Effect of Micro-Osteoperforations on External Apical Root Resorption

 

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  • This prospective randomized controlled trial enrolled 30 participants older than 18 years with 5 to 8 mm of maxillary anterior crowding to evaluate the role of micro-osteoperforations (MOPs) on external apical root resorption. The test group, consisting of 15 people, underwent MOPs with appliances, and the control group was treated with fixed appliances only. There were no significant differences in root lengths 6 months following treatment between the groups, and few teeth in both groups were classified as having moderate resorption (7.1% of incisors in the MOP group and 4.8% in the control group).

  • MOP does not contribute to worsened external apical root resorption compared with fixed appliances alone in the treatment of moderate maxillary incisor crowding. Alignment duration and discomfort were not reported in this manuscript.
– James  Boynton, DDS, MS

 Clinical Dentistry

This randomized parallel clinical trial compared the effect of micro-osteoperforations (MOPs) on external apical root resorption (EARR) during the initial orthodontic alignment phase of anterior maxillary crowding. A total of 30 patients receiving extraction-based fixed appliance treatment were randomized to fixed appliances (control group; n = 15) and adjunctive therapy with MOPs (n = 15). EARR was measured per tooth from long cone periapical radiographs at the start and after 6 months of treatment. Intra and intergroup comparisons of global EARR were performed. The authors found no differences regarding the incidence of EARR between groups. Changes in root length within each group were nonsignificant, too.

This well-designed trial shows some differences with previous research. Most of the studies dealing with this topic have focused on root resorption during space closure, assessing canine roots adjacent to the area where MOPs were performed. In this study, two MOPs were performed between the six anterior teeth excluding the midline alveolar bone and were repeated at 4-week intervals. Although EARR was assessed in the six anterior teeth, no results per teeth have been reported. It would have been interesting to report these data and correlate EARR with the initial amount of anterior crowding.

The follow-up of 6 months in this study is much longer than that in previous studies. Increased treatment time or prolonged treatment duration positively correlate with increased EARR. Therefore, long-term evaluation of MOP effects is recommended, ideally with an endpoint of 1 year after initiation of the study.

As a limitation, EARR was evaluated by 2-D periapical x-rays. The validity of these x-rays is questionable because of the potential superimpositions of adjacent structures and the inadequacy of using a 2-D radiograph to examine a 3-D phenomenon.

In this study, the effect of the intervention on inflammatory markers was not evaluated. Perhaps a minimal surgical insult of MOPs may not be enough to trigger the inflammatory response to activate the regional acceleratory phenomenon or even cytokine expression.

The effect of MOPs and other techniques related to surgically assisted tooth movement on EARR has been unclear, with different studies showing controversial results. The biologic mechanism underlying the increased rate of tooth movement appears to involve a marked increase in cortical bone porosity and bone turnover due to increased activities of fibroblasts, osteoclasts, osteoblasts, and cementoblasts. This osteoporotic environment may offer less mechanical resistance against tooth movement through the alveolar bone and less stress on dental roots. On the other hand, some studies have found that the increase in osteoclastic activity has been found to exacerbate the root resorption process. Considering the resemblance between osteoclasts and odontoclasts, it is possible that excessive localized activation of osteoclasts, as seen after surgical procedures such as MOPs, can lead to an increase in odontoclastic activity.

Further research is needed in this field, and long-term follow-up that resembles the normal duration of orthodontic treatments is encouraged.


OBJECTIVE

This study aimed to investigate the effect of micro-osteoperforations (MOPs) on external apical root resorption (EARR) during the initial orthodontic alignment phase of maxillary anterior crowding.

METHODS

Thirty patients (25 females, 5 males; mean age, 22.66 ± 3.27 years) who presented with moderate crowding of the upper labial segment and underwent extraction-based fixed appliance treatment were recruited. They were randomly allocated to receive adjunctive therapy with MOPs (n = 15) or treatment with fixed appliances only (control group; n = 15). EARR was measured from long-cone periapical radiographs taken at the start and the sixth month of treatment. A correction factor for the enlargement difference was used to calculate EARR. Data were analyzed with descriptive statistics and repeated-measures analysis of variance.

RESULTS

The mean root lengths of 168 teeth were measured and showed no statistically significant difference (p > 0.05) after six months of fixed appliance treatment in the MOP (mean difference [MD] = 0.13 mm; 95% confidence interval [CI] = -0.10-0.35) and control group (MD = 0.14 mm; 95% CI = -0.10-0.37). Most of the roots in the MOP and control groups (42.86% and 52.38%, respectively) showed only mild resorption. Less than 8% of the roots in both groups (7.14% in the MOP group and 4.76% in the control group) showed moderate resorption.

CONCLUSIONS

Acceleration of orthodontic tooth movement with adjunctive MOPs therapy during the alignment phase does not exacerbate EARR in patients with moderate crowding of the upper labial segment in comparison with controls.

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