Does the time-point of orthodontic space closure initiation after tooth extraction affect the incidence of gingival cleft development? A randomized controlled clinical trial

Risk factors for gingival invagination: A retrospective study

AIM

This study aimed to identify the risk factors for gingival invagination during orthodontic treatment after premolar extraction.

MATERIALS AND METHODS

The medical records of 135 patients who had undergone interdental space closure after premolar extraction were collected, and cone beam computed tomography was performed to determine the presence of gingival invagination. The risk factors were examined using mixed-effects models and generalized propensity score weighting (GPSW) to develop a predictive model.

RESULTS

Univariate analysis revealed that the extraction site, buccal bone thickness 4 mm apical to the cemento-enamel junction (MB1), mid-root buccal bone thickness (MB2) and vertical skeletal relationships were related to gingival invagination (p < .05). Furthermore, a subsequent multivariable mixed-effects model analysis indicated a significantly increased risk of gingival invagination at MB1 < 1 mm (p < .001; odds ratio [ORMB1≤0.5mm] = 29.304; 95% confidence interval [CI]: 8.986-93.807; OR0.5

CONCLUSIONS

The risk of gingival invagination is higher in patients with MB1 < 1 mm and in normodivergent or hyperdivergent patients.

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Key Words

• gingiva
• orthodontics
• periodontal diseases
• risk factors
• tooth extraction

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MESH Headings Collapse

Grants

• 2022Z02 Applied Basic Research Program, Affiliated Stomatological Hospital of Southwest Medical University
• 2023ZYD0112 Centralized Guided Local Science and Technology Development Project

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Affiliation(s)

M Han Department of Orthodontics, The Affiliated Stomatological Hospital, Southwest Medical University, Luzhou, China
S H Li Department of Orthodontics, The Affiliated Stomatological Hospital, Southwest Medical University, Luzhou, China
Y Yao Department of Orthodontics, The Affiliated Stomatological Hospital, Southwest Medical University, Luzhou, China
Yijiao Zhao The Center of Digital Dentistry, Faculty of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
L P You Department of Orthodontics, The Affiliated Stomatological Hospital, Southwest Medical University, Luzhou, China
Q Zheng Department of Orthodontics, The Affiliated Stomatological Hospital, Southwest Medical University, Luzhou, China
X M Xu Department of Orthodontics, The Affiliated Stomatological Hospital, Southwest Medical University, Luzhou, China

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The effect of early versus delayed space closure on the rate of orthodontic tooth movement: a systematic review and meta-analysis

BACKGROUND

Orthodontic space closure of extraction sites can be initiated early, within 1-week post-extraction, or it can be delayed for a month or more.

OBJECTIVE

This systematic review aimed to evaluate the effect of early versus delayed initiation of space closure after tooth extraction on the rate of orthodontic tooth movement.

SEARCH METHODS

Unrestricted search of 10 electronic databases was conducted until September 2022.

SELECTION CRITERIA

Randomized controlled trials (RCTs) investigating the initiation time of space closure of extraction sites in patients undergoing orthodontic treatment were included.

DATA COLLECTION AND ANALYSIS

Data items were extracted using a pre-piloted extraction form. The Cochrane's risk of bias tool (ROB 2.0) and the Grading of Recommendations, Assessment, Development, and Evaluation approach were used for quality assessment. Meta-analysis was undertaken if there are at least two trials reporting the same outcome.

RESULTS

Eleven RCTs met the inclusion criteria. Meta-analysis revealed that early canine retraction resulted in a statistically significant higher rate of maxillary canine retraction when compared to delayed canine retraction [mean difference (MD); 0.17 mm/month, 95% CI: 0.06 to 0.28, P = 0.003, 4 RCTs, moderate quality]. Duration of space closure was shorter in the early space closure group, but not statistically significant (MD; 1.11 months, 95% CI: -0.27 to 2.49, P = 0.11, 2 RCTs, low quality). The incidence of gingival invaginations was not statistically different between early and delayed space closure groups (Odds ratio; 0.79, 95% CI: 0.27 to 2.29, 2 RCTs, P = 0.66, very low quality). Qualitative synthesis found no statistically significant differences between the two groups regarding anchorage loss, root resorption, tooth tipping, and alveolar bone height.

CONCLUSIONS

Based on the available evidence, early traction within the first week after tooth extraction has a minimal clinically significant effect on the rate of tooth movement compared to delayed traction. Further high-quality RCTs with standardized time points and measurement methods are still needed.

REGISTRATION

PROSPERO (CRD42022346026).

Demineralized dentin matrix promotes gingival healing in alveolar ridge preservation of premolars extracted for orthodontic reason: a split-mouth study

Objective

The purpose of this study was to prospectively evaluate the efficacy of a demineralized dentin matrix (DDM) in decreasing the initial inflammatory response of the gingiva and facilitating the repair and regeneration of soft tissue in alveolar ridge preservation.

Methods

This clinical study employed a split-mouth design. Fourteen patients with a total of forty-four sites underwent extraction and alveolar ridge preservation (ARP) procedures. A Bilaterally symmetrical extraction operation were conducted on the premolars of each patient. The experimental group received DDM as a graft material for ARP, while the control group underwent natural healing. Within the first month postoperatively, the pain condition, color, and swelling status of the extraction sites were initially assessed at different time points Subsequently, measurements were taken for buccal gingival margin height, buccal-lingual width, extraction socket contour, and the extraction socket area and healing rate were digitally measured. Additionally, Alcian Blue staining was used for histological evaluation of the content during alveolar socket healing.

Results

Both groups experienced uneventful healing, with no adverse reactions observed at any of the extraction sites. The differences in VAS pain scores between the two groups postoperatively were not statistically significant. In the early stage of gingival tissue healing (3 days postoperatively), there were statistically significant differences in gingival condition and buccal gingival margin height between the two groups. In the later stage of gingival tissue healing (7, 14, and 30 days postoperatively), there were statistically significant differences in buccal-lingual width, extraction socket healing area, and healing rate between the two groups. Furthermore, the histological results from Alcian Blue staining suggested that the experimental group may play a significant role in promoting gingival tissue healing, possibly by regulating inflammatory responses when compared to the control group.

Conclusion

The application of DDM in alveolar ridge preservation has been found to diminish initial gingival inflammation after tooth extraction. Additionally, it has shown the ability to accelerate early gingival soft tissue healing and preserve its anatomical contour.

Clinical trial registration

chictr.org.cn, identifier ChiCTR2100050650.

Complications and treatment errors involving periodontal tissues related to orthodontic therapy

In this review, typical clinical complications involving periodontal tissues are illustrated that can be encountered in conjunction with orthodontic therapy (OT). Special considerations are given for various clinical scenarios, such as the patient presenting in periodontal health, with periodontitis, or with mucogingival conditions. While some of the complications are seen as common side effects of OT, other, more severe, problems that could have been avoided may be viewed as treatment errors. Recommendations are made on how to prevent these complications, based on the currently available evidence, on clinical practice guidelines, and on expert opinion. In conclusion, while there are several areas in which OT can have unwanted adverse effects on periodontal/mucogingival conditions, there is also great potential for synergies, offering opportunities for close cooperation between the two specialties (periodontics and orthodontics) for the benefit of patients affected by tooth malpositioning and/or periodontal or mucogingival problems.

Augmented Corticotomy on the Lingual Side in Mandibular Anterior Region Assisting Orthodontics in Protrusive Malocclusion: A Case Report

Adequate alveolar bone volume is a prerequisite condition for successful orthodontic tooth movement and posttreatment stability. Mandibular anterior teeth are more likely to exhibit dehiscence and fenestration in adult patients, which make orthodontic treatment in adults challenging, especially when the amount of retraction of the anterior teeth is large. Herein, we report the treatment of augmented corticotomy only on the lingual side in the mandibular anterior region to increase the volume of soft and hard tissue assisting orthodontics in a Class I bialveolar protrusive malocclusion and propose management strategies of mandibular incisor retractions. A 22-year-old female with a chief complaint of protrusive mouth presented to the Department of Orthodontics for orthodontic treatment, diagnosed with Class I bialveolar protrusive. The orthodontic treatment plan involved the extraction of four premolars and extensive retraction of the anterior teeth using microimplant anchorage. In consideration of the fenestration and dehiscence in the mandibular anterior alveolar bone and the pattern of tooth movement, augmented corticotomy was performed on the lingual side combined with bone grafting. Clinical and radiographic evaluation after treatment revealed significant improvements in the facial profile and in periodontal phenotype. Augmented corticotomy assisting orthodontic treatment could be a promising treatment strategy for adult patients with alveolar protrusion to maintain periodontal health.

Does the time-point of orthodontic space closure initiation after tooth extraction affect the incidence of gingival cleft development? A randomized controlled clinical trial

Background

Gingival clefts (GCs) develop frequently during orthodontic space closure and may compromise the treatment outcome. This study assessed whether the time‐point of orthodontic space closure initiation, after permanent tooth extraction, affects the incidence of GC.

Methods

In 25 patients requiring bilateral premolar extraction because of orthodontic reasons, one premolar, chosen at random, was extracted 8 weeks before space closure initiation (“delayed movement,” DM), whereas the contralateral premolar was extracted 1 week before (“early movement,” EM) (“treatment group”). Presence or absence of GC after 3 and 6 months (“time‐point”) was recorded and any association with various parameters (i.e., treatment group, time‐point, gender, jaw, craniofacial growth, gingival biotype, buccal bone dehiscence after extraction, space closure) was statistically assessed.

Results

Twenty‐one patients contributing with 26 jaws were finally included in the analysis. Overall, GCs were frequent after 3 (DM: 53.9%; EM: 69.2%) and 6 months (DM: 76.9%; EM: 88.5%). EM (P = 0.014) and larger space closure within the study period (P = 0.001) resulted in a significantly higher incidence of GC. Further, there was a tendency for GC development in the presence of buccal bone dehiscence (P = 0.052) and thin gingival biotype (P = 0.054). “Fast movers” (herein cases with a tooth movement ≥1 mm per month) developed a GC in >90% of the cases already after 3 months. “Slow movers” developed a GC in 25% and 70% after 3 months and final evaluation, respectively.

Conclusions

GC development is a frequent finding during orthodontic space closure and seems to occur more frequently with early tooth movement initiation and in “fast movers.”