Three-dimensional assessment of the synergistic effects of Micro-osteoperforation combined with platelet-rich fibrin local injection on the rate of orthodontic tooth movement during canine retraction: a split-mouth randomized controlled clinical trial

The study will be explained to every subject in detail and an informed consent will be obtained by the patient or parents, also obtained an individualized attendance records with an outcomes assessment sheet for all participants formalized for study monitoring. According to the random allocation process, study groups will be categorized according to the intervention procedures into 2 groups: A: micro-osteoperforations only (MOPs) / Control group B: micro-osteoperforations (MOPs) with injectable rich plasma fibrine i-RPF/ interventional group A randomly selected side of maxillary arch will receive PRF combined with MOPs. The contralateral side will receive only MOPs and served as the control. The application of micro-osteoperforations (MOPs) for both sides will be done by the primary investigator following a systematic protocol at UST clinics . The MOPs will be placed at 5, 10 and 15 mm from the gingival margin and performed under local anesthesia using a mini-screw (1.8 mm diameter, 8 mm length) through a self-drilling method placed distal and mesial to the canine tooth. The procedures anticipated to take 20-30 minutes. canine retraction with absolute anchorage using mini-screws or temporary anchorage devices (TADs) will be initiated in both sides utilizing a NiTi closed coil spring with 150g force. The TADs placed between roots of 2nd premolar and 1st molar. the protocol of platelet-rich fibrin local injection, including : the inject-able plasma rich fibrin (i-PRF) will be obtained from 20 ml of blood drawn from each patient’s brachial vein, centrifuged at 700 rpm for 3 min and then the separated plasma in an sterile needle will be immediately injected. the injection of 5 ml of plasma rich fibrin (PRF) will be performed under local anesthesia into the mucous membrane of the buccal and palatal aspects of oral mucosa at the extraction sites for the intervention side at three level distance along the 1st premolar socket. creation and injection of platelet-rich fibrin anticipated to take 30 - 40 minutes. The procedures ( MOPs and platelet-rich fibrin injection) will be repeated 4 weeks later. means it's done a twice only in the study duration.