Patients at the Orthodontic Department of University of Damascus Dental School will be examined and subjects who meet the inclusion criteria will be included. Then, initial diagnostic records (diagnostic gypsum models, internal and external oral photographs, as well as radiographic images) will be studied to ensure that the selection criteria are accurately matched. The aim of this study is to compare two groups of patients with moderate crowding of the lower anterior teeth First group (Experimental): the patients in this group will be treated with orthodontic fixed appliances + surgery to the alveolus of the lower anterior teeth in order to induce remodeling of the bony structures and enhance orthodontic movement. Second group (Control): the patients in this group will be treated using fixed appliances with any acceleration method.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
38
Surgery will be performed to the lower anterior bony segment of the lower jaw in order to accelerate tooth movement
Department of Orthodontics, University of Damascus Dental School
Damascus, Syria
Duration of Alignment
The time required in days will be calculated from the beginning of treatment till the end of the alignment stage
Time frame: The assessment is based on calculating days from the beginning of treatment till the end of the alignment stage which is expected to happen within 5 to 6 months
Change in Little's Index of Irregularity
The irregularity of the lower incisors is calculated by measuring the amount of deviations of the anatomic contact points between the six anterior teeth in the horizontal direction in mm, since the sum of these measurements represents the value of the index (Little, 1975). When the sum of these deviations is less than 3 mm, this indicates that the teeth are slightly crowded. When the sum is greater than 10 mm, this indicated very severe crowding. The ordinary orthodontic treatment aims to keep this Index less than 1 mm at the end of treatment.
Time frame: T0: one day before the beginning of treatment; T1: after 1 month; T2: after 2 months; T3: after 4 months; T4: after 5 months; T5: at the end of the alignment stage which is expected within 5 - 6 months
Change in Alveolar Defect
Using cone-beam computed tomography (CBCT), each tooth root will be evaluated in axial and cross-sectional slices at the buccal and lingual surfaces. When no cortical bone is observed around the root in at least three sequential views, this will be considered an alveolar defect. If the alveolar bone height is more than 2 mm from the cemento-enamel junction, it will be classified as dehiscence ,When the defect does not involve the alveolar crest, this case will be classified as fenestration. The status of the alveolar bone will be assessed twice.
Time frame: T1: One day before the beginning of treatment; T2: at the end of the alignment stage which is expected within 5-6 months
Change in inter-canine width
The distance between the cusp tips of the lower canines. This variable will be measured on plaster models. T1: One day before the beginning of treatment; T2: at the end of the alignment stage
Time frame: T1: One day before the beginning of treatment; T2: at the end of the alignment stage which is expected within 5-6 months
Change in Alveolar Bone Thickness
Will be measured for each of the lower anterior teeth in the cervical, middle, and apical regions. This will be achieved by using the ruler which will be positioned perpendicular to tooth long axis from the root surface (without measuring the periodontal ligament ) to the most external surface of the cortical bone.
Time frame: T1: One day before the beginning of treatment; T2: at the end of the alignment stage which is expected within 5-6 months
Change in Lower Incisors' Inclination
The angle between the long axis of the lower Incisors and the mandible plane (Go-Me) will be measured.
Time frame: T1: One day before the beginning of treatment; T2: at the end of the alignment stage which is expected within 5-6 months
Change in the positioning of the upper lip
It is going to be evaluated by Ricketts' analysis (E-Line). This is done by drawing a reference line between the tip of the nose and the most prominent point on the chin contour (Pogonion). The distance of the upper lip from this line is a measure of lip positioning.
Time frame: T1: One day before the beginning of treatment; T2: at the end of the alignment stage which is expected within 5-6 months
Change in the positioning of the lower lip
It is going to be evaluated by Ricketts' analysis (E-Line). This is done by drawing a reference line between the tip of the nose and the most prominent point on the chin contour (Pogonion). The distance of the lower lip from this line is a measure of lower lip positioning.
Time frame: T1: One day before the beginning of treatment; T2: at the end of the alignment stage which is expected within 5-6 months
Change in the naso-labial angle
It is the angle formed between the lower border of the nose and the upper lip.
Time frame: T1: One day before the beginning of treatment; T2: at the end of the alignment stage which is expected within 5-6 months
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