Yavuz et al.

Progress in Orthodontics (2018) 19:44

https://doi.org/10.1186/s40510-018-0244-y

RESEARCH Open Access

Comparison of piezocision and discision

methods in orthodontic treatment
Mustafa Cihan Yavuz1, Oguzhan Sunar2, Suleyman Kutalmış Buyuk3* and Alpdogan Kantarcı4

Abstract
Background: Discision method may provide an alternative to the piezocision approach in accelerated orthodontic
treatment. The purpose of this study was to investigate the efficacy of discision on accelerated orthodontic tooth
movement in comparison to the piezocision method in moderate crowding Angle Class I malocclusions.
Methods: Thirty-five female individuals were included in this clinical study. The participants were classified into
three groups as conventional fixed non-extraction orthodontic treatment only (OT, n = 14), piezocision in addition
to fixed non-extraction orthodontic treatment (PG, n = 9), and discision in addition to fixed non-extraction
orthodontic treatment (DG, n = 12). The piezocisions and discisions were performed 1 week after placement
of bonding brackets. The patients were seen at 2–3 week-intervals. Initial Little’s irregularity index scores were
recorded from dental casts. Periodontal parameters were measured initially, after the 1-month orthodontic
treatment. Probing pocket depth, bleeding on probing, plaque index, and gingival index were recorded. Visual
analog scale (VAS) was performed over the first month at different times following the bracket bonding for
pain assessment. The total orthodontic treatment duration was noted.
Results: The duration of orthodontic treatment was statistically decreased in PG and DG compared to OT
(P = 0.003). There was no statistical difference between PG and DG in orthodontic treatment duration (P > 0.05). There
was no statistical difference between the two experimental groups in terms of VAS and periodontal parameter values
(P > 0.05).
Conclusions: This is the first clinical orthodontic study to assess the effect of discision on the rate of orthodontic tooth
movement. Discision is comparable to piezocision in terms of tooth movement acceleration, pain level, and periodontal
status. The discision seems to be effective in reducing the time of orthodontic treatment.
Keywords: Accelerated orthodontics, Piezocision, Discision, Orthodontic treatment

Background surgery with full-thickness flaps to create cortical per-

The duration of orthodontic treatment may vary ac- forations in both buccal and palatal regions as a bony
cording to the severity of the case [1]. Decreasing the block [7, 8]. The “bony block” approach led to the
average 24-month treatment time has become an im- concept of a healing process named as regional accel-
portant area for clinicians and researchers [2, 3]. Dur- eratory phenomenon (RAP) due to a reduction in bone
ing the last decade, several strategies for accelerating density and increased bone turnover after surgical
the orthodontic treatment have been proposed. These wounding of the bone [9]. RAP is a transient condition
included chemical agents, physical stimulants, and and does not cause permanent damage to the bones
surgical procedures [4–6]. Surgical selective decortica- [10]. However, the original bony block and later-devel-
tion of the alveolar bone to shorten the duration of oped selective alveolar decortication approaches are
orthodontic treatment has been used since the 1950s invasive strategies posing an increased risk for root re-
[7]. Initially, corticotomy was performed by open sorption and dental problems. Therefore, there is an
increased desire to implement less invasive methods
* Correspondence: [email protected] such as micro-osteoperforation and piezocision to
3
Department of Orthodontics, Faculty of Dentistry, Ordu University, Ordu,
Turkey achieve rapid orthodontic tooth movement [11–13].
Full list of author information is available at the end of the article

© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made.
Yavuz et al. Progress in Orthodontics (2018) 19:44 Page 2 of 7

Piezocision approach has been the most studied, min- discision in addition to fixed orthodontic treatment (DG;
imally invasive surgical technique in accelerated ortho- n = 12; aged 13 to 18 years). Before the orthodontic
dontic treatment [14]. Recently, the computer-guided treatment, panoramic radiographs, lateral cephalometric
piezocision technique was introduced as a non-invasive radiographs, intra- and extra-oral photographs, and
and safe technique to accelerate the orthodontic move- maxillary and mandibular dental casts were taken. Peri-
ment [15, 16]. However, the microvibration sound of the odontal parameters were measured initially, after the
piezo tips may cause discomfort in some patients. As 1-month orthodontic treatment. Probing pocket depth,
there is a certain thickness of the piezosurgery knife, bleeding on probing, plaque index, and gingival index
there are also limited indications for use around very were recorded. The study sample size was calculated by
close-proximity roots. In addition, piezocision surgery using G*Power Software version 3.1.9.2 (Universität
involves the use of a device designed to perform opera- Düsseldorf, Germany) for a reduction of the total ortho-
tions on bones and is successfully used in surgical treat- dontic treatment duration with a power of 85% at the
ments; however, the availability of this device in clinics 5% significance level [13].
where only orthodontic patients are treated may be not All individuals were treated with 0.022-in. slot Roth pre-
available for orthodontists making it impractical in daily scription self-ligated brackets. The order of orthodontic
orthodontic treatments [12, 15]. arch wires was as follows: 0.014-in., 0.016-in., 0.018-in.,
The discision method may provide an alternative to 0.016 × 0.022-in., 0.017 × 0.025-in. nickel-titanium arch
the piezocision approach. The technique has been re- wires were utilised for tooth alignment, and 0.019 ×
cently used successfully in an adolescent patient who 0.025-in. stainless-steel arch wires were utilised for finish-
had moderate crowding in both arches [17] and involves ing stage in groups. The patients were seen at 2–3 week--
the use of a disc saw bur attached to a micromotor de- intervals. The intraoral elastics were used if necessary.
vice, which is commonly used for arranging or cutting The orthodontic treatment was completed when adequate
the ridge crest in dental implant surgery. Disc saws can criteria were provided. Fixed and removable retainers were
be more ergonomic and economical than piezosurgery placed at the end of the orthodontic treatment. The total
devices. Therefore, the purpose of this clinical study was orthodontic treatment duration was noted. Initial Little’s
to investigate the efficacy of discision method on accel- irregularity index scores were performed with a digital cal-
erated orthodontic tooth movement in comparison to liper (Mitutoyo, Tokyo, Japan) on dental stone models. In
the piezocision method. We tested the hypothesis that PG and DG groups, piezocision and discision procedures
there will be similar effects of these two methods on were performed on both dental arches 1 week after place-
orthodontic treatment duration due to similar osteo- ment of bonding brackets.
genic impact on moderate crowding orthodontic cases. Visual analog scale (VAS) was performed over the
first month at different times following the bracket
Methods bonding. Lateral cephalometric skeletal and dental
This study was planned as a single-center clinical trial. measurements were measured on digital radiographs.
The study procedures were approved by the Clinic Root resorptions were identified and classified on fin-
Research Ethics Local Commission of Ordu University ishing radiographs.
(2018/24). The patients and their parents signed an in-
formed consent form describing the procedures in detail.
The inclusion criteria were as follows: (1) requiring fixed Piezocision procedure
non-extraction orthodontic treatment, (2) full perman- Following local anaesthesia, vertical micro-incisions were
ent dentition except third molar, (3) good oral hygiene, performed to correspond to the centre of each inter-
(4) no smoking, (5) no radiographic alveolar bone loss, dental papilla and starting from 1 mm below the free
(6) Class I malocclusion with moderate or severe crowd- gingival groove and passing the mucogingival line. All
ing in both arches, (7) no systemic disease, and (8) no piezocision procedures were performed starting from
previous orthodontic and orthognathic surgery teeth number 6 in both sides of the mandibular and
treatment. maxillary arch. Vertical corticotomies were performed
Thirty-five female individuals were selected at the with a piezoelectric knife (Mectron Piezosurgery Device,
Department of Orthodontics, Faculty of Dentistry, Ordu Mectron, Genova, Italy) approximately 7 mm in length
University, Turkey. The participants were classified into and 3 mm in depth. There was no need for suturing the
three following groups: (1) patients who will receive con- incision lines; all piezocision procedures were done flap-
ventional fixed orthodontic treatment (OT; n = 14; aged less. Irrigation was used in piezocision procedure. No
13 to 19 years), (2) patients who will receive piezocision hard or soft tissue grafts were applied to the vestibular
in addition to fixed orthodontic treatment (PG; n = 9; region of the teeth. The patients were advised to take
aged 13 to 18 years), and (3) patients who will receive analgesics such as paracetamol if necessary.
Yavuz et al. Progress in Orthodontics (2018) 19:44 Page 3 of 7

Fig. 1 a Intraoral discision application. b Discision post-operative view

Discision procedure PG and DG groups are shown in Tables 4 and 5. There

The disc incision protocol was performed as defined was no statistical difference between the two experimen-
[17]. Following local anaesthesia, vertical micro-incisions tal groups in terms of VAS values (P > 0.05).
were performed to correspond to the centre of each The orthodontic treatment durations of all groups are
interdental papilla and starting at 1 mm below the free shown in Table 6. The duration of orthodontic treatment
gingival groove and crossing the mucogingival line. Ver- was statistically decreased in PG and DG compared to
tical corticotomies were then performed with a disc saw OT (P = 0.003). There was no statistical difference be-
(Osstem Implant, Esset KIT-Saw, Seoul, Korea) approxi- tween PG and DG in orthodontic treatment duration
mately 7 mm in length and 3 mm in depth. There was (P > 0.05).
no need for flap elevation or suturing (Fig. 1). Also, irri-
gation was used in discision procedure. The patients Discussion
were advised to take analgesics such as paracetamol if In this study, we compared the efficacy of the discision
necessary. method to the piezocision in accelerating the orthodon-
tic tooth movement. Both methods significantly en-
Statistical analyses hanced the rate of orthodontic treatment compared to
All data parameters were statistically analysed by the conventional approach with no significant difference
using the SPSS (SPSS for Windows version 20.0; SPSS between them suggesting that discision approach could
Inc., Chicago, IL) program. After performing the nor- be a cheaper alternative to the piezocision in rapid
mal distribution test, parametric tests were performed orthodontics.
to the parameters having a normal distribution, while Various factors can affect the quality and rate of ortho-
non-parametric tests were performed to the parame- dontic tooth movement [18]. Age [19], sex hormones
ters with non-normal distributions. The Shapiro-Wilk [20], and occlusal forces [21] can alter the speed of tooth
test was performed to test the data for normal distri- movement by affecting bone density and remodelling.
bution. The data were analysed by using one-way ana- Alikhani et al. [18] stated the gender distribution as an
lysis of variance, Kruskal-Wallis, Mann-Whitney U important factor while Charavet et al. [13] identified the
test, and independent t tests. Post hoc LSD test was age as critical for the outcomes. Patients with moderate
used for parametric variables, and the Mann-Whitney or severe crowding associated with Class I or II are the
U test was used for non-parametric variables.

Results Table 1 Initial Little’s irregularity index score of the groups

This study consisted of three groups. There was a statis- Groups Maxillary Mandibular
tical homogeneity in terms of age distribution in all Little’s score Little’s score
three groups (P > 0.05). The initial Little’s irregularity Discision + orthodontic 6.86 (3.76) 6.14 (3.79)
treatment
index scores of the study groups are shown in Table 1.
All groups were statistically homogeneous in terms of Piezocision + orthodontic 10.48 (6.16) 6.47 (3.87)
treatment
dental crowding scores in both arches.
Periodontal measurements of study groups are shown Orthodontic treatment only 8.65 (3.48) 6.72 (2.53)
in Tables 2 and 3. There was no statistical difference be- P .247* .906**
tween groups in any parameters. The VAS values in the *Results of Kruskal-Wallis test; **results of one-way ANOVA test
Yavuz et al. Progress in Orthodontics (2018) 19:44 Page 4 of 7

Table 2 Comparison of maxillary periodontal parameters in experimental groups according to different treatment periods
Variables T0 P T1 P
PPD
Discision + orthodontic treatment 2.08 (1.96) .688* 2.21 (0.18) .480*
Piezocision + orthodontic treatment 2.11 (0.18) 2.28 (0.24)
BOP
Discision + orthodontic treatment 5.69 (5.07) .321* 3.18 (3.82) .148**
Piezocision + orthodontic treatment 8.39 (7.11) 6.70 (5.72)
Plaque index
Discision + orthodontic treatment 0.62 (0.32) .536* 0.44 (0.22) .434*
Piezocision + orthodontic treatment 0.71 (0.34) 0.54 (0.34)
Gingival index
Discision + orthodontic treatment 0.41 (0.56) .164** 0.42 (0.80) .474**
Piezocision + orthodontic treatment 0.56 (0.38) 0.48 (0.48)
PPD probing pocket depth, BOP bleeding on probing, T0 before orthodontic treatment, T1 1 month after discision/piezocision procedure. *Results of independent
t test, **results of Mann-Whitney U test

most appropriate cases for corticotomy indications [14]. Charavet et al. [13] reported that overall recession scores
To eliminate these potential confounding variables, we did not increase after treatment in both piezocision
distributed our patients with similar age range only fe- group and control group. The results of gingival reces-
male subjects and selected our patients among those sion scores in our study were consistent with this study.
with Angle Class I malocclusion in non-extraction The gingival recession that existed prior to treatment in
orthodontic treatment groups. 3 of the 24 patients, in 2 from the control group, and in
Patients included in the study were periodontally 1 from the piezocision group increased during ortho-
healthy and there was no statistical difference in peri- dontic treatment. This increase in initial gingival reces-
odontal status between groups. This is an expected out- sions may be related to the bone topography and
come for patients with cooperation and good oral whether the positioning of the teeth regardless of
hygiene and is consistent with the results of other stud- whether the orthodontic treatment is conventional or
ies [13]. Orthodontic tooth movement is one of the there is a rapid tooth movement. Casetta et al. [22]
causes of gingival recession. It is not known whether treated ten patients with severe dental crowding with
rapid tooth movement increases gingival recession. clear aligners and corticotomy-facilitated orthodontics,

Table 3 Comparison of mandibular periodontal parameters in experimental groups according to different treatment periods
Variables T0 P T1 P
PPD
Discision + orthodontic treatment 1.93 (0.08) .294* 2.03 (0.20) .355**
Piezocision + orthodontic treatment 2.00 (0.18) 2.13 (0.19)
BOP
Discision + orthodontic treatment 6.84 (5.74) .972** 5.28 (4.69) .930*
Piezocision + orthodontic treatment 6.82 (5.69) 5.09 (5.09)
Plaque index
Discision + orthodontic treatment 0.73 (0.39) .487* 0.56 (0.26) .886*
Piezocision + orthodontic treatment 0.61 (0.33) 0.54 (0.32)
Gingival index
Discision + orthodontic treatment 0.45 (0.41) .255** 0.36 (0.23) .859**
Piezocision + orthodontic treatment 0.53 (0.33) 0.46 (0.42)
PPD probing pocket depth, BOP bleeding on probing, T0 before orthodontic treatment, T1 1 month after discision/piezocision procedure. *Results of independent
t test, **results of Mann-Whitney U test
Yavuz et al. Progress in Orthodontics (2018) 19:44 Page 5 of 7

Table 4 Comparison of maxillary VAS scores within Table 6 Comparison of orthodontic treatment duration among
experimental groups after the accelerated procedures according the groups
to different observation periods Groups Orthodontic P* Post hoc rests
Variables VAS score P treatment
DG-PG DG-OT PG-OT
duration-day
4h
Discision + orthodontic 209.580 .003 .255 .002 .011
Discision + orthodontic treatment 2.00 (1.00–7.00) .701* treatment (73.50)
Piezocision + orthodontic treatment 3.00 (1.00–5.00) Piezocision + orthodontic 238.56
24 h treatment (69.90)

Discision + orthodontic treatment 0.00 (0.00–1.00) .897* Orthodontic treatment 324.50

only (81.65)
Piezocision + orthodontic treatment 0.00 (0.00–2.00) *
Results of Kruskal-Wallis test
3 days
Discision + orthodontic treatment 0.00 (0.00–0.00) .744*
Piezocision + orthodontic treatment 0.00 (0.00–1.00)
movement. Yet, according to a recently published sys-
tematic review, there is only one study related to piezo-
7 days
cision applied to the entire maxillary and mandibular
Discision + orthodontic treatment 0.00 (0.00–0.00) .109* dental arch [23]. Charavet et al. [13] reported that the
Piezocision + orthodontic treatment 0.00 (0.00–1.00) treatment of the piezocision group was 43% faster than
30 days that of the control group comparable to our 27% reduc-
Discision + orthodontic treatment 0.00 (0.00–0.00) .269* tion in treatment time with piezocision. The
Piezocision + orthodontic treatment 0.00 (0.00–0.00)
above-mentioned study had the rate of crowding less than
that of our study; therefore, it is possible that the piezoci-
*Mann-Whitney U test
sion in our study had a higher rate of tooth movement.
The shorter treatment time may also be due to the youn-
and they found that there was no difference between the ger age range of the participants included in the study.
pre-treatment and post-treatment periodontal indices. In The discision method was recently introduced as a
our study, there was no statistical difference between ex- case report [17]. The authors suggested that the disci-
perimental groups in any periodontal parameters. sion method shortened the duration of treatment by
Piezocision is widely used as a selective decortication performing rapid tooth movement. The present study
method in association with successful and rapid tooth is the first clinical study evaluating the effect of the
discision method on rapid orthodontic tooth move-
ment. Thus, we could not identify an article in the
Table 5 Comparison of mandibular VAS scores within
literature to compare the DG results of our study.
experimental groups after the accelerated procedures according
to different observation periods
Our data demonstrated that the discision method ac-
celerates orthodontic tooth movement by 35.5%. The
Variables VAS score P
technique is performed with a disc-shaped saw-bur,
4h
which is placed on a micromotor. This saw-bur is
Discision + orthodontic treatment 2.00 (2.00–4.00) .511* normally used for bone augmentation in implant den-
Piezocision + orthodontic treatment 3.00 (1.50–6.00) tistry. The blade thickness of the disc saw and piezo-
24 h surgery knife are 0.3 mm and 0.6 mm, respectively
Discision + orthodontic treatment 1.00 (0.00–2.00) .512* (Fig. 2). As the disc saw is two times thinner than
the piezosurgery knife, it may provide more reliable
Piezocision + orthodontic treatment 0.00 (0.00–1.00)
indications for flapless corticotomies, which are
3 days
already a risky procedure between close adjacent
Discision + orthodontic treatment 0.00 (0.00–0.00) .827* roots, especially for crowded mandibular incisors. In
Piezocision + orthodontic treatment 0.00 (0.00–0.00) piezocision studies, it is suggested that an incision
7 days line should be formed with an average length of 5–
Discision + orthodontic treatment 0.00 (0.00–0.00) .827* 8 mm at a depth of 3 mm. Since the disc saw that
we use has a 3.5-mm radius and the main body will
Piezocision + orthodontic treatment 0.00 (0.00–0.00)
act as a stopper, we can form the desired 3-mm-deep
30 days
incision line in a more controlled and practical way
Discision + orthodontic treatment 0.00 (0.00–0.00) 1.000* than in the piezocision method. In addition, since the
Piezocision + orthodontic treatment 0.00 (0.00–0.00) disc saw has a diameter of 7 mm, an incision line of
*Mann-Whitney U test the desired length can be formed at a single
Yavuz et al. Progress in Orthodontics (2018) 19:44 Page 6 of 7

Fig. 2 a Disc saw. b Comparison of piezocision and discision in a dental study model

entry-point (Fig. 3). The discision method was twice A limitation of this study was that cone-beam com-
as much faster than the piezocision method. Thus, puted tomography was not used to examine discision
application of the discision method in a shorter time and piezocision cuts. Although cone-beam computed
can be considered an advantage of this method. tomography is a reliable method in three-dimensional
The evaluation of root resorption after orthodontic imaging, we did not prefer it to not give the patients
tooth movement is important. No study evaluating extra radiation doses. Another limitation of this study
root resorption after acceleration techniques reported was that disc saw may damage alveolar soft tissues, so
significant root shortening compared to the conven- the operator must consider it.
tional approaches [13, 21, 23]. In fact, Shoreibah et al.
[24] reported less resorption of the root in the corti- Conclusions
cotomy group than in the control group. This result is This was the first clinical trial to assess the effect of
not surprising, as the root will encounter relatively discision method on the rate of orthodontic tooth
less resistance in the process of rapid tooth movement movement. In this study, irregularity index, periodon-
that is known to occur due to the temporary dimin- tal status, pain, and duration of orthodontic treatment
ution of bone density. In our study, both methods of were focused and compared between groups. We have
acceleration resulted in similar root resorption rates shown that this technique successfully facilitated rapid
compared to the conventional tooth movement. tooth movement. The discision method can be used

Fig. 3 a Controlled entry with a maximum depth of 3 mm. b Single entry-point with a 7 mm length
Yavuz et al. Progress in Orthodontics (2018) 19:44 Page 7 of 7

in daily orthodontic practice because the disc saw is 6. Teixeira CC, Khoo E, Alikhani M. Different methods of accelerating tooth
much cheaper than the piezosurgery device, it is easy movement. In: Clinical Guide to Accelerated Orthodontics: Springer
International Publishing Switzerland. 2017;19–31.
to carry, and most importantly, the disc saw is twice 7. Köle H. Surgical operations on the alveolar ridge to correct occlusal
as thin as the piezosurgery knife. The efficacy of dis- abnormalities. Oral Surg Oral Med Oral Pathol. 1952;12:515–29.
cision procedure must be confirmed in more numer- 8. Anholm JM, Crites D, Hoff R, Rathbun W. Corticotomy-facilitated
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Abbreviations 10. Medeiros RB, Pires FR, Kantarci A, Capelli J Jr. Tissue repair after selective
DG: Discision in addition to fixed orthodontic treatment; OT: Conventional alveolar corticotomy in orthodontic patients: a preliminary study. Angle
fixed orthodontic treatment; PG: Piezocision in addition to fixed orthodontic Orthod. 2018;88:179–86.
treatment; VAS: Visual analog scale 11. Tunçer NI, Arman-Özçırpıcı A, Oduncuoğlu BF, Kantarcı A. Osseous
outgrowth on the buccal maxilla associated with piezosurgery-assisted en-
Availability of data and materials masse retraction: a case series. Korean J Orthod. 2018;48:57–62.
The data supporting the conclusions of this article are included in the tables 12. Tunçer NI, Arman-Özçırpıcı A, Oduncuoğlu BF, Göçmen JS, Kantarcı A.
within the article. Efficiency of piezosurgery technique in miniscrew supported en-masse
retraction: a single-centre, randomized controlled trial. Eur J Orthod. 2017;
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MCY and SKB have made substantial contributions to the conception and 13. Charavet C, Lecloux G, Bruwier A, et al. Localized piezoelectric alveolar
design of the study. Acquisition of data and analysis and interpretation of decortication for orthodontic treatment in adults: a randomized controlled
data have been performed by MCY, SKB, OS, and AK. MCY and AK have been trial. J Dent Res. 2016;95:1003–9.
involved in drafting the manuscript or revising it critically for important 14. Sebaoun JD, Surmenian J, Dibart S. Accelerated orthodontic treatments with
intellectual content. MCY, SKB, and AK also contributed to the general piezocision: a mini–invasive alternative to alveolar corticotomies. Orthod Fr.
supervision. All authors contributed significantly to this manuscript and have 2011;82:311–9.
given final approval of the version to be published. 15. Alikhani M. Clinical guide to accelerated orthodontics. Springer Science and
Business Media, 2017.
Ethics approval and consent to participate 16. Cassetta M, Pandolfi S, Giansanti M. Minimally invasive corticotomy in
The study was conducted in accordance with the ethical principles of the orthodontics: a new technique using a CAD/CAM surgical template. Int J
World Medical Association Declaration of Helsinki (2008 version). The study Oral Maxillofac Surg. 2015;44:830–3.
procedures were approved by the Clinic Research Ethics Local Commission 17. Buyuk SK, Yavuz MC, Genc E, Sunar O. A novel method to accelerate
of Ordu University (2018/24). orthodontic tooth movement. Saudi Med J. 2018;39:203–8.
18. Alikhani M, Raptis M, Zoldan B, et al. Effect of micro-osteoperforations on the
Consent for publication rate of tooth movement. Am J Orthod Dentofac Orthop. 2013;144:639–48.
Not applicable. This manuscript has not been published elsewhere in part or 19. Bridges T, King G, Mohammed A. The effect of age on tooth movement
in entirety and is not under consideration by another journal. and mineraldensity in the alveolar tissues of the rat. Am J Orthod Dentofac
Orthop. 1988;93:245–50.
Competing interests 20. Haruyama N, Igarashi K, Saeki S, Otsuka-Isoya M, Shinoda H, Mitani H.
The authors declare that they have no competing interests. Estrous-cycle-dependent variation in orthodontic tooth movement. J Dent
Res. 2002;81:406–10.
21. Usumi-Fujita R, Hosomichi J, Ono N, et al. Occlusal hypofunction causes
Publisher’s Note periodontal atrophy and VEGF/VEGFR inhibition in tooth movement. Angle
Springer Nature remains neutral with regard to jurisdictional claims in Orthod. 2012;83:48–56.
published maps and institutional affiliations. 22. Cassetta M, Giansanti M, Di Mambro A, Calasso S, Barbato E. Minimally
invasive corticotomy in orthodontics using a three-dimensional printed
Author details CAD/CAM surgical guide. Int J Oral Maxillofac Surg. 2016;45(9):1059–64.
1
Department of Periodontology, Faculty of Dentistry, Istanbul Medeniyet 23. Yi J, Xiao J, Li Y, Li X, Zhao Z. Efficacy of piezocision on accelerating
University, Istanbul, Turkey. 2Department of Periodontology, Faculty of orthodontic tooth movement: a systematic review. Angle Orthod. 2017;87:
Dentistry, Ordu University, Ordu, Turkey. 3Department of Orthodontics, 491–8.
Faculty of Dentistry, Ordu University, Ordu, Turkey. 4Department of Applied 24. Shoreibah EA, Ibrahim SA, Attia MS, Diab MM. Clinical and radiographic
Oral Sciences, Forsyth Institute, Boston, Mass, USA. evaluation of bone grafting in corticotomy-facilitated orthodontics in adults.
J Int Acad Periodontol. 2012;14:105–13.
Received: 21 May 2018 Accepted: 1 October 2018

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