary canine retraction.
Materials and Methods: The sample in this clinical trial study consisted of 15 adult female
patients with therapeutic need for extraction of maxillary first premolars and maximum canine
retraction. By use of split‑mouth design, at the time of premolars extraction, buccal corticotomy
was performed around the maxillary first premolar, randomly on one side of maxilla, and the other
side was reserved as the control side. Canine retraction was performed by use of friction – less
mechanic with simple vertical loop. Every 2 weeks, distance between canines and second premolars
was measured until complete space closure.The velocity of space closure was calculated to evaluate
Received: June 2015
Accepted: March 2016 the effect of this technique in accelerating orthodontic tooth movement. The obtained data were
statistically analyzed using independent t‑test, and the significance was set at 0.05.
Address for correspondence: Results: The rate of canine retraction was significantly higher on the corticotomy side than the
Dr. Ali Mohammad
Kalantar Motamedi,
control side by an average of 1.8 mm/month versus 1.1 mm/month in the corticotomy side and
Department of control side, respectively (P < 0.001).
Orthodontics, School of Conclusion: Based on result of this study, corticotomy can accelerates the rate of orthodontic
Dentistry, Islamic tooth movement about two times faster than conventional orthodontics and it is significant in
Azad University,
Isfahan (Khorasgan)
early stages after surgical porsedure. Therefore Buccal corticotomy is a useful adjunct technique
Branch, Isfahan, Iran. for accelerating orthodontic tooth movement.
E‑mail: drmotamedi@
khuisf.ac.ir Key Words: Accelerated, orthodontics, buccal, cortex, surgerycorticotomy, tooth movement

INTRODUCTION damage. There is a reduced chance of root

resorption  [3], enamel decalcification, and better patient
Changed lifestyles and patient awareness have cooperation when treatment time is shortened.[4]
increased the demand for adult orthodontic
Therefore, researchers have increasingly sought
treatment.[1] Adult patients are more susceptible to
and eager for finding ways to shorten orthodontic
periodontal complications.[2]
treatment time.
In addition, prolonged treatment time is one of the
This is an open access article distributed under the terms of the Creative
definite risk factors of root resorption and periodontal Commons Attribution-NonCommercial-ShareAlike 3.0 License, which
allows others to remix, tweak, and build upon the work non-commercially,
Access this article online as long as the author is credited and the new creations are licensed under
the identical terms.

For reprints contact: [email protected]

Website: www.drj.ir
www.drjjournal.net
www.ncbi.nlm.nih.gov/pmc/journals/1480 How to cite this article: Jahanbakhshi MR, Motamedi AM, Feizbakhsh
M, Mogharehabed A. The effect of buccal corticotomy on accelerating
orthodontic tooth movement of maxillary canine. Dent Res J 2016;13:303-8.

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Jahanbakhshi, et al.: Buccal corticotomy and orthodontic tooth movement

Several approaches have proposed for accelerating and lingual side of the alveolar bone. This evaluation
orthodontic tooth movement. These approaches can showed that rapid orthodontic tooth movement was
be summarized into three major groups:[5,6] apparent following the application of orthodontic
• Biologic approaches or local administration of force after corticotomy.
chemicals Another study by Iino et al.[14] on 12 beagle dogs
• Physical or mechanical stimulation of the alveolar protracted premolars after corticotomy. Their results
bone, such as the use of lasers, piezoelectric, direct showed an increase in velocity of orthodontic tooth
electrical current, or magnets movement.
• Surgical approaches including dental distraction
and alveolar corticotomies. Numerous studies have confirmed the usefulness
of the corticotomy to accelerate orthodontic tooth
Among these approaches, the method of orthodontic movements. However, most studies have been
treatment using corticotomies has recently become conducted on animals.
popularized[2] which uses bone healing mechanisms
in combination with orthodontic loads to accelerate There are some differences in bone metabolism rate
orthodontic tooth movement and thereby decrease between species and even between individuals of
treatment time. Bryan was the first researcher who the same species. This difference can be considered
introduced some surgical approaches based on as a confounding factor. Therefore, in this study, we
osteotomy to accelerate orthodontic treatment in decided to evaluate the effect of buccal corticotomy
Guilford textbook.[7] However, it was Henrich Kole’s to accelerate orthodontic tooth movement in human
publication in 1959[8] that reintroduced a combination samples. Based on a random manner in each patient,
of osteotomy and corticotomy for reducing the maxillary canine on one side was considered as
orthodontic treatment time. Kole believed that the the intervention side and the other side as the control
continuity of cortical bone offered the most resistance side. Thus, the effect of confounding factor such as
to tooth movement. His surgical intervention was different turnover rate is eliminated. Our surgery was
accomplished by creating separated bony blocks applied only on buccal cortical plate; therefore, in
with vertical buccal and lingual corticotomies and a case of a positive result, we would be able to achieve
supra‑apical horizontal osteotomy connecting mesial the desired result by a more conservative procedure.
and distal cuts and postulated this theory as “bony In another investigation, Aboul‑Ela et al.[15] evaluated
block movement.” the rate of tooth movement after application of
On the other hand, Wilcko et al.[9‑11] stated that rapid corticotomy. They concluded that the rate of tooth
orthodontics with corticotomies is not because of movement in the first and second months had
creating bony blocks but is attributed to increasing bone increased 2 times, and the third and fourth months,
turnover and decreasing bone density. His suggestion 1.6 times comparing to the control side.
was based on Harold Frost’s investigation.[12] Frost Al‑Naoum et al.[16] evaluated effect of corticotomy
found a direct correlation between the severity of to accelerate orthodontic space closure after first
bone corticotomy and/or osteotomy and the magnitude maxillary premolar extraction in thirty patients.
of the physiologic bone healing response, leading to Velocity of canine movement in the intervention side
accelerated bone turnover at the surgical site. This was in the 1st and 2nd  weeks after corticotomy was as
called “Regional Acceleratory Phenomenon”  (RAP). 4 times as the control side, and between the 2–4th and
RAP was explained as a transient stage of localized 8–12th weeks, it was almost 3 times.
tissue remodeling that resulted in healing of the
injured bone, through recruitment of osteoclasts and MATERIALS AND METHODS
osteoblasts.
This study is a clinical trial with
According to Hajji et al.,[3] to resolve crowding in
IRCT2013082014415N1 registration code. The sample
mandibular arch, orthodontic treatment times in
consisted of 15 adult female patients (mean age,
patients with corticotomies were 3–4 times shorter
25  years) requiring therapeutic extraction of the first
compared to those of patients without corticotomies.
maxillary premolars. These volunteers were selected
Cho et al.[13] in a study conducted on two beagle from patients who referred to the Department of
dogs applied corticotomy intervention on the buccal Orthodontics of Isfahan Azad University. Samples

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Jahanbakhshi, et al.: Buccal corticotomy and orthodontic tooth movement

with certain systemic diseases, using certain and installed. Force magnitude of retractors was
administrated drugs, previous orthodontic treatment, checked (in situ) and calibrated with a gram force
advanced or active periodontal disease, and poor oral gauge  (Correx, Dentaurum, Springen, Germany) to
hygiene were excluded from the study. This study was deliver approximately 200  g force in each side every
performed by using split mouth design method. In a 2  weeks and as long as canines reached the vicinity
randomized manner, one side of the maxillary arch of the second premolars. These retractors were
on which corticotomy was applied was considered activated in each session (due to increased velocity of
as the experimental group, and the other side without tooth movement almost 2–3 times after corticotomy
surgical intervention was considered as the control 2  times activations per month seems logical).[17]
group. All patients were completely informed of the Using a compass and a caliper, the distance between
procedure and signed an informed consent. Since the canine and second premolar was measured on
the split‑mouth design was applied, the experimental each side, and the traveled distance was divided by
and control groups were the same and they were the time of treatment, to specify the rate of tooth
completely matched in the terms of age, sex, etc. movement. Then, by comparing complete canine
All patients were treated with standard fixed appliances, retraction time and by determination of movement
with 0.018  ×  0.022 slot brackets  (Equilibrium, velocity, the influence of this technique on reducing
Dentaurum, Springen, Germany). the treatment time was assessed. These measurements
were considered an indicator of canine retraction
To enhance posterior segment anchorage in all speed taking into account that the anchor segment
patients, strap up was extended to the second molar. was almost immobilized.
The anchorage segment was additionally stabilized by
use of a miniscrew on buccal segment between the Statistical analysis was conducted using SPSS
first and second molar, tying second premolar to the version  20. Kolmogorov–Smirnov and paired‑sample
screw. t‑tests were employed to evaluate inter‑group
differences (with α set at 0.05).
After initial segmental leveling and alignment, one
maxillary quadrant was randomly assigned to have RESULTS
corticotomy procedure. After administration of local
anesthesia, by application of a sulcular incision and According to evaluation of velocity of tooth movement
two vertical releasing incisions, a mucoperiosteal in two groups in the 1st, 2nd, 3rd, and 4th months and
flap was reflected in the buccal side from distal whole assessment time  (because the average time to
surface of the canine to the mesial surface of the complete canine retraction was about 4 months, the total
second premolar. Two millimeters of marginal crestal duration of the study was 4 months and comparing the
bone held intact and using a high‑speed drill and a monthly rate of tooth movement was included in the
number 2 round bur  (1  mm in diameter) vertical study to find out how long the effect of corticotomy in
groove with depth of 0.5–1  mm and a length of accelerating tooth movement is statistically significant),
approximately 1 cm in the distal surface of canine the following results were observed.
tooth and a similiar groove in the mesial surface of
the second premolar were created only on cortical Average velocity of maxillary canine retraction in the
bone. In addition, 10 small holes in the cortical bone 1st  month in the experimental group was significantly
overlying the first premolar were created. The surgical higher than the control group  (2.2  mm/month vs.
site was rinsed, and the flap was repositioned and 1 mm/month), (P < 0.0001) [Table 1].
sutured. The opposite side served as the control side, Average velocity of maxillary canine retraction in the
without flaps or corticotomies. 2nd month in the experimental group was significantly
At the same session, the first maxillary premolars in higher than the control group (2  mm/month vs.
both sides were extracted. 1.1  mm per month) and was significantly higher
(P < 0.001) [Table 1].
Two weeks after surgery, the patients were met to
install fixed sectional canine retractors on both sides. Average velocity of maxillary canine retraction in the
Using 0.016  ×  0.016 steel wires  (Orthotechnology, 3rd  month in the experimental group was significantly
Florida, USA), for both sides, similar canine higher than the control group  (1.8  mm/month vs.
retractors  (simple open vertical loop) were made 1.2 mm/month) (P < 0.001) [Table 1].

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Jahanbakhshi, et al.: Buccal corticotomy and orthodontic tooth movement

Average velocity of maxillary canine retraction in the Table 1: Average velocity of tooth movement in two
4th  month in the experimental group was significantly groups in the first, second, third, and fourth months
higher than the control group  (1.4  mm/month vs. Times Group Mean±SD P
1.1 mm/month) (P < 0.001) [Table 1]. First month Control 1±0.13 <0.000
Experimental 2.2±0.32 <0.000
The measurements showed a significant difference Second month Control 1.1±0.23 <0.000
in the velocity of tooth movement between the Experimental 2±0.15 <0.000
experimental and the control groups.  (Averages of Third month Control 1.2±0.25 <0.000
1.8 mm/month vs. 1.1 mm/month) [Table 2]. Experimental 1.8±0.22 <0.000
Fourth month Control 1.1±0.12 <0.000
DISCUSSION Experimental 1.4±0.19 <0.000
SD: Standard deviation

This randomized controlled trial was established to

investigate the effect of buccal corticotomy on tooth Table 2: Average velocity of tooth movement in
movement in comparison with the conventional control and experimental group
orthodontic technique. It was assumed that if Groups Mean±SD P
corticotomy be applied only on the buccal side, Control 1.1±7.39 <0.000
instead of both the buccal and palatal cortical plates, Experimental 1.8±0.17 <0.000

orthodontic forces in conjunction with the corticotomy SD: Standard deviation

procedures will still produce substantially greater

The findings of this study are consistent with the
maxillary canine movement velocity than orthodontic
findings of Iino et al.,[14] Wilcko et al.,[2] and Ren
forces alone.
et al.,[18] which have reported the increase rate of
Compared to osteotomy and two‑sided corticotomy, corticotomy speed by 2–3 times.
this single‑side approach creates less discomfort for
The results of the study by Lee et al.[19] showed that
the patient, and the surgeon also spends less treatment
on contrary to the initial hypothesis, based on the
time. The results of this study show that buccal
need to create a separate block of bone to accelerate
corticotomy alone could accelerate orthodontic canine
orthodontic tooth movement, corticotomy without
movement significantly.
need for creating blocks of bone, and only reliance on
In one study, Aboul‑Ela et al.[15] concluded that the regional acceleration phenomenon, increases the rate
rate of tooth movement in the 1st and 2nd months of tooth movement, . Moreover, they stated that even
accelerated by 2 times and in the 3rd month increased orthodontic tooth movement alone can initiate local
by 1.6  times which was in agree with our findings acceleration phenomenon, which corticotomy will
but in the 4th month, the velocity of tooth movement intensify the phenomenon. Since orthodontic tooth
accelerated by 1.04  times, which was not statistically movement was done on both sides, the difference in
significant, and was not in agree with the present velocity between the two sides is merely related to
study. The reason may be that although in the study the role of corticotomy, and this does not prejudice
of Aboul‑Ela et al.,[15] as with   the present study, the results of our study.
corticotomy was applied only on the buccal cortex;
In a recent investigation, Aboul‑Ela et al.[15] found
however, unlike the recent study, they did not make
no significant molar anchorage loss during canine
a vertical incision in the cortical bone and just made
retraction on either the corticotomy or the control
some perforations on the cortical bone. Probably,
side. They had used mini implants for anchorage on
it can explain the shorter duration of the local
both sides.
acceleration phenomenon in that study. This issue
is in agree with Harold Frost that observed a direct Cho et al.[13] have reported an acceleration of speed
correlation between the amount of injury with the as 4  times in upper jaw of two beagle dogs. The
intensity of physiological healing response, which reason for this more acceleration than the recent study
he named regional accelerated phenomena  (RAP). can be referring to two definite differences existing
RAP does not offers new healing processes but rather between the two studies. First, they had employed
explains the acceleration of normal healing events; animal models. It has been found that dog bone in
the greater the insult, the more accelerated regional terms of composition and density is most similar to
healing response. human bone. However, in terms of metabolism and

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Jahanbakhshi, et al.: Buccal corticotomy and orthodontic tooth movement

iliac bone formation rate, the speed is 2 times faster CONCLUSION

than humans. Further, the duration of a single cycle
remodeling for dog is almost 42% faster than humans. Selective alveolar corticotomy only on the buccal
maxillary cortex can significantly increase the rate
Second, they had done corticotomy on both the buccal
of orthodontic canine retraction, and it is probably a
and lingual sides, which may be responsible for more
useful adjunct to shorten treatment time. It is perhaps
accelerating of tooth movement.
due to regional accelerated phenomenon that accrue
Our findings are consistent with the Sanjideh et al.[20] after surgical procedure and results in increased bone
research which represents an 85% greater amount of turn over and decrease bone density
tooth movement in the corticotomy sides than the
control ones. Financial support and sponsorship
Nil.
Ferguson[21] in a human study have reported that using
corticotomy, mandibular crowding has been resolved Conflicts of interest
four times faster. The more acceleration in tooth The authors of this manuscript declare that they have
movement compared to our study probably relates no conflicts of interest, real or perceived, financial or
to the type of tooth movement examined in the two non‑financial in this article.
studies. In that study, no tooth has been extracted, so
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