We read the article entitled “Rate of tooth movement and dentoskeletal effects of rapid canine retraction by dentoalveolar distraction osteogenesis: a prospective study” in the August 2017 issue with great interest (Kurt G, İşeri H, Kişnişçi R, Özkaynak O. Am J Orthod Dentofacial Orthop 2017;152:204-13).
We found the article to be esoteric and were overwhelmed to see the rate of tooth movement achieved by the process of distraction. Other articles have been published in various international journals and cited in the literature, but none achieved canine retraction in just 11 days. The article was interesting because it clearly indicated the steps of the surgical procedure. Moreover, the ingenious design of the distractor meant that it could be placed in the deepest part of the vestibule close to the center of resistance of the anchor and the teeth to be moved. This probably helped the authors to distalize the canine in bodily fashion with minimum tipping compared with the control group, which suffered relatively more tipping.
There are some aspects regarding this article that we wish to bring to the notice of the reader.
It is obvious from the surgical procedure that a 1-wall defect is created at the end of the surgery due to removal of the buccal cortical plate, which has a poor prognosis according to the literature.
Maximum vertical bone loss occurs in the first 3 months if the socket has not been preserved or grafted. According to this article, the buccal cortical plate was removed during surgery, and the socket was deepened to achieve unhindered distal movement of the canine housing. The defect that was in the premolar region had shifted to the canine region after distalization. Although callus formation would result in bone formation, nothing was mentioned about the vertical bone height achieved posttreatment, and this creates some doubt in the minds of readers.
Furthermore, the authors showed pretreatment and posttreatment panoramic radiographs, but they did not show a 2-dimensional occlusogram or a 3-dimensional view of the surgical area at posttreatment to quantify the amount of bone width or height achieved compared with the original width. That creates doubt about the buccolingual width of the bone at the end of the treatment, since we cannot truly appreciate bone height and width in an panoramic radiograph.
It is clearly mentioned in the article that the distalized canine was splinted for 3 months to stablize it using ligatures, but the authors did not report whether the fixed mechanotherapy was started immediately after dentoalveolar distraction or after the prescribed waiting period. The fixed mechanotherapy should be done before distraction because immediately after canine distraction, heavier rectangular wires can stabilize the tooth and act as a better splint.
The article also discussed nonsignificant mesial movement of the molars during distraction and claims this as superior over previous studies in terms of anchorage loss, but when we look at the clinical photographs (Figs 5 and 6), we notice that the end-on molar relationship has become Class II, which needs to be discussed precisely in terms of molar anchorage loss.
At last, the area that cannot be disregarded is the retention protocol for the treatment undergone, which was not considered.
∗ The viewpoints expressed are solely those of the author(s) and do not reflect those of the editor(s), publisher(s), or Association.