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ePaper created 2018-03-13, 09:28:55 | version 1.38.0
research | Tab. 1: Surgical protocols for performing alveolar corticotomy. Open-flap corticotomies Flapless corticotomies · Periodontally Accelerated Osteogenic Orthodontics · Fiberotomy · Segmental corticotomy · Corticision · Any corticotomy performed during an open-flap surgery · Piezocision · Micro-osteoperforations Fig. 5 Fig. 6 in association with the decortication. Piezo- surgical calibrated micro-saws are preferred to rotating surgical burs because of their selective, safer, micrometric and more precise cuts; better irrigation/cooling effect from cavitation; better comfort for the surgeon; and better healing for the patient. The open-flap corticotomy pro- cedure is routinely used during orthognathic surgery, when exposing impacted teeth, to treat transverse max- illary deficiencies and periodontally involved cases. Flapless surgery has been proposed as an alternative way of performing a corticotomy. Corticision31 and Piezo- cision32 have been an attempt to reduce the invasive- ness of the decortication and the possible periodontal damage and postoperative discomfort with raising a flap. Even if attractive, they seem to have surgical and biome- chanical limitations. The surgical limitations include risks when per- formed in crowded arches, limited visibility when pro- ducing the cuts, limitation of the cuts to the inter- proximal areas and the roots, difficult control of the grafting in the apico - coronal direction and need for optimal extension of the attached gingiva in the area of decortication. The biome- chanical limitations are strictly related to the fact that cor- the middle to third of ticotomy is performed only on the buccal side and middle third of the roots. They are definitely not minimally invasive surgeries as claimed and are quite expensive for the patient, since only a well-trained periodontist/oral surgeon can perform them and they often require complex planning with digi- tally designed 3-D surgical guides.33 The Micro-Osteo-Perforations (MOPs) described by Alikhani et al.34 and Teixeira et al.35 are an effective and min- imally invasive way of producing insult to the cortical alveo- lar bone. These MOPs may be created with manual instru- ments (Excellerator, Propel Orthodontics) or with dedicated burs on a reduced-speed electric handpiece (Fig. 5). MOPs are produced with a penetration in the cortex of a maximum of 1–2 mm. Instead of conventional local anaesthesia, a strong anaesthetic gel placed on the mucosa for three minutes is sufficient to control the patient’s pain and discomfort. It is advisable to produce two to three MOPs in each interproximal area of the teeth and both buccally and lingually (Fig. 6), to ensure that the metabolic changes are extended around the entire radic- ular alveolar bone. Manual MOP is usually created in the frontal areas, whereas drilled MOP is usually performed in the posterior and lingual areas (Figs. 7–9). The pro- ortho 1 2018 23