Patients and orthodontists seek to reduce treatment time in braces. Rapid canine retraction through dentoalveolar distraction osteogenesis is one of several treatment approaches to reduce treatment in braces. This article provides an overview of technique of dentoalveolar distraction osteogenesis to accomplish rapid canine retraction and associated outcomes. When this treatment protocol is implemented well, rapid canine retraction is achieved predictably with minimal side effects. Although current evidence suggests that adverse sequelae, such as root resorptions and pulp devitalization, are rare, prospective clinical studies that are adequately powered and documenting long-term follow-up of these outcomes are lacking.

This article reports the camouflage treatment of a female patient, aged 15 years 2 months, who had a Class II Division 1 malocclusion with severe anterior protrusion and deep incisor overbite. The camouflage treatment plan included bilateral extraction of the maxillary first premolars combined with the use of temporary anchorage devices (TADs) and tension coil springs to retract canines into the extraction spaces and then the 4 incisors. The treatment included use of a mandibular fixed labial arch with minimal use of Class II elastics to correct mild mandibular spacing and level the curve of Spee. Ideal overjet and overbite relationships were established, and the final result was well balanced and esthetically pleasing. The molars were finished in a Class II relationship. Total treatment time was 2 years 6 months. Cephalometric superimpositions revealed that mandibular molars were not disturbed by the limited use of Class II elastics. Surgical miniscrews in canine and incisor retraction in Class II Division 1 malocclusion are an alternate type of temporary anchorage that reduce or remove reliance on conventional intermaxillary anchorage.

The purpose of this study was to test the null hypothesis that duration of orthodontic treatment can be significantly reduced by accelerating canine retraction using dentoalveolar distraction (DAD).

Thirty-six maxillary canines of 19 patients comprised the DAD group, and 28 canines of 14 patients were included in the distalization group (DG). The initial mean ages were 15.8 ± 1.96 years for the DAD group and 16.02 ± 2.8 years for the DG. A custom-made, rigid, tooth-borne intraoral distraction device was used for the DAD group, and intraoral elastics were applied for canine distalization in the DG. Six skeletal and 11 dental variables were measured for the cephalometric evaluation.

Canine retraction was 7.9 ± 1.49 mm in 11.8 ± 1.3 days and canine distal tipping was 11.48° ± 4.37° after DAD; the canines were distalized 5.29 ± 2.01 mm and tipped 13.64° ± 9.54° in 200 ± 57 days in the DG. The rates of posterior canine movement were 0.67 ± 0.14 mm per day after DAD and 0.03 ± 0.01 mm per day in the DG. No significant first molar anchorage loss was observed after DAD, although the DG showed some vertical and sagittal first molar movement.

We failed to reject the null hypothesis. DAD can reduce the duration of orthodontic treatment time by accelerating canine retraction in extraction patients without undesirable side effects.

Canine distraction was introduced as an alternative treatment to retract the canines in minimum possible period of 3 weeks. It involved rapid canine retraction through distraction of the periodontal ligament. Another technique for rapid canine distalization involved osteotomies surrounding the canines to achieve rapid movement of the canines in the dentoalveolar segment known as dentoalveolar distraction. The present study is intended to assess and evaluate canine retraction by the above two mentioned methods of distraction osteogenesis.

Eight orthodontic patients who required first premolar extractions were selected and 16 canines were distracted into the extraction space, using a distraction screw.

The distraction procedure was completed in 15.38 ± 1.51 days on the side of periodontal ligament distraction while it took 14.50 ± 2.45 days on the side of dentoalveolar distraction. No significant anchorage loss was seen in both the sides. The distal displacement of the canines was 6.63 ± 0.90 mm on the periodontal distraction side at the rate of 0.43 ± 0.05 mm/day and 6.91 ± 1.16 mm on the side of dentoalveolar distraction at the rate of 0.48 ± 0.08 mm/day. An angulation change of 14.94° ± 7.58° was observed in canine inclination in periodontal distraction side while change of 14.88° ± 3.15° was seen in the dentoalveolar distraction side.

No significant differences in the various parameters were found between both the techniques of canine retraction by distraction osteogenesis, while reducing orthodontic treatment duration by 6-9 months without any unfavorable short-term effects on the periodontium.

New studies have been published and aimed to retract canines by means of distraction osteogenesis to reduce treatment time. Although a great care has been given to achieve a bodily movement of the canines, a significant amount of tipping of the canines has been observed. This trial aimed to assess the effect of applying a modified distractor on canine angulation.

The sample of the study consisted of 14 canines in seven patients (16-25 years). After the osteotomy procedure, two distractors were applied (one distractor on each side). After 5 days of a latency period, the two distractors were activated at a rate of 1 mm/day.

There was a significant difference between the two distractors regarding the time required to retract the canines (p = 0.008) and the observed change in canine angulation following retraction (p = 0.028). The change in the overjet and the mandibular plane angle was statistically insignificant. Eight out of 14 distracted canines reacted positively to the pulp vitality tester after 3 months of completion of distraction. There was no clinical sign of discoloration or pulpal pain in any canine.

Within the limits of this study, the modified distractor caused a bodily movement of the canine with a minimal tipping. Further research is required on a long-term basis on a larger group of patients to gain more insight on the observed changes.

Corticotomy is an effective method of accelerating the orthodontic treatment. The aim of this study was to compare the treatment time for the extraction space closure, between corticotomy assisted and conventional orthodontic tooth movement and to check the alveolar bone thickness before and after corticotomy procedure in the corticotomy group.

Cross-sectional clinical study.

Twenty patients (age>15 y) requiring orthodontic treatment with upper anterior retraction in the extraction space of 1(st) premolar were selected and were randomised into control and corticotomy group each group consisted of 10 subjects. Pre retraction, corticotomy was performed in the maxillary anterior segment. The pre and post retraction CT scans were recorded and the thickness of the alveolar plates were measured at crestal level (S1), mid root level (S2) and apical level (S3) PreTreatment (T1). The same measurements were repeated after incisor retraction was completed PostTreatment (T2).

Student's t-test, Pearson correlation coefficient.

There was a significant difference in retraction time (days) between control and corticotomy groups (p<0.001). Also, there were significant difference in total alveolar bone thickness at the crest region for all the four incisor teeth (p<0.05). A significant difference was observed in total alveolar bone thickness at the S2 and S3 level for 11, 21 and 11, 12 and 22 (p<0.05) respectively.

Alveolar corticotomies not only accelerates the orthodontic treatment but, also provides the advantage of increased alveolar width to support the teeth and overlying structures.

The aim of this study was to analyze the majority of publications using effective methods to speed up orthodontic treatment and determine which publications carry high evidence-based value. The literature published in Pubmed from 1984 to 2013 was reviewed, in addition to well-known reports that were not classified under this database. To facilitate evidence-based decision making, guidelines such as the Consolidation Standards of Reporting Trials, Preferred Reporting items for systematic Reviews and Meta-analyses, and Transparent Reporting of Evaluations with Non-randomized Designs check list were used. The studies were initially divided into three groups: local application of cell mediators, physical stimuli, and techniques that took advantage of the regional acceleration phenomena. The articles were classified according to their level of evidence using an alternative method for orthodontic scientific article classification. 1a: Systematic Reviews (SR) of randomized clinical trials (RCTs), 1b: Individual RCT, 2a: SR of cohort studies, 2b: Individual cohort study, controlled clinical trials and low quality RCT, 3a: SR of case-control studies, 3b: Individual case-control study, low quality cohort study and short time following split mouth designs. 4: Case-series, low quality case-control study and non-systematic review, and 5: Expert opinion. The highest level of evidence for each group was: (1) local application of cell mediators: the highest level of evidence corresponds to a 3B level in Prostaglandins and Vitamin D; (2) physical stimuli: vibratory forces and low level laser irradiation have evidence level 2b, Electrical current is classified as 3b evidence-based level, Pulsed Electromagnetic Field is placed on the 4(th) level on the evidence scale; and (3) regional acceleration phenomena related techniques: for corticotomy the majority of the reports belong to level 4. Piezocision, dentoalveolar distraction, alveocentesis, monocortical tooth dislocation and ligament distraction technique, only had case series or single report cases (4(th) level of evidence). Surgery first and periodontal distraction have 1 study at level 2b and corticision one report at level 5. Multiple orthodontic acceleration reports on humans were identified by an alternative evidence level scale, which is a simple and accurate way of determining which techniques are better and have a higher rate of effectiveness. The highest level of evidence for a specific procedure to accelerate orthodontic dental movement up to October 2013 was surgery first followed by low level laser application, corticotomy and periodontal distraction located on level 2, recommendation grade b from this proposed scientific evidence-based scale.

The aim of this clinical prospective study is to apply and evaluate an approach to reduce the overall orthodontic treatment time, by means of dentoalveolar distraction osteogenesis to achieve rapid canine retraction using an indigenously developed intra-oral tooth-borne distraction device.

This study was carried out in the Department of Orthodontics and Dentofacial Orthopedics. Four patients selected for the purpose of Maxillary and/or Mandibular canine distraction with a rigid custom-made, intra-oral distraction device made of stainless steel and were scheduled for orthodontic treatment with bilateral first premolar extraction and then subsequent bilateral canine teeth distalization.

In all the patients the canine teeth moved distally and made contact with the second premolars within 14-16 days range after which they were kept passive, with the appliance for a week of consolidation. The amount of canine retraction was in 7-7.5mms range, in all the patients, in each of the four quadrants studied. Bodily movement, tipping and buccal flaring of the canine teeth were noticed in all the cases.

Combination of newer orthodontic appliances and the principles of biomechanics to maintain the control over rapid tooth movement, rapid canine distalization using distraction osteogenesis awaits further development before routine application, of this innovative and exciting approach. How to cite the article: Nair A, Kumar JP, Venkataramana V, Yuvaraj A, Reddy VS, Kumar SK. Dento-Alveolar distraction osteogenesis using rigid intra-oral tooth borne distraction device. J Int Oral Health 2014;6(2):106-13.

Dental distraction is an orthodontic tooth movement technique that allows closure of extraction spaces, usually of premolars, in periods from 1 to 3 weeks, by bodily retraction of the canine. This article reports on canine distalization by using a distractor device obtained from a conventional hyrax screw. The patient was an adolescent boy, aged 17 years 9 months, who came to the clinic with the chief complaint of tooth crowding. The clinical examination showed a convex profile, retroclined and protruded maxillary incisors, buccally tipped and protruded mandibular incisors, and a Class I malocclusion. The treatment comprised extractions and rapid canine distraction procedures. Pretreatment, posttreatment, and 2-year follow-up records are shown and demonstrate that dental distraction is a viable alternative of treatment. With this treatment strategy, satisfactory results were obtained without additional anchorage devices, achieving an attractive smile and optimal occlusion. The main considerations about the treatment alternatives and their clinical concerns are discussed.

The orthodontic treatment period with extractions is prolonged in many cases because of the limited rate of biological tooth movement. An approach using transport distraction osteogenesis was designed to reduce orthodontic and orthognathic treatment time. Overall management of selected alveolar cleft cases with wide defects may also be optimized and simplified through transport distraction of a tooth-bone segment. We will discuss our experience with 73 cases, both conventional orthodontic cases and orthognathic patients, in which dentoalveolar distraction was used to reduce orthodontic treatment time and to treat wide alveolar clefts with compromised soft tissues to facilitate optimal outcome.