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On Sep 2018




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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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Calcutta National Medical College & Hospital , Kolkata




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Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Dentistry
Year : 2011 | Month : November | Volume : 5 | Issue : 7 | Page : 1473 - 1477 Full Version

Rapid Canine Retraction and Orthodontic Treatment with Dentoalveolar Distraction Osteogenesis


Published: November 1, 2011 | DOI: https://doi.org/10.7860/JCDR/2011/.1703
Pankaj J. Akhare, Akshay M. Daga, Shilpa Pharande

1. Corresponding Author. 2. BDS., MDS, Assistant Professor Department of Oral & Maxillofacial Surgery VSPM’s Dental College & Research Centre. Nagpur, Maharashtra, India. 3. Assistant Professor Sinhgad Dental College, Pune, Maharashtra. India.

Correspondence Address :
Pankaj J. Akhare (BDS., MDS), Assistant Professor
Department of Orthodontics & Dentofacial Orthopedics
VSPM’s Dental College & Research Centre.
Nagpur, Maharashtra, India.
E-mail: dr_pankaj_a@yahoo.co.in
Phone: +91 98900 98980

Abstract

Duration of treatment is one of the things that orthodontic patients complain about most. To shorten the treatment time, a new technique of rapid canine retraction through distraction osteogenesis was introduced. The effects of dentoalveolar distraction on the dentofacial structures are presented in this article.

Material: The study sample consisted of 20 maxillary canines in 10 growing or adult subjects (mean age, 16.53 years; range, 13.08-25.67 years). First premolars were extracted, the dentoalveolar distraction surgical procedure performed, and a custom-made intraoral, rigid, tooth-borne distraction device was placed. The canines were moved rapidly into the extraction sites in 8 to 14 days, at a rate of 0.8 mm per day.

Results: Full retraction of the canines was achieved in a mean time of 10.05 (–2.01) days. The anchorage teeth were able to withstand the retraction forces with minimal anchorage loss. The mean change in canine inclination was 13.15° – 4.65°, anterior face height and mandibular plane angle increased. No clinical and radiographic evidence of complications, such as root fracture, root resorption, ankylosis, periodontal problems, and soft tissue dehiscence, was observed. Patients had minimal to moderate discomfort after the surgery.

Conclusions: The dentoalveolar distraction technique is an innovative method that reduces overall orthodontic treatment time by nearly 50%, with no unfavorable effects on surrounding structures.

Keywords

Rapid Canine Distraction, Dentoalveolar distraction device, Canine Retraction

Introduction
Distraction osteogenesis was used as early as 1905 by Codivilla (1) and was later popularized by the clinical and research studies of Ilizarov in Russia. Distraction osteogenesis was performed in the human mandible by Guerrero (3) in 1990 and by McCarthy et al (4) in 1992. Since then, it has been applied to various bones of the craniofacial skeleton.

Most of the orthodontic patients have some crowding. Although non-extraction treatment has become popular during the last decade, many patients do need extractions (5). The first phase of the treatment for the premolar extraction patients is the distal movement of the canines. With the conventional orthodontic treatment techniques, biological tooth movement can be achieved (6),(7), but the canine retraction phase usually lasts for 6 to 8 months.

Therefore, under normal circumstances, a conventional treatment with fixed appliances is likely to last for 20 to 24 months. The duration of the orthodontic treatment is one of the major concerns that orthodontic patients complain about the most – especially the adult patients. To address this problem, a technique of rapid canine retraction in which the concepts of distraction osteogenesis are used, has been developed: dentoalveolar distraction (DAD). In this technique, which has been described and used by I’s¸ eri et al (8) and Kis¸ nis¸ ci et al (9), osteotomies surrounding the canines are made to achieve the rapid movement of the canines in the dentoalveolar segment, in compliance with the principles of distraction osteogenesis.

The purpose of this study was to examine the effect of the DAD technique on the dentofacial structures.

Material and Methods

Class I or II patients who needed orthodontic treatment with fixed appliances and tooth extractions were selected for this study. All the patients were in the permanent dentition and had moderate to severe crowding or an increased overjet at the start of the treatment (6 females and 4 males). Because the treatment involved surgery, only subjects who were aged 13 years or older were included. The initial mean age was 16.53 years (range-13.08–25.67 years). A custom-made, rigid, tooth-borne intraoral distraction device was designed for DAD and rapid tooth movement (Table/Fig 1). Ethical clearance was obtained from the local ethical committee for the surgical procedure.

The device is made of stainless steel and has a distraction screw and 2 guidance bars. The patient or his/her parent turns the screw clockwise with a special apparatus, and this moves the canine distally.

The device is placed after a surgical procedure, which has been described below, which includes the extraction of the first premolars. No other appliances are placed on the second premolars or the incisors during the distraction procedure. The treatment procedure was explained in detail to all the patients and their parents, and their informed consent was obtained before surgery.

SURGICAL PROCEDURE The surgery was performed on an outpatient basis, with the patient under local anaesthesia, sometimes being supplemented with sedation. The procedure was described previously by Kis¸ nis¸ ci et al (9). Briefly, a horizontal mucosal incision was made parallel to the gingival margin of the canine and the premolar beyond the depth of the vestibule.

Cortical holes were made in the alveolar bone with a small, round, carbide bur (Table/Fig 2) from the canine to the second premolar, curving apically to pass 3 to 5 mm from the apex. A thin, tapered, fissure bur was used to connect the holes around the root. Fine osteotomes were advanced in the coronal direction.

The first premolar was extracted and the buccal bone was removed between the outlined bone cut at the distal canine region anteriorly and the second premolar posteriorly (Table/Fig 2). The buccal and apical bone through the extraction socket and the possible bony interferences at the buccal aspect that could be encountered during the distraction process were eliminated or smoothed between the canine and the second premolar, thus preserving the palatal or the lingual cortical shelves. The palatal shelf was preserved, but the apical bone near the sinus wall was removed, leaving the sinus membrane intact to avoid interferences during the active distraction process.

The incision was closed with absorbable sutures, and an antibiotic and a non-steroidal anti-inflammatory drug were prescribed for 5 days. The surgical procedure lasted for approximately 30 minutes for each canine (9).

THE DISTRACTION PROTOCOL AND DENTOALVEOLAR DISTRACTION The distractor was cemented on the canine and on the first molar immediately after the surgery. To ensure that the alveolar segment which was carrying the canine was fully mobilized intra-operatively, the device was activated for several millimeters and set back to its original position.

The distraction was initiated within 3 days after the surgery. The distractor was activated twice per day, in the morning and in the evening, for a total of 0.8 mm per day. Immediately after the canine retraction was completed, fixed orthodontic appliance treatment was initiated, and the leveling stage was started in both the dental arches. Ligatures were placed under the archwire between the distracted canine and the first molar and they were kept at least 3 months after the DAD procedure. Periapical radiographs of the canines and the first molars and panoramic films were taken at the start and at the end of the distraction procedure to evaluate the root structures. The root resorption was evaluated with a root resorption scale, which was a modified form of Sharpe et al’s procedure (10), which was as follows:

S0: no apical root resorption; S1: widening of the periodontal ligament (PDL) space at the root apex; S2: moderate blunting of the root apex (up to one third of the root length); S3: severe blunting of the root apex (beyond one third of the root length). The pulp vitality was evaluated and recorded with an electronic digital pulp tester. All teeth which were subjected to the pulp vitality test (canines, incisors, second premolars and first molars) were cleaned and tested on the buccal surfaces.

Results

Tables I and II show the mean rate and the duration of the distraction, the mean posterior anchorage loss (NSLv-ms), and the mean change in the canine inclination (NSL/can). The canines were moved into the socket of the extracted first premolars, in compliance withthe distraction osteogenesis principles. The distraction procedure was completed in 8 to 14 days (mean- 10.05 –2.01 days) at a rate of 0.8 mm per day (Table/Fig 4). The canines were fully retracted, and the anchorage teeth (first molars and second premolars) were able to withstand the retraction forces, with minimal anchorage loss (Table/Fig 5). The mean sagittal (NSLv-ms) and vertical (NSL-ms) anchorage loss was 0.19 mm and 0.51 mm, respectively, during the rapid distraction of the canines, and these were statistically insignificant. The distal displacement of the canines was mainly a combination of tipping and translation, with a mean change in the canine inclination of 13.15° (–4.65°) at the end of the distraction period (Table/Fig 6).

In addition, the anterior face height (n me) and the mandibular plane angle (NSL/ML) were increased and the overjet was decreased significantly during the distraction period (P–.05, P–.01). No significant changes were observed in the other measurements. The clinical and radiographical examination showed no evidence of complications such as root fracture, root resorption, ankylosis, and soft tissue dehiscence, in any patient. No apical root resorption (S0) was detected in any subject, at the start or at the end of the dentoalveolar distraction (Table/Fig 7). The patients reported minimal to moderate discomfort, especially during the first 2 days after the surgery, and oedema was observed in some patients [Table/Fig 8].

Before the start of the treatment, the pulp vitality was tested with an electronic pulp tester. All the teeth reacted positively, with the exception of a right maxillary central incisor in a patient who had previously had root canal therapy. At the end of the dentoalveolar distraction procedure and during the fixed appliance orthodontic treatment, it was found that the pulps of all the concerned teeth remained vital, as was confirmed by the pulp vitality tests.

Discussion

Orthodontic tooth movement is a process whereby the application of a force induces bone resorption on the pressure side and bone apposition on the tension side (6),(7). Classically, the rate of the orthodontic tooth movement depends on the magnitude and the duration of the force (6), the number and the shape of the roots, the quality of the bony trabecula, the patient’s response, and the patient’s compliance. The rate of the biological tooth movement with the optimum mechanical force was approximately 1 to 1.5 mmin 4 to 5 weeks (11),(12) (13). Therefore, in the maximum anchorage premolar extraction cases, canine distalization usually takes 6 to 9 months, contributing to an overall treatment time of 1.5 to 2 years. The duration of orthodontic treatment is one of the issues which patients complain about the most, especially the adult patients. Many attempts have been made to shorten the orthodontic tooth movement (14),(15),(16). Liou and Huang (16) reported a rapid canine retraction technique which involved the distraction of the PDL after the extraction of the first premolars.

The method was described as an innovative approach; however, refinements in the surgical technique, such as the use of corticotomies versus full osteotomies and the applicability of the technique to the teeth, close to the mandibular dental nerve, weresuggested (17). I’s¸ eri et al (8) and Kis¸ nis¸ ci et al (9) described and clinically used a new technique for the rapid retraction of the canines, the DAD.

With this technique, the horizontal and the vertical osteotomies surrounding the canines are made to achieve the rapid movement of the canines in the dentoalveolar segment, in compliance with the principles of distraction osteogenesis.

Ten patients with Class I or II malocclusion, with moderate to severe crowding, were selected for this study. Two patients had Class II Division 1 malocclusions, and 1 had an open bite. The maxillary and the mandibular canines were moved rapidly into the cavity of the extracted first premolars, following a surgical procedure that lasted about 30 minutes for each canine.

Nine vertical corticotomies were performed around the root of the canine, and the spongy bone around it was split. With this surgical technique, the dentoalveolus could be used as a bone transport segment for the rapid posterior movement of the canines. This surgical technique does not rely on the stretching and the widening of the PDL, which prevents overloading and stress accumulation in the periodontal tissues. The buccal bone, the apical bone through the extraction site and the palatal cortical plate did not interfere with the movement of the canine-dentoalveolar segment during the distraction procedure.

All the patients tolerated the surgery and the device after the surgery. Fixed appliance orthodontic treatment was started immediately after the termination of the canine distraction in all the patients (18).

The term physiological tooth movement designates, primarily, the slight tipping of the tooth in its socket and, secondarily, the changes in tooth position that occur during and after tooth eruption (19). In fact, there is basically no great difference between the tissue reactions which are observed in the physiological tooth movement and those which are observed in the orthodontic tooth movement.

However, because the teeth are moved more rapidly during (Table/Fig 3) the treatment, the tissue changes which are elicited by the orthodontic forces are more marked and extensive. It has been assumed that the application of force will result in hyalinization, which is caused partly by anatomical and partly by mechanical factors (20). The hyalinization period usually lasts for 2 or 3 weeks (19), and the tooth movement continues at a rate of 1 to 1.5 mm in 4 to 5 weeks (13). On the other hand, with the custom-made, rigid, tooth-borne distraction device, the canines were retracted at a rate of 0.8 mm per day and they were moved into the socket of the extracted first premolars in compliance with the distraction osteogenesis principles. The mean distraction time was 10 days (the canines were retracted until they came into contact with the second premolars), and the distraction procedure was completed in 8 to 14 days. This was the most rapid movement of a tooth which was demonstrated in the literature (13),(16).

Although every attempt was made to achieve the bodily movement of the canines with distraction osteogenesis (the distractor was designed with 2 guidance bars and was placed as high as possible on the buccal side of the teeth), a significant amount of tipping of the canines was observed (Table/Fig 2). Therefore, the distal displacement of the canines was mainly a combination of tipping and translation.

The full retraction of the canines was achieved, and the anchorage teeth (first molars and second premolars) were able to withstandthe retraction forces, with minimal anchorage loss. The mean sagittal and vertical anchorage losses were 0.19 mm and 0.51 mm, respectively, during the rapid distraction of the canines.

In fact, the mandibular plane angle (NSL/ML) and the anterior face height (n me) were increased slightly (0.67°–0.80° and 0.99–0.57 mm, respectively), which may be related to the insignificant amount of extrusion of the maxillary first molars (0.51–0.93 mm). Therefore, one should consider the vertical anchorage loss of the maxillary first molars, especially in patients with an open bite or with a tendency to open bite, who were treated with DAD. In a previously published study (16) which demonstrated rapid canine retraction with the PDL distraction technique, the average mesial movement of the first molars was less than 0.5 mm in 3 weeks; however, no data regarding the vertical posterior anchorage loss were presented.

After the extraction of the first premolars and the rapid retraction of the canines into the socket, a significant spontaneous decrease in the overjet was observed. This may be expected by taking into account the recently distracted fibrous new bone tissue, just behind the incisors. Another observation of this study was the rapid movement of the lateral incisors into the newly generated fibrous bone tissue after DAD.

Liou et al (18) demonstrated in mature beagles, that the best time to initiate the tooth movement was immediately after the distraction, when the edentulous space was still fibrous and the bone formation was just starting; they suggested that the tooth movement should be initiated when the osteogenic activity which was brought about by the distraction process was active, the new bone was still fibrous, and the trabeculae were not well developed.

Our clinical observations support the findings of that experimental study and may provide an example to relieve severe dental crowding and overjet in an extremely short time. However, systematic clinical and experimental research studies are still needed. No clinical and radiographical evidence of the complications, such as root fracture, root resorption, ankylosis, and soft tissue dehiscence, was observed in any of the patients. Although the fundamental causes of the treatment-associated root resorption are still poorly understood, and the magnitude of resorption is almost unpredictable, an association between the duration of the applied force and increased root resorption has been reported (21). It has generally been accepted that the best way to minimize root resorption was to complete the tooth movement in a short time. Root resorption begins 2 to 3 weeks after the orthodontic force is applied and can continue for the duration of the force application (21),(22),(23).

The full retraction of the canines with DAD occurred in 8 to 14 days in our study, an extremely short time for root resorption to begin. Although no meaningful findings were achieved with the electronic pulp tester, we still think that the distracted canines preserved their pulp vitality at the end of the dentoalveolar distraction. The pulp-vitality test is not a reliable technique when it is performed during the orthodontic tooth movement (16). Moreover, no colour change was observed in any teeth during the observation period of this study. Block et al (24) demonstrated that the inferior alveolar nerve and the blood vessels regenerate a in short time after the mandibular distraction (25),(26),(27),(28),(29).

The findings of our study indicate that the distal movement of the canines is a combination of tipping and translation. This means that the crown moves more than the root apex, and, similar to the neurovascular bundle in mandibular distraction, the pulp tissues of the teeth will remain vital under controlled rapid stretching.

Therefore, the observed tipping of the canines might be an advantage with regards to the pulp vitality during the rapid tooth movement with DAD. However, further investigation of the pulp vitality is needed in patients who are subjected to rapid tooth movement with dentoalveolar distraction.

Conclusion

Distraction osteogenesis for rapid orthodontic tooth movement is a promising technique. With DAD, canines can be fully retracted in 8 to 14 days. The following older adolescent and adult patients could benefit from the technique: those with compliance problems; those with moderate or severe crowding; those with Class II malocclusions with overjet; those with bimaxillary dental protrusion; orthognathic surgery patients who need dental decompensation; and those with small root-shape malformations, short roots, periodontal problems, or ankylosed teeth. With the DAD technique, the anchorage teeth can withstand the retraction forces with no anchorage loss and without any clinical or radiographical evidence of the complications, such as root fracture, root resorption, ankylosis, periodontal problems, and soft tissue dehiscence.

The DAD technique reduces the orthodontic treatment duration by 6 to 9 months in the patients who need extraction, with no need for extraoral or intraoral anchorage devices and with no unfavourable short-term effects in the periodontal tissues and in the surrounding structures.

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