Korean J Orthod.  2017 Mar;47(2):130-141. 10.4041/kjod.2017.47.2.130.

The combined use of computer-guided, minimally invasive, flapless corticotomy and clear aligners as a novel approach to moderate crowding: A case report

• Cassetta M
• Altieri F
• Pandolfi S
• Giansanti

• KMID: 2400390
• DOI: http://doi.org/10.4041/kjod.2017.47.2.130

Abstract

The aim of this case report was to describe an innovative orthodontic treatment method that combined surgical and orthodontic techniques. The novel method was used to achieve a positive result in a case of moderate crowding by employing a computer-guided piezocision procedure followed by the use of clear aligners. A 23-year-old woman had a malocclusion with moderate crowding. Her periodontal indices, oral health-related quality of life (OHRQoL), and treatment time were evaluated. The treatment included interproximal corticotomy cuts extending through the entire thickness of the cortical layer, without a full-thickness flap reflection. This was achieved with a three-dimensionally printed surgical guide using computer-aided design and computer-aided manufacturing. Orthodontic force was applied to the teeth immediately after surgery by using clear appliances for better control of tooth movement. The total treatment time was 8 months. The periodontal indices improved after crowding correction, but the oral health impact profile showed a slight deterioration of OHRQoL during the 3 days following surgery. At the 2-year retention follow-up, the stability of treatment was excellent. The reduction in surgical time and patient discomfort, increased periodontal safety and patient acceptability, and accurate control of orthodontic movement without the risk of losing anchorage may encourage the use of this combined technique in appropriate cases.

Keyword

Clear aligners; Accelerated orthodontics; CAD-CAM; Piezocision

MeSH Terms

Computer-Aided Design
Crowding*
Female
Follow-Up Studies
Humans
Malocclusion
Methods
Operative Time
Oral Health
Periodontal Index
Quality of Life
Tooth
Tooth Movement
Young Adult

Figure

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  Figure 1 Pretreatment facial and intraoral photographs.

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  Figure 2 Pretreatment radiographs. A, Panoramic; B, lateral cephalometric.

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  Figure 3 Pretreatment cephalometric analysis.

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  Figure 4 The surgical phases of the computer-guided, minimally invasive piezocision procedure performed using a three-dimensional printed surgical guide: A, B, The surgical guide positioned on the upper arch. The images show the vertical gingival incisions made interproximally below the interdental papilla; C, D, the corticotomy cuts, extended through the entire thickness of the cortical layer, using a piezosurgical microsaw; E, the piezocision in the lower arch; F, at the end of the surgery, the mandibular right first premolar is extracted and the clear aligners are positioned.

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  Figure 5 Postoperative facial photograph and cone-beam computed tomography image. Limited postoperative swelling is seen 3 days after the surgery.

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  Figure 6 Intraoral photographs. A, At 2 months of treatment; B, at 4 months of treatment.

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  Figure 7 Facial and intraoral photographs at the end of treatment.

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  Figure 8 Superimposition of pretreatment and posttreatment lateral cephalometric tracings (Ceph.).

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  Figure 9 Posttreatment extraoral and intraoral photographs at 24 months.

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  Figure 10 Three-dimensionally reconstructed images of pretreatment cone-beam computed tomography (CBCT) and posttreatment CBCT.

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