Orthodontic treatment of periodontal defects. A systematic review

Comparative evaluation of treatment of angular bone defect related to over-erupted tooth using guided tissue regeneration (GTR) followed by orthodontic intrusion (OI) versus OI followed by GTR: a controlled clinical trial

BACKGROUND

Prematurity resulted from pathological migration of periodontally involved teeth with the loss of vertical stopping points between teeth, which can lead to teeth over eruption with dimensional changes favoring occlusal discrepancies. Therefore, evaluating and comparing the effect of guided tissue regeneration followed by orthodontic intrusion as opposed to orthodontic intrusion tracked by guided tissue regeneration in the treatment of an over-erupted tooth with angular bone loss.

METHODS

Twenty teeth in ten cases were selected with at least two teeth with vertical over-eruption and angular bone loss with the presence of their opposing. In group one, ten teeth over-erupted were treated by guided tissue regeneration followed by orthodontic intrusion, whereas, in group two, ten teeth over-erupted were treated by orthodontic intrusion followed by guided tissue regeneration. They were evaluated clinically for pocket depth, bleeding on probing, and tooth mobility. Radiographical evaluation assessed by cone beam computed tomography.

RESULTS

Clinically, there existed a statistically significant difference (P value ≤ 0.05) in favor of group one at six months post and in favor of group two at one year from re-evaluation regarding pocket depth and tooth mobility. Radiographically, in group one, there was a statistically significant improvement (P value ≤ 0.05) at six months post-guided tissue regeneration or orthodontic intrusion regarding defect depth and dimensional changes of the defect area, with a statistically significant difference (P value ≤ 0.05) in favor of group two at one year from re-evaluation phase regarding defect depth and defect area dimensional changes.

CONCLUSION

There was a short-term improvement in group one, which deteriorated over a long period compared with group two, so it is preferable to start orthodontic intrusion before guided tissue regeneration.

Effect of orthodontic treatment on periodontal health of periodontally compromised patients: A randomized controlled clinical trial

OBJECTIVES

To evaluate the effect of fixed orthodontic treatment on periodontal parameters in periodontally compromised adult orthodontic patients.

MATERIALS AND METHODS

This was a prospective, randomized, controlled clinical trial. Thirty-six periodontally compromised adult patients (mean age: 29.67 ± 4.8 years) were randomly allocated to either test (perio-ortho) or control group (perio). After periodontal stabilization in both groups, orthodontic treatment was started in the test group, whereas the control group remained on periodontal maintenance only. Evaluation and comparison of clinical parameters (plaque index [PI]; gingival index [GI]; bleeding on probing [BOP]; probing depth [PD]; clinical attachment level [CAL]) of both groups was assessed at three time intervals: T0 (base line), T1 (at start of orthodontic treatment), and T2 (1 year after start of orthodontic treatment). Radiological parameters (alveolar bone levels [ABL]) were recorded using CBCT at T1 and T2.

RESULTS

Intragroup analysis showed statistically significant improvement in all clinical and radiological periodontal parameters in both groups (P ≤ .05). Intergroup comparison revealed improvement in the periodontal parameters was not statistically significant between the groups (P ≥ .05). Subgroup analysis showed reduction in the number of moderate and severe periodontitis sites in both groups with significant more gains in ABL in the test group compared to the control group.

CONCLUSIONS

Orthodontic treatment after periodontal stabilization does not have any detrimental effect on periodontal health in adult periodontally compromised orthodontic patients and may add to the benefits achieved by periodontal treatment alone.

Timing of orthodontic tooth movement in bone defects repaired with synthetic scaffolds: A scoping review of animal studies

OBJECTIVE

The optimal timing of orthodontic tooth movement (OTM) could allow earlier tooth movements across alveolar bone defects while minimizing the adverse effects. The objective of this scoping systematic review was therefore designed to review pre-clinical animal studies on the ideal protocol for the timing of orthodontic traction across alveolar defects augmented with synthetic scaffolds.

DESIGN

Following the PRISMA-ScR guidelines, three electronic databases were searched (Pubmed, Scopus and Web of Science).

RESULTS

A total of twelve studies were included in the final review that reported on small-animal (rats, guinea pigs, rabbits) and large-animal (dogs and goats) models. Based on the grafting biomaterials, eight papers used cell-free scaffolds, four articles utilised cell-based scaffolds. The timing protocol for the initiation of OTM employed in the studies ranged from immediate to 6 months after surgical grafting. Only four studies included autologous bone graft (gold standard) as positive control. Most papers reported positive results with regards to the rate of OTM and bone augmentation effects while only a few reported side effects such as root resorptions. Overall, the included articles showed a massive heterogeneity in terms of the animal bone defect model characteristics, scaffold materials, study designs, parameters of OTM and methods of analysis.

CONCLUSION

Since there was inadequate evidence to identify the optimal protocol of OTM, optimization of animal bone defect models and outcome measurements is needed to improve the translational ability of future studies.

Bone Graft Materials for Alveolar Bone Defects in Orthodontic Tooth Movement

Clinically, orthodontic tooth movement (OTM) across the narrow alveolar ridge area inevitably entails some adverse reactions such as limited movement and periodontal tissue damage. Hence, it is essential to reconstruct the morphology of the alveolar crest before the tooth movement. Unlike the routine reconstruction of alveolar ridge in the field of implant, the orthodontic practices are distinctive, which require dental movement across the constructed alveolar ridge with safety and stability. Herein, we addressed the pros and cons of reconstruction of the defected orthodontic alveolar ridge with different bone graft materials. Attention is also paid to other factors such as the postgraft initiation time of OTM that can substantially influence the bone reconstruction and tooth movement effect. Rather, considering the lack of a unified standard in orthodontic clinics related to bone reconstruction for OTM, we provide some recommendations and guidance for OTM through alveolar ridge defect area.

Combined Orthodontic-Orthognathic Approach for Dentofacial Deformities as a Risk Factor for Gingival Recession: A Systematic Review

PURPOSE

The objective of this systematic review was to evaluate the risk of development of gingival recession (GR) as a result of the combined orthodontic-orthognathic approach.

MATERIALS AND METHODS

The PubMed, Google Scholar, ClinicalTrials.gov, and Cochrane Library databases were searched. Included articles mentioned gingival parameters in their materials and methods sections; specifically, they evaluated GR, which was measured before and after the surgical procedure. Study parameters such as methodology, evaluation period, sample characteristics, and follow-up were extracted by 2 authors independently.

RESULTS

In total, 133 relevant articles were identified from the databases; after screening and full-text analysis, 9 studies were included in this systematic review. Meta-analysis could not be conducted because of considerable heterogeneity in methods. The incidence of GR in the range of 0.5 to 3.0 mm as a significant clinical finding after orthognathic surgery showed statistically significant differences in all included articles. Among patients with GR, the mean age was 23.0 to 29.5 years and the mandibular incisors were the most common site. However, no case of recession greater than 3.0 mm was associated with surgery.

CONCLUSIONS

On the basis of the findings of this review, GR of approximately 0.5 to 3.0 mm is a common finding after the combined orthodontic-orthognathic approach. Although periodontal damage up to 3 mm can be observed as an isolated finding in mainly the incisors, true recession is not associated with orthognathic surgery in general.

Systematic reviews in orthodontics: Impact of the PRISMA for Abstracts checklist on completeness of reporting

INTRODUCTION

This study evaluated and compared the completeness of reporting of abstracts of orthodontics systematic reviews before and after the publication of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Abstracts Checklist (PRISMA-A).

METHODS

Abstracts of systematic reviews and meta-analyses in orthodontics published in PubMed, Latin American and Caribbean Health Sciences Literature, and the Cochrane Database of Systematic Reviews databases before March 23, 2018, that met the predefined inclusion and exclusion criteria, were evaluated using the 12 items of PRISMA-A, scoring each item from 0 to 2. Abstracts were classified into 2 groups: before and after publication of the PRISMA-A checklist. Three calibrated evaluators (intraclass correlation coefficient and kappa > 0.8) assessed the scores for compliance with the checklist. The number of authors, country of affiliation of the first author, performance of meta-analysis, and topic of the article were recorded. A regression analysis was performed to assess the associations between abstract characteristics and the PRISMA-A scores.

RESULTS

Of 1034 abstracts evaluated, 389 were included in the analysis. The mean PRISMA-A score was 53.39 (95% CI, 51.83-54.96). The overall score for studies published after the publication of the checklist was significantly higher than for studies published before (P ≤ 0.0001). The components returning significantly higher scores after publication of PRISMA-A were title (P = 0.024), information from databases (P = 0.026), risk of bias (P ≤ 0.0001), included studies (P ≤ 0.0001), synthesis of results (P ≤ 0.0001), interpretation of results (P = 0.035), financing and conflict of interest (P ≤ 0.0001), and registration (P ≤ 0.0001). These results showed the positive effect of PRISMA-A had on the quality of reporting of orthodontics systematic reviews. Nevertheless, the poor adherence revealed that there is still need for improvement in the quality of abstract reporting.

CONCLUSIONS

The quality of reporting of abstracts of orthodontic systematic reviews and meta-analyses increased after the introduction of PRISMA-A.

Microarchitecture and Biomechanical Evaluation of BoneCeramic Grafted Alveolar Defects during Tooth Movement in Rat

OBJECTIVE

BoneCeramic can regenerate bone in alveolar defects, but it remains unknown whether it is feasible to move a tooth through BoneCeramic grafting sites. The objective of this study was to investigate three-dimensional real-time bone responses and micromechanical properties in the grafting sites during orthodontic tooth movement.

METHODS

Sixty 5-week-old rats were randomly assigned into three groups to receive BoneCeramic, natural bovine cancellous bone particles (Bio-Oss), and no graft, respectively, after the extraction of the left maxillary first molar. After 4 weeks, the maxillary left second molar was moved into the extraction for 28 days. Dynamic bone microstructures and root resorption were evaluated using in vivo micro-computed tomography and histology. Stress distribution of tooth roots and biomechanical properties of corresponding bone tissue were examined by finite element methods and nanoindentation. Mixed-model analysis of variance was performed to compare the difference among time points with Bonferroni post hoc tests at the significance level of P < .05.

RESULTS

The BoneCeramic group had the least amount of tooth movement and root resorption volume and craters, highest bone volume fraction, trabecular number, mean trabecular thickness, microhardness, and elastic modulus, followed by Bio-Oss and the control group. The highest stress accumulated in the cervical region of the mesial roots.

CONCLUSION

BoneCeramic has better osteoconductive potential and biomechanical properties and induces less root resorption compared with Bio-Oss grafting and naturally recovered extraction site.

BoneCeramic graft regenerates alveolar defects but slows orthodontic tooth movement with less root resorption

INTRODUCTION

BoneCeramic (Straumann, Basel, Switzerland) can regenerate bone in alveolar defects after tooth extraction, but it is unknown whether it is feasible to move a tooth through BoneCeramic grafting sites. The objective of this study was to investigate 3-dimensional real-time root resorption and bone responses in grafted sites during orthodontic tooth movement.

METHODS

Sixty 5-week-old rats were randomly assigned to 3 groups to receive BoneCeramic, natural bovine cancellous bone particles (Bio-Oss; Geistlich Pharma, Wolhusen, Switzerland), or no graft, after the extraction of the maxillary left first molar. After 4 weeks, the maxillary left second molar was moved into the extraction site for 28 days. Dynamic bone microstructures and root resorption were evaluated using in-vivo microcomputed tomography. Stress distribution and corresponding tissue responses were examined by the finite element method and histology. Mixed model analysis of variance was performed to compare the differences among time points with Bonferroni post-hoc tests at the significance level of P <0.05.

RESULTS

The BoneCeramic group had the least amount of tooth movement and root resorption volumes and craters, and the highest bone volume fraction, trabecular number, and mean trabecular thickness, followed by the Bio-Oss and the control groups. The highest stress accumulated in the cervical region of the mesial roots.

CONCLUSIONS

BoneCeramic has better osteoconductive potential and induces less root resorption compared with Bio-Oss grafting and naturally recovered extraction sites.

Finishing procedures in Orthodontics: dental dimensions and proportions (microesthetics)

OBJECTIVE: The objective of the present article is to describe procedures that can be performed to achieve excellence in orthodontic treatment finishing. The content is limited to microesthetics, which comprises the concept of ideal dental dimensions and proportions (white esthetics) and its correlation with the periodontium (pink esthetics). Standards of normality are described both in their real dimensions (dental height and width), and in those effectively perceived by the observer, the virtual dimensions. METHODS: The best scientific evidence was sought in the literature to support the clinical procedures that must guide the professional to obtain maximum esthetic quality on their treatments. Therefore, it is necessary to investigate what the other specialties in Dentistry expect from Orthodontics and, specially, what they have to offer. Clinical cases will be used to illustrate the dental movement that might maximize treatment outcome and to confront the ideal standards with the current state of the art. CONCLUSION: Treatment quality is directly related to the amount of procedures implemented by the orthodontist, associated with concepts and resources from Periodontics and Dental Prosthesis. Microesthetics cannot be seen in isolation, but rather as the key to establish a pleasant smile (miniesthetics) in addition to a harmonious face (macroesthetics) and a human being with high self-esteem (hyper-esthetics).

Orthodontic treatment of periodontal defects. Part II: A systematic review on human and animal studies

Several studies have been published focusing on the possibility to treat patients affected by periodontal defects by means of orthodontic treatment. The aim of this systematic review is to evaluate the efficacy of the orthodontic treatment applied to the therapy of infraosseous defects, gingival recessions, and furcation lesions. An electronic and a manual search were performed based on a PICO assessment worksheet. Both human and animal studies were selected for this review. The electronic search (from January 1966 to December 2009) and the hand search (from January 1988 to December 2009) were conducted by 3 independent reviewers. A total of 197 articles were found and only 29 were considered eligible for this review. In particular, 22 studies dealing with infrabony defects, 1 gingival recession, and 6 furcation defect treatments. Due to the weak evidence and the controversial and unclear results, it appears important to encourage the researchers to produce Randomized Controlled clinical Trials aimed to investigate the efficacy of the orthodontic treatment for the correction of periodontal defects.