Impact of Full-Thickness Mucoperiosteal Flap Elevation on Orthodontic Tooth Movement in Split-Mouth Extraction Cases: An In-Vivo Study.

This will be a split-mouth study. Thirty-one patients undergoing orthodontic treatment will be selected. Each participant will be treated using a fixed pre-adjusted appliance with a metal 0.022 x 0.028” slot MBT prescription bracket system. Detailed information about the study will be provided, and written informed consent will be obtained.

Study Phases:Phase I – Initial Orthodontic Phase: Orthodontic bonding and banding will be performed. Levelling and alignment will be done using 0.014" and 0.016" NiTi archwires, followed by 0.019 x 0.025" NiTi wires. Maxillary first premolars will be extracted after alignment.

Allocation Method: In each patient, one side of the maxillary arch will be randomly designated as the experimental side and the opposite as control. The experimental side will be selected by lottery for the first patient, and then alternated for the rest.

• Control group: Conventional extraction.
• Experimental group: Extraction with elevation of a Full-Thickness Mucoperiosteal Flap (FTMPF).

Phase II – Surgical Intervention: Control side extraction will be done three days before the test side. On the experimental side, after local anesthesia, a trapezoidal FTMPF will be raised in the canine-premolar region using a No. 15 blade and Molt No. 9 elevator. A sulcular incision will be made from the mesial of the second premolar to the mesial of the canine, avoiding the canine eminence. Palatal mucosa will be elevated using a tunneling technique. First premolars will be extracted on both sides using premolar forceps. The sockets will be irrigated with saline, and the flap on the test side will be sutured with 3-0 black braided silk.

Postoperative Instructions: Cap. Amoxicillin 500 mg (TID) and Tab. Paracetamol 650 mg (BID) will be given for three days. Patients will be advised to avoid spitting, gargling, and hot/hard foods for one week.

Phase III – Retraction Phase: A 0.019 x 0.025” stainless steel archwire will be inserted on both sides on the same day. En-masse retraction will begin using 12 mm NiTi closed coil springs from the power arm mesial to the canine to the molar tube. Force will be standardized at 150g using a Dontrix gauge.

Results: Canine retraction will be evaluated monthly for four months using study models. The distance moved by the canine will be measured from the cusp tip to a reference plane perpendicular to the occlusal plane just mesial to the first molar, using a Digital Vernier Caliper.