European Journal of Orthodontics, 2019, 1–8

doi:10.1093/ejo/cjz006

Original article

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The effect of the extent of surgical insult on
orthodontic tooth movement
Joy Chang, Po-Jung Chen, Eliane H. Dutra, Ravindra Nanda and
Sumit Yadav
Division of Orthodontics, Department of Craniofacial Sciences, University of Connecticut Health Center, Farmington, CT, USA

Correspondence to: Sumit Yadav, Division of Orthodontics, 263 Farmington Avenue, University of Connecticut Health Center,
Farmington, CT 06030, USA. E-mail: Yadav_sumit17@yahoo.com

Summary
Objective: The primary objective of this study was to investigate how the extent of surgical insult
affects the orthodontic tooth movement (OTM) and the alveolar bone modelling and remodelling
in a rodent model.
Material and methods: 15-week-old male Wistar rats were used in the research and they were
randomly divided into three treatment groups: (1) OTM only (N  =  8); (2) OTM + 2 alveolar
decortication (AD) (less surgical insult) (N = 8); and (3) OTM + 4 AD (more surgical insult) (N = 8).
A nickel-titanium spring delivering 5–8 g of force was used to protract the molar mesially using
maxillary incisors as an anchorage. AD was done using a hand piece and a round bur, adjacent to
the left first maxillary molar on the palatal alveolar bone. After 14 days of OTM Wistar rats were
killed and microfocus computed tomography and histological analysis were performed.
Results: The OTM + 4AD group presented with a significant increase (P < 0.05) in the rate of tooth
movement when compared to OTM + 2AD group and OTM only group. In addition, the OTM + 4AD
group had a significant decrease in bone volume and tissue density (P < 0.05) and a significant
increase (P < 0.05) in the trabecular spacing and trabecular thickness when compared to OTM only.
Histological quantification of tartrate-resistant acid phosphatase indicated a significant percent
increase (P < 0.05) in OTM + 4AD group, when compared to OTM + 2AD and OTM only group.
Results: Increased surgical insult increases the rate of OTM. Additionally, increased surgical insult
decreases the bone volume and the tissue density.

Introduction White spot lesions are found in 96% and caries in 2.3% of ortho-
dontic patients, with prolonged treatment time as a risk factor for
Orthodontic treatment ranges from 18 to 36  months, averaging
their development (5,8). External apical root resorption is highly
around 20 months to complete (1). The duration of treatment can be
correlated to the duration of orthodontic treatment, as longer period
influenced by factors such as the severity of malocclusion, incidence
of hyalinization precedes external apical root resorption (9). Poor
of impacted teeth, treatment mechanics, and patient compliance (2).
gingival health is also significantly influenced by the duration of
Perhaps the most important determinant of the duration of treatment
orthodontic treatment (7).
are the biological principles underpinning orthodontic tooth move-
With the myriad of complications associated with orthodontic
ment (OTM), an inflammatory process resulting in bone modelling
treatment duration, the advent of interventions to accelerate OTM
and remodelling (3,4).
has gained momentum in the last decade. Adjunctive modalities to
Long treatment duration is not only associated with an increased
accelerate OTM could be divided into non-invasive and invasive
financial burden to the clinician, but also detrimental to the patient’s oral
interventions (10,11). Non-invasive interventions include mechani-
health. Adverse consequences from long treatment time include white
cal vibration, low-level light energy, and low-intensity pulsed
spot lesions, caries, root resorption, and poor gingival health (5–7).

© The Author(s) 2019. Published by Oxford University Press on behalf of the European Orthodontic Society.
1
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2 European Journal of Orthodontics, 2019
ultrasound (12). Invasive surgical interventions include alveolar
perforations/decortication, piezocision, corticision, corticotomy, and
dental distraction (13).
Invasive modalities to accelerate orthodontics are theoretically
based on the regionally acceleratory phenomenon (RAP) (13).
Described initially by Frost, RAP is a biologic reaction where tran-
sient burst of catabolic bone modelling followed by anabolic bone
modelling expedites bone healing (14,15). Invasive interventions to
accelerate tooth movement harnesses RAP produced through small
surgical procedure to expedite bone turnover in the surrounding
alveolar bone during tooth movement. Limited evidence supports
the use of adjunctive surgical procedures to accelerate orthodon-
tic treatment; nevertheless, its routine use is still controversial
(13,16–18).
The extent of injury has been suggested to be correlated to the
duration and effect of RAP (14,15,19). Current surgical adjuncts to
accelerate tooth movement vary in its invasiveness, ranging from
flapless microperforations to more traumatic approaches such as
corticotomy and dental distraction (13). There is a paucity of evi-
dence to evaluate the balance between maximizing the effect of RAP
while minimizing the extent of trauma. A study by Abbas et al. (20)
compared the effects of corticotomy and piezocision in rapid canine
retraction found that corticotomy produced more rapid canine
movement than piezocision. Another study by Alfawal et  al. (21)
which compared flapless corticotomy with piezocision found no
significant difference in rate of canine retraction over the 4-month
period. Tsai et al. (22) found no difference in flapless micro-osteop-
erforation and corticision during tooth movement in rats.
Alveolar decortication (AD) is a minimally invasive surgical pro-
cedure used to accelerate OTM, where a flapless osteoperforation
is performed adjacent to the region of interest (23). AD is gaining
popularity because of minimal traumatic effects and relative ease of
use in clinical practice and has been shown to increase the rate of
OTM both in an animal and clinical studies (24). It has been shown
that AD (4 alveolar decortications) increases the tooth movement
significantly both at day 7 and day 14 when compared to the control
group (24). However, no study has been published on examining the
effect of the surgical insult (more AD versus less AD) on the degree
and the nature of the OTM.
The aim of our study was to evaluate the rate of OTM and al-
veolar bone response to differing degrees of trauma in a rodent
model. Our null hypothesis is that there will be no difference in the
rate of OTM with different amounts of surgical trauma. Our objec-
tives are the following: (1) to determine the effect of the extent of
surgical insult (2AD when compared to 4AD) on the amount OTM,
and (2) to quantify the changes in the surrounding alveolar bone
with differing amounts of AD using microfocus computed tomog-
raphy (micro-CT) and histology.
Materials and methods
Our study was approved by the Institutional Animal Care and Use
Committee of University of Connecticut Health Center. Sixteen-
week-old, 24 male Wistar rats (Charles River Laboratories,
Wilmington, Massachusetts, USA) weighing approximately 600  g,
were used in our research. The animals were housed in the animal
tower and four Wistar rats were housed in each rat cage and all the
rats were in controlled environment with a 12-hour light and dark
cycle. All the rats were fed with standard crushed diet and water ad
libitum. All the rats were acclimatized for a week before the start of
the experiments.
Experimental design
The Wistar rats were randomly divided into three groups: (1) group
1 (8 Wistar rats), OTM for 14  days; (2) group 2 (8 Wistar rats),
OTM for 14 days + 2 AD (Figure 1); and (3) group 3 (8 Wistar rats),
OTM for 14 days + 4AD (Figure 1). In all the groups, 5–8 g of force
was applied using nickel-titanium (NiTi) coil spring.
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Orthodontic spring placement and alveolar
decortication
The animals were anaesthetized by an intraperitoneal mixture of two
different anaesthetics xylazine (13 mg/kg) and ketamine (87 mg/kg).
After the induction of the anaesthesia, a mouth prop was fabricated
for the forced mouth opening and the prop was inserted between
the maxillary and mandibular incisors. The NiTi closed-coil spring
(Ultimate Wireforms, Bristol, Connecticut, USA) was ligated to the
maxillary first molar using a 0.006-inches stainless-steel ligature
wire and the other side of the NiTi closed-coil spring was ligated to
the maxillary incisors. The maxillary incisors were coligated to con-
solidate the anchorage and 5–8 g of orthodontic force was applied
to move the left maxillary molar mesially (Figure 1). Self-etching
primer (Transbond Plus; 3M Unitek, Monrovia, California, USA)
and light-cure adhesive resin cement (Transbond; 3M Unitek) were
applied to the palatal surfaces of the maxillary first molar and buccal
and lingual surface of the maxillary incisors to prevent the slippage
of the ligature wire holding the NiTi closed-coil spring (Figure 1).
The surgical insult (ADs) was done immediately after attaching
the NiTi coil spring to the first molar and the maxillary incisors.
ADs were made using the hand piece and the round bur. In group
2, two ADs were made on the palatal alveolar bone around the first
maxillary molar, whereas in group 3, four ADs were made on the
palatal alveolar bone close to the left maxillary first molar (Figure 1).
Immediately after the surgery rats in OTM + 2AD and OTM + 4AD
group were administered a single dose of buprenorphine to minimize
the pain and discomfort. The rats in all the groups were returned
to their individual cages once full ambulation and self-cleansing
returned. The rats were monitored closely for pain and discomfort
and the appliance was checked thrice a week. In addition, the max-
illary and the mandibular incisors of the rats were trimmed twice
a week to prevent the dislodgement of the spring. Rats in all the
groups were killed by inhalation of carbon dioxide followed by cer-
vical dislocation at the end of the experimental period of 14 days.
Tissue preparation and micro-CT imaging
To evaluate the differences in the alveolar bone at the tissue level,
micro-CT and histological quantification and analyses were done.
The maxilla from each Wistar rat was dissected free of the adja-
cent muscles and fixed in 10% formalin for 5 days. For micro-CT
imaging, the maxilla from each animal was dehydrated with a series
of graded alcohol. The scanner setting for imaging the maxilla of
the rats were 55  kV and 145 mA, obtaining 1000 projections per
rotation at 300 ms. OTM was analysed on a two dimensional sag-
ittal sections taken through the centres of the maxillary first and
second molars and measured at the interproximal heights of contour
between these teeth. The alveolar bone changes in different experi-
mental and control groups were analysed in the region of interest
in the area of the left maxillary first molar. The region of interest
was defined vertically as the most occlusal point of the furcation
to the apex of the maxillary roots. Transversely, it formed a rec-
tangular confirmation, which included the points on the most distal
part of the distobuccal root and distopalatal root and the other sides
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Figure 1. (a) Schematic of OTM only group; (b) schematic of OTM + 2AD group; (c) schematic of OTM + 4AD group; (d) sagittal reconstructed micro-CT image
of OTM only group; (e) sagittal reconstructed micro-CT image of OTM + 2AD group; (f) Sagittal reconstructed micro-CT image of OTM + 4AD group; and (g)
histogram showing significant increase (P < 0.05) in the orthodontic tooth movement in OTM + 4AD group. # P < 0.05, *P < 0.05. AD, alveolar decortication;
micro-CT, microfocus computed tomography; OTM, orthodontic tooth movement.

extending to the points of the most distal parts of the mesiobuccal
and mesiopalatal roots. The parameters evaluated were bone vol-
ume fraction (BVF), tissue density, trabecular spacing, and trabecular
thickness.
After imaging, the maxilla from each rat was rehydrated and
decalcified using 14% ethylenediaminetetraacetic acid for 2 weeks
at 4°C. Subsequently samples were processed for standard paraf-
fin embedding and serial sagittal sections 5–7 µm in thickness were
obtained. Tartrate-resistant acid phosphatase (TRAP) staining
was performed using the yellow fluorescent substrate ELF97 (Life
Technologies, Grand Island, New York, USA) according to the manu-
facturer’s instructions. Quantification of fluorescent staining (TRAP)
was performed by Adobe Photoshop (Adobe Systems Incorporated)
on the alveolar bone surfaces on the mesial sides of the distobuccal
roots. The positive pixels for TRAP (yellow fluorescent pixels gener-
ated by ELF97) were counted by selecting each pixel colour. The
number of positive fluorescent pixels were divided by the total num-
ber of pixels in the region of interest and multiplied by 100, obtain-
ing the percentage of positive pixels. The osteoclast numbers were
counted in three sections from four rats in each group, and the values
were then averaged for each animal to run a statistical test.
Statistical analysis
Statistical analysis was done using the GraphPad prism software (La
Jolla, California, USA). The power analysis was based on a previ-
ously published study. The number of animals was calculated by the
G power software and was determined to be six in each group. For
this calculation, an alpha level of 0.05 and beta level of 0.8 were
4 European Journal of Orthodontics, 2019

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Figure 2. Micro-CT data showing BVF, tissue density, trabecular thickness, and trabecular spacing in the OTM only, OTM + 2AD, and OTM + 4AD. (a) Coronally
reconstructed micro-CT image of OTM group; (b) coronal reconstructed micro-CT image of OTM + 2AD group; (c) coronal reconstructed micro-CT image of OTM
group + 4AD; (d) histogram showing significant decrease (P < 0.05) in the BVF in OTM + 4AD group; (e) histogram showing significant decrease (P < 0.05) in the
tissue density in OTM + 4AD group when compared to OTM only; (f) histogram showing significant decrease (P < 0.05) in the trabecular thickness in OTM + 4AD
group; and (g) histogram showing significant increase (P < 0.05) in the trabecular spacing in OTM + 4AD group. # P < 0.05, *P < 0.05. AD, alveolar decortication;
BVF, bone volume fraction; micro-CT, microfocus computed tomography; OTM, orthodontic tooth movement.

selected. The outcome variables examined were intermolar distance
(IMD), BVF, tissue density, trabecular number, trabecular spaces, and
osteoclast percentage. Mean, standard deviation, percentile distribu-
tion, and confidence interval were computed for all the outcome
variables. Normality of the data distribution was examined using
D’Agostino and Pearson omnibus normality test. The osteoclast
percentage (TRAP positive pixels) was not normally distributed and
Wilcoxon signed rank test was used to compare osteoclast percent-
age (TRAP positive pixels) between the control and experimental
groups. Nonparametric tests were used to examine the outcome
J. Chang et al. 5

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Figure 3. Histological examination and quantification of TRAP positive pixels (osteoclasts) in the OTM only, OTM + 2AD, and OTM + 4AD groups. (a) osteoclasts
as evident by TRAP positive pixels in the OTM only group; (b) osteoclasts as evident by TRAP positive pixels in the OTM + 2AD group; (c) osteoclasts as evident by
TRAP positive pixels in the OTM + 4AD group; and (d) histogram showing significant increase (P < 0.05) in the trabecular thickness in OTM + 4AD group. # P < 0.05,
*P < 0.05. AD, alveolar decortication; micro-CT, microfocus computed tomography; OTM, orthodontic tooth movement; TRAP, tartrate resistant acid phosphatase.

variables between the control and the experimental groups. Kruskal–
Wallis test was used to compare the intermolar distance (IMD), BVF
tissue density, trabecular number, and trabecular spaces. All statisti-
cal tests were two-sided and a P value of <0.05 was deemed to be
statistically significant.
Results
Overall weight and health of the rats
All rats used in the study were 15 weeks old at the start of the experi-
ments and 17 weeks old when they were killed. None of the rats lost
the spring during the entire duration of the study in all the three
experimental groups. The rats in all the groups for the entire dura-
tion remained healthy and had a slight increase in the body weight.
Intermolar distance (OTM)
The IMD was significantly higher in the OTM + 4AD group, when
compared to OTM + 2AD (P  =  0.0088) and OTM only group
(P = 0.0004). OTM + 4AD group had 60.71% more tooth movement
than OTM + 2AD group and 119.51% more than OTM only group.
However, there was no significant distance in the IMD between OTM
+ 2AD and OTM group (P = 0.3214) (IMD: OTM = 0.418 ± 0.199;
95% confidence interval [CI] = 0.208 to 0.627; OTM + 2AD = 0.568 ±
0.195; 95% CI = 0.363 to 0.774; OTM + 4AD = 0.904 ± 0.127; 95%
CI = 0.786 to 1.023) (Figure 1g, Table 1).
Bone parameters in the region of interest
Our micro-CT analysis showed a significant decrease in BVF in the
OTM + 4AD group when compared to OTM + 2AD (P = 0.0004) and
OTM group only (P = 0.0004). In addition, there was also a signifi-
cant difference in the BVF between OTM + 2AD and OTM group
(P = 0.0004). OTM + 4AD group had a 37.47% decrease in BVF when
compared to OTM + 2AD group and 57.7% decrease when com-
pared to OTM only group (BVF%: OTM only = 62.52 ± 11.68; 95%
CI = 50.26 to 74.77; OTM + 2AD = 42.46 ± 7.61; 95% CI = 33.01
to 51.91; OTM + 4AD = 26.55 ± 7.35; 95% CI  =  18.83 to 34.27)
6 European Journal of Orthodontics, 2019

Table 1. Distribution of data (orthodontic tooth movement). AD, alveolar decortication; CI, confidence interval; OTM, orthodontic tooth
movement; SD, standard deviation.

Tooth movement (mm)

OTM OTM+ 2AD OTM + 4AD OTM

Mean 0.4183 0.5688 0.9043 62.52

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SD 0.1997 0.1958 0.1278 11.68
Minimum 0.203 0.324 0.712 46.6
Maximum 0.713 0.896 1.053 77.4
Percentiles
25 0.2728 0.4178 0.796 50.13
50 0.343 0.5455 0.924 64.9
75 0.6373 0.7138 1.032 71.85
Lower 95% CI 0.2087 0.3633 0.7861 50.26
Upper 95% CI 0.6279 0.7744 1.023 74.77

Table 2. Distribution of data (bone parameters). AD, alveolar decortication; BVF, bone volume fraction; CI, confidence interval; OTM, ortho-
dontic tooth movement; SD, standard deviation.

Distribution of data (bone Trabecular

parameters) BVF (%) Tissue density mg/ccmHA Trabecular thickness (um) spacing (um)

OTM + OTM + OTM + OTM + OTM + OTM + OTM + OTM

OTM 2AD 4AD OTM 2AD 4AD OTM 2AD 4AD OTM 2AD + 4AD

Mean 62.52 42.46 26.55 1146 1034 941.5 97.8 77.83 64.67 73.4 94.33 111.5
SD 11.68 7.611 7.358 88.01 65.1 97.76 7.014 13.27 9.136 5.32 9.771 8.432
Minimum 46.6 32.1 17.1 1036 935 814 89 56 53 66 79 101
Maximum 77.4 51.3 37.2 1270 1110 1110 107 93 76 79 107 121
Percentiles
25 50.13 34.95 20.18 1071 980.5 882.3 91 67.25 54.5 68.5 86.5 102.5
50 64.9 43.9 25.85 1134 1030 925 99 79 66 73 95 112.5
75 71.85 49.25 33.38 1229 1090 1005 104 90 73 78.5 102.5 119.5
Lower 95% CI 50.26 33.01 18.83 1037 953.4 838.9 89.09 63.9 55.08 66.79 84.08 102.7
Upper 95% CI 74.77 51.91 34.27 1256 1115 1044 106.5 91.76 74.25 80.01 104.6 120.3

Table 3. Distribution of data (histological evaluations) AD, alveolar compared to OTM + 2AD group and 17.84% decrease when com-
decortication; BVF, bone volume fraction; CI, confidence interval; pared to OTM only group (tissue density: OTM only  =  1146  ±
OTM, orthodontic tooth movement; SD, standard deviation; TRAP, 88.01; 95% CI = 1037 to 1256; OTM + 2AD = 1034 ± 65.1; 95%
tartrate resistant acid phosphatase. CI = 953.4 to 1115; OTM + 4AD = 941.5 ± 97.76; 95% CI = 838.9
to 1044) (Figure 2a–2c and 2e, Table 2).
Distribution of data (histological evaluation)
There was a significant decrease in the trabecular thickness in
TRAP (%) OTM + 4AD group when compared to OTM only group. Similarly,
we observed a significant decrease in the trabecular thickness in
OTM OTM + 2AD OTM + 4AD OTM + 2AD group when compared to OTM only group. However,
there was no difference significant between OTM + 4AD and OTM
Mean 0.4183 0.5688 0.9043
+ 2AD groups (trabecular thickness: OTM only = 97.8 ± 7.01; 95%
SD 0.1997 0.1958 0.1278
Minimum 0.203 0.324 0.712
CI = 89.09 to 106.5; OTM + 2AD = 77.83 ± 13.27; 95% CI = 63.9
Maximum 0.713 0.896 1.053 to 91.76; OTM + 4AD = 64.67 ± 9.13; 95% CI = 55.08 to 74.25)
Percentiles (Figure 2a–2c and 2f, Table 2). There was a significant increase in
25 0.2728 0.4178 0.796 the trabecular spacing in the OTM + 4AD group when compared
50 0.343 0.5455 0.924 to OTM + 2AD and OTM only group. Similarly, significant increase
75 0.6373 0.7138 1.032 was observed in OTM + 2D group when compared with OTM
Lower 95% CI 0.2087 0.3633 0.7861 only group (trabecular spacing: OTM only  =  73.4  ± 5.32; 95%
Upper 95% CI 0.6279 0.7744 1.023 CI = 66.79 to 80.016; OTM + 2AD = 94.33 ± 9.77; 95% CI = 84.08
to 104.6; OTM + 4AD = 111.5 ± 8.43; 95% CI = 102.7 to 120.3)
(Figure 2a–2c and 2g, Table 2).
(Figure 2a–2d). However, tissue density was significantly lower
in the OTM + 4AD group when compared to OTM only group
(P  =  0.006). There was no significant difference between OTM + TRAP staining for osteoclast
4AD group when compared to OTM + 2AD group and no signifi- Our histological analysis revealed significant increase in the TRAP
cant difference between OTM + 2AD group and OTM only group. positive pixels (TRAP staining for osteoclast) OTM + 4D when com-
OTM + 4AD group had a 8.95% decrease in tissue density when pared to OTM + 2D (P = 0.002) and OTM only group (P = 0.002)
J. Chang et al.
(TRAP (%): OTM = 2.41 ± 1.20; 95% CI = 1.65 to 3.18; OTM +
2AD = 11.28 ± 6.58; 95% CI = 6.56 to 16.00; OTM + 4AD = 24.57 ±
5.78; 95% CI = 19.73 to 29.41) (Figure 3, Table 3).
Discussion
The results of our study rejected our null hypothesis and the OTM
was significantly increased as the intensity of the ADs increases. The
group with 4AD had 60.71 and 119.51% more OTM than the 2AD
group and control group, respectively. This finding corresponded
with the decrease in BVF, decrease in the tissue density, and increase
in osteoclast numbers. The group with 4AD had 37.47% decrease
in BVF in comparison with the 2AD group, and 57.7% decrease in
BVF in comparison with the tooth movement only control. In addi-
tion, the 4AD group had a 51.25% increase in osteoclast numbers in
comparison with the tooth movement only group.
The objective of our study was to observe the effects on varying
the degree of injury to the cortical bone in a minimally invasive, flap-
less AD procedure. We chose to study the effects of AD because it is
atraumatic and is simple to conduct in a clinical setting, and has been
shown to effectively accelerate tooth movement (23,24). In addition,
AD can be localized to the region of interest without causing signifi-
cant damage to the adjacent alveolar bone.
The results from our study parallel the findings of Frost (25) and
Wilcko et al. (26), who postulated that the intensity of bone healing
response and resulting rate of OTM are directly correlated with the
amount of bone injury. A split-mouth randomized controlled trial by
Abbas et al. (20) which compared the effects of corticotomy with pie-
zocision on canine retraction showed that corticotomies, which were
more invasive, had greater rates of canine retraction at all time points
during a 3-month follow-up period. Another study by Teixeira et al.
comparing the effect of a soft tissue flap with three small perforations
of the cortical plate along with a flap on OTM in adult male Sprague–
Dawley rats produced similar results. In addition, they showed higher
numbers of osteoclasts accompanied by generalized osteopenia and
increased rate of OTM in the group with osteoperforations in com-
parison with the flap only group (27). The results of the Teixeira’s
study were corroborated by Peron et  al. (28) who investigated the
effect of corticotomy in comparison with corticision in 9-week-old
male Wistar rats, showing that the more invasive corticotomy effec-
tively increased bone resorption. Likewise, a study by Kurohama
et al. (29) investigating the effect of different amounts of corticotomy
in 10-week-old female Wistar rats shows that increasing the amount
of corticotomy decreases the BVF. Our results of decreased BVF with
increased injury corroborated with the above studies.
One possible explanation for the variation in results is the diverse
methodologies used to produce injury to induce RAP in the different
studies. Many of the studies compared techniques requiring a flap
with those without while varying the magnitude of damage to the
cortical or medullary bone, introducing confounding variables to the
severity of the injury. Another explanation for the variation in results
is the differing age groups of the rats in the animal studies. Ren et al.
had found that age had an impact on the amount of OTM (30). Our
previous study (31) and the study by Tsai et al. (22) which found no
difference between the magnitude of injury with difference in rate
of tooth movement looked at young, growing rats. In contrast, our
present study along with the study conducted by Teixeira et al. (27)
found a correlation between the degree of injury and the rate of
tooth movement in adult rats.
This study was not conducted without its limitations. Extrapolation
of our findings to the clinical setting must be done with caution because
7
rats, unlike humans, do not have osteonal remodelling (secondary
remodelling). Nonetheless, our in vivo study has provided insight on
titration of the amount of AD on the rate of tooth movement, and its
corresponding change in osteoclast number and bone turnover. Our
future goals involve studying the long-term effects of differing amounts
of ADs on the alveolar bone modelling and remodelling. Our future
goals involve studying, the adverse effects, especially root resorption,
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with varying amounts of AD, in order to find the optimal balance
between acceleration of tooth movement and root resorption.
Conclusions
1. There was a significant increase in the rate of the OTM with
increasing the extent of the ADs.
2. Increasing the extent of ADs leads to significant decrease in the
BVF and the tissue density.
3. There was a significant increase in the number of TRAP positive
pixels (osteoclast number) with increasing the extent of the ADs.
Conflict of interest
None declared.
Funding
American Association of Orthodontic Foundation and Career Development
Grant from NIDCR 5KO8DE025914.
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