Khlef Hanin N, Mousa Mudar Mohammad, Ammar Ali Mohsen, Hajeer Mohammad Y, Awawdeh Mohammed Adel
Department of Orthodontics, Faculty of Dentistry, University of Damascus, Damascus, SYR.
Department of Orthodontics, Faculty of Dentistry, Arab Private University for Science and Technology, Hama, SYR.
Cureus. 2023 Jul 21;15(7):e42273. doi: 10.7759/cureus.42273. eCollection 2023 Jul.
This study aimed to assess the levels of pain, discomfort, and functional impairment associated with the en-masse retraction of the upper anterior teeth when treating Class II division 1 malocclusion patients using traditional corticotomy or flapless corticotomy. In addition, an assessment of patients' satisfaction with the selected surgical intervention was undertaken at one-month post-operatively.
The study sample comprised 40 patients with Class II division 1 malocclusion, randomly assigned to either the traditional corticotomy group (n=20) or the flapless corticotomy group (n=20). Patients underwent extraction of the maxillary first premolars, and orthodontic mini-screws were placed between the maxillary second premolars and the first molars for skeletal anchorage. An en-masse retraction was accomplished in both groups. Patients were asked to fill in a questionnaire at 24 hours (T1), four days (T2), seven days (T3), 14 days (T4), and 28 days (T5) after the surgical intervention using standardized questionnaires. Most questions were answered on a visual analog scale where zero scores meant the absence of pain, discomfort, or functional impairment, and 100 scores meant the worst feelings of these traits.
All patients in both groups entered data analysis with no dropouts. All measured levels were significantly greater in the traditional corticotomy group during the first two weeks following the corticotomy intervention in terms of pain perception (P˂0.001), discomfort (P=0.004), and difficulty in chewing (P=0.015). Additionally, during the first week following corticotomy, levels of perception of discomfort (P˂0.001), difficulty in swallowing (P=0.001), and limitation of jaw movement (P˂0.001) were significantly greater in the traditional corticotomy group. Patient satisfaction, the recommendation to a friend, and acceptance of flapless corticotomy were significantly greater than traditional corticotomy (P=0.002, P=0.001, respectively). 78% of patients in the traditional corticotomy group considered it more discomfort than a tooth extraction, while 50% of patients in the flapless corticotomy group considered tooth extraction more discomfort, with a significant difference between the two groups (P=0.001).
The levels of negative patients' reported outcomes were significantly smaller with flapless corticotomy than with traditional corticotomy. Traditional corticotomy was associated with mild to moderate levels of pain, swallowing difficulty, moderate levels of discomfort, chewing difficulty, and jaw movement limitation after 24 hours of the surgical procedure. In contrast, flapless corticotomy was less problematic and associated with mild pain, swelling, chewing difficulty, jaw movement limitation, and swallowing difficulty at the same assessment time. Patient satisfaction, acceptance, and recommendation to a friend were greater for flapless corticotomy than traditional intervention.
本研究旨在评估在治疗安氏II类1分类错牙合畸形患者时，使用传统骨皮质切开术或无瓣骨皮质切开术整体后移上前牙时的疼痛、不适及功能障碍水平。此外，在术后1个月对患者对所选手术干预的满意度进行评估。
研究样本包括40例安氏II类1分类错牙合畸形患者，随机分为传统骨皮质切开术组（n = 20）和无瓣骨皮质切开术组（n = 20）。患者拔除上颌第一前磨牙，并在上颌第二前磨牙与第一磨牙之间植入正畸微螺钉用于骨锚固。两组均完成整体后移。在手术干预后的24小时（T1）、4天（T2）、7天（T3）、14天（T4）和28天（T5），要求患者使用标准化问卷填写调查表。大多数问题采用视觉模拟评分法回答，0分表示无疼痛、不适或功能障碍，100分表示这些特征的最严重感受。
两组所有患者均进入数据分析，无失访。在骨皮质切开术干预后的前两周，传统骨皮质切开术组在疼痛感知（P＜0.001）、不适（P = 0.004）和咀嚼困难（P = 0.015）方面的所有测量水平均显著更高。此外，在骨皮质切开术后的第一周，传统骨皮质切开术组的不适感知水平（P＜0.001）、吞咽困难（P = 0.001）和下颌运动受限（P＜0.001）显著更高。患者对无瓣骨皮质切开术的满意度、向朋友推荐度及接受度均显著高于传统骨皮质切开术（分别为P = 0.002，P = 0.001）。传统骨皮质切开术组78%的患者认为其比拔牙更不适，而无瓣骨皮质切开术组50%的患者认为拔牙更不适，两组间差异有统计学意义（P = 0.001）。
无瓣骨皮质切开术患者报告的负面结果水平显著低于传统骨皮质切开术。传统骨皮质切开术在手术24小时后会导致轻至中度疼痛、吞咽困难、中度不适、咀嚼困难及下颌运动受限。相比之下，在相同评估时间，无瓣骨皮质切开术问题较少，仅伴有轻度疼痛、肿胀、咀嚼困难、下颌运动受限及吞咽困难。患者对无瓣骨皮质切开术的满意度、接受度及向朋友推荐度均高于传统干预。
