INTRODUCTION

The orthodontics facilitated by corticotomy corresponds to a modern surgical technique described for the first time by Heinrich Köle, in 1959¹. Until now, it was thought that the accelerated dental movement was due to the displacement of the bone segment individually, but in 2001 Wilcko et al2 demonstrate that the speed of dental movement is due to a local and transient demineralization / remineralization in the alveolar bone compatible with the accelerated regional phenomenon (RAP)^3,4.

Corticotomy is defined as osteotomy of the cortical bone. It is a procedure by which only cortical bone is cut, perforating or mechanically altering, in a controlled surgical way and at the same time minimally penetrating the bone marrow^1,2. H. Frost describes the so-called regional acceleration phenomenon (rap) as a physiological process that is observed after an aggression in hard and / or soft tissues and consists of an acceleration of the healing process with a greater bone cell turnover and a decrease in regional bone densities⁴.

Orthodontics in general has evolved in terms of techniques and mechanics that have helped to generate changes when establishing the treatment plan5. Within the advantages of corticotomy we have that it serves to accelerate the movement of the teeth, the bone can be increased, thus avoiding periodontal defects that occur as a result of a thin alveolar bone. Despite being a convenient auxiliary technique, we can find disadvantages such as being considered an invasive procedure, the risk of damage to adjacent vital structures, postoperative pain, inflammation, chances of infection, and avascular necrosis^5,6.

The bad dental position is responsible for aesthetic and occlusal problems in many adults, this can be caused by severe factors that include an advanced periodontal problem, dental migration due to tooth loss and dental movements caused by occlusal trauma⁷. The clinical indications for the use of corticotomy have been wide, reporting success in the management of surgically assisted palatal expansion, bimaxillary dentoalveolar protrusion, anterior open bite, severe skeletal protrusion and dental crowding, additionally they are used in adult patients to accelerate the time of orthodontic treatment⁸.

The demand of the patients regarding the effectiveness of the treatment is increasingly acceptable since they refer to a great change both in their oral structure and in the rapid movement of each of the area in which it was performed in either specific or generalized treatment^8,9. This is why this article aims to present results of a bibliographic review, determine the distance and time in which an orthodontic movement or displacement is achieved after having performed a selective corticotomy.

Materials and methods

The information was obtained through the bibliographic review of articles in digital format, published from 2001 to 2017. Platforms such as Pubmed, Scielo, Science Direct and Google Scholar were used, in which keywords such as selective corticotomy, distance, rap were used , orthodontics, alveolar bone, dental movement. For the selection, the importance of its scientific value and updating was raised as an inclusion criterion. As exclusion criteria, articles published more than 17 years ago were discarded. 65 articles were reviewed and a selection of 33 was made, complying with the inclusion criteria already mentioned.

Results

The objective of this study was to conduct a bibliographic review of the distance and time of movements with selective corticotomy in orthodontic treatments. Of the 33 articles that were analyzed, it was found that there is an average of 4 months in which the dental movement is performed, the time that the bone has while it is remineralized again^{9,10,11,12,13,14,15}.

On the other hand, in terms of the distance of displacement it was found that movements such as mesialization, distalization, intrusion and extrusion, are commonly used by the corticotomy method, and that progress is made approximately 3.5 mm thus reducing 50% of the treatment period^{16,17,18,109,20,21,22}.

It was observed that experimental studies in animals report as a consequence of corticotomy an increase in the speed of dental movement, with average movement rates in the corticotomy group of 4.67 ± 0.58 mm. 2.33 ± 0.58 mm in the control group^{16,17,18,109,20,21,22}.

In addition, some case reports in humans with corticotomy, show that the treatment time ranges between 4 and 18 months depending on the complexity of the malocclusion^{9,10,11,12,13,14,15,3,16,17,18,109,20,21,22}.

Figure 1. Selective corticotomy, courtesy of the C.D. Querly Cuellar.

Discussion

Selective corticotomy was first introduced by Heinrich Köle, in 1959, who developed a technique that consists of cutting cortical bone into blocks, leaving the entire mobile segment, this technique was little accepted because it was very invasive. However, in 2001, the Wilcko brothers modified this technique and developed a protocol that consists of making cuts in the cortical bone through the use of a round surgical drill, without drilling or leaving it mobile, and after that applying bone grafting. This proposed technique, unlike Köle's, was very well accepted and is currently used^3,16,24.25.

The speed of tooth movement is an important factor that determines the duration of orthodontic treatment. Physiologically, the speed of movement of the teeth reflects the rates of bone turnover and remodeling. Previous approaches by authors such as Yamasaki17, mention that corticotomy has been used in an attempt to accelerate the movement of teeth, with this approach techniques such as low energy laser irradiation, magnetic fields, pharmacological interventions with injection have also been included of prostaglandin E2 17 and vitamin D^26,27,28,29.

Selective corticotomies are considered a useful tool in orthodontics, since they allow working in malocclusions such as biprotrusions; according to Frost 30 (2006), in just 1 year of treatment, he was able to successfully complete a case of 4 extractions, with a slight orthodontic force of 1 N (Newton). It is well known that a 4.5 N force is generally used for conventional orthodontic treatment, so that movement can be performed, however, in this case, thanks to the alveolar corticotomy, a smaller force could be implemented, and by less time. Total orthodontic treatment was dramatically reduced from 31 months, which is an average treatment period for cases with extractions, to 12 months, having a total reduction of 50% of the time^31,32.

Akay and cols.10 conclude that on average a molar, with a previous corticotomy, can be intruded from 3.1 to 3.5 mm in just 12 to 15 weeks of intrusion period with forces of 200 to 300 g. This finding supports the view that combining corticotomy with orthodontic biomechanics has the potential to shorten the period of time³³.

T. Motohashi27, showed in his article that the greatest displacement was achieved in cases combined with corticotomy, suggesting that not only the teeth, but also the anterior alveolar segment is moved in block by an orthodontic treatment combined with corticotomy34. This statement corroborates the studies presented by Wang and cols. Pavlin, 2001, reported as a consequence of corticotomy an increase in the speed of dental movement, with average movement rates in the corticotomy group of 4.67 ± 0.58 mm. 2.33 ± 0.58 mm in the control group³⁴.

In relation to time, the studies carried out by Wilcko and cols., 2009; coincide with the research of Akay and cols., 2009, which shows that the treatment time ranges between 4 and 18 months according to the complexity of the malocclusion. The above suggests that corticotomy may be a viable alternative in some patients^3,10,16.

Conclusions

Currently, the demand for reducing orthodontic treatment times has increased; the orthodontics facilitated by corticotomy is able to carry out a successful treatment, reducing times considerably. However, the evidence is scarce, since it is mainly based on case reports, so more research is required about this procedure.

Interest Conflict

The authors declare no conflict of interest in the presentation of data, preparation and publication of this article.

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	Méndez H; https://orcid.org/0000-0003-1025-6432