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Golež A, Ovsenik M, Cankar K. Effect of orthodontic space closure on dental pulp sensitivity. Prospective clinical trial. Orthod Craniofac Res 2024. [PMID: 38634207 DOI: 10.1111/ocr.12792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Orthodontic tooth movement (OTM) is a biological process that can influence the function of the pulp, including its innervation. The excitability of the nerve fibres of the pulp may be altered by forces exerted on the nerve fibres or by reduced blood flow to the pulp. The aim of this clinical study was to evaluate the sensitivity of the dental pulp during levelling and during the phase of space closure, to assess the role of certain controlled risk factors. METHODS Twenty-two adolescent participants requiring orthodontic space closure in transcanine sector were enrolled in a prospective clinical study. Patients were observed before OTM, after levelling and 1 month during active space closure. The sensitivity threshold of the pulp was measured using the electric pulp test (EPT). Dental models were obtained using an intraoral scanner, allowing measurement of interdental distances and calculation of OTM speed. The teeth were categorized according to position and tooth type. RESULTS The EPT values increased significantly during orthodontic treatment (one-way RM-ANOVA, P = .014). There was a significant difference in EPT values between the tooth categories. Teeth with a single root adjacent to the residual space had the highest EPT thresholds (two-way RM-ANOVA, P < .001; Holm-Sidak, P < .05). CONCLUSIONS OTM reduced pulpal sensitivity. Pulpal sensitivity during active space closure was similar to sensitivity during the levelling phase. The pulpal sensitivity of molars was less affected by OTM than that of single-rooted teeth, while teeth closer to the gap had a significantly higher pulpal sensitivity threshold during active OTM.
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Affiliation(s)
- Aljaž Golež
- Faculty of Medicine, Institute of Physiology, University of Ljubljana, Ljubljana, Slovenia
- Orthos Institute, Ljubljana, Slovenia
| | - Maja Ovsenik
- Orthos Institute, Ljubljana, Slovenia
- Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ksenija Cankar
- Faculty of Medicine, Institute of Physiology, University of Ljubljana, Ljubljana, Slovenia
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Putrino A, Marinelli E, Agrillo A, Zaami S. New Perspectives in Third Molar Auto-Transplantation: Literature Review and a Case Report of Clinical, Financial and Forensic Implications. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:473. [PMID: 38541199 PMCID: PMC10972373 DOI: 10.3390/medicina60030473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 07/23/2024]
Abstract
Third molar extraction is the most common procedure in oral and maxillofacial surgery. Third molars are considered less functional than other teeth and are often extracted. Sometimes, they are also used for auto-transplantation for the benefit of oral rehabilitation. Since many biological factors are involved in this surgical approach, herein, we outline a review of the biological characteristics of medico-legal/forensic interest, in addition to presenting a successful clinical case. A scoping review of currently available research data (following the principles of PRISMA-ScR or the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) on third molar auto-transplantation was conducted by drawing upon the main databases (Scopus, PubMed, Google Scholar and LILACS) to evaluate biological and clinical characteristics possibly relatable to forensic issues. All the collected data were summarized and elaborated on for the purpose of this article. A patient underwent extraction of the right upper first molar and auto-transplantation of the unerupted ipsilateral third molar. Many biologic and clinical factors are involved in the success of this clinical procedure. Knowledge of third molar anatomy, of its development and viable surgical approaches are all essential elements; just as important are the treatment of the tooth before and after transplantation and the integrity of the periodontal ligament. Follow-up of the clinical case for 5 years made it possible to verify the stability of the procedure over time. Third molar auto-transplantation is feasible and cost-effective. However, the use of third molars as donor teeth in auto-transplantation may have medico-legal implications. The lack of official protocols and consistent evidence-based guidelines for operators still prevent such a procedure from becoming mainstream; therefore, it is viewed with suspicion by clinicians and patients, even though the biological factors herein detected point to a reasonably high degree of safety. The understanding of many specific biological and clinical factors involved in the stability of third molar auto-transplantation allows for a thorough understanding of the forensic implications relevant to clinical practice. Effective communication and information provision are therefore of utmost importance, in the interest of both patients and doctors.
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Affiliation(s)
- Alessandra Putrino
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy;
| | - Enrico Marinelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy;
| | - Alessandro Agrillo
- Maxillofacial Surgery Unit, San Filippo Neri Hospital, 00135 Rome, Italy;
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy;
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Golež A, Ovsenik M, Cankar K. The effect of orthodontic tooth movement on the sensitivity of dental pulp: A systematic review and meta-analysis. Heliyon 2023; 9:e14621. [PMID: 37025792 PMCID: PMC10070381 DOI: 10.1016/j.heliyon.2023.e14621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/02/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
Objectives Orthodontic tooth movement (OTM) is a process that's initiated by orthodontic forces. As a consequence, the forces could restrict pulpal blood supply, possibly affecting dental pulp. The study aimed to review the available evidence on the short and long-term effects of orthodontic tooth movement on dental pulp sensitivity and to identify clinically relevant risk factors. Sources PubMed, Embase, Scopus, and Web of Science were searched for papers from 1990 to the end of December 2021. Study selection The studies that evaluated dental pulp sensitivity of teeth undergoing OTM were included in the systematic review. Randomized, nonrandomized and case-controlled studies were included in the analysis. Risk of bias in each study was assessed using the ROBINS-I tool. Data The systematic search yielded an initial sample of 1110 studies, 17 were included in qualitative analysis. Most studies were classified as moderate risk of bias, however only limited long-term evidence with a higher risk of bias exists. Electric pulp test (EPT) sensitivity threshold during active OTM was increased by 4.25 SD (P < 0.001) and the relative risk (RR) of pulpal non-sensitivity was 13.27 (P < 0.001) higher compared to pre-orthodontic baseline status. Significant differences were between subgroups associated with the type of OTM. A positive relationship between pulpal non-sensitivity and mean patient age was discovered (P = 0.041). After OTM the risk of pulpal non-sensitivity remained 5.76 times higher (P < 0.001) in the long term. Conclusions Evidence showed that OTM could affect dental pulp sensitivity. The type of OTM and patients' age were identified as clinically relevant risk factors. Clinical significance Orthodontic tooth movement negatively impacts the sensitivity of dental pulp during active treatment and to a lesser degree in the long term. Pulpal sensitivity tests during active OTM should therefore be interpreted with caution. Data indicates younger patients have a lower risk of negative pulpal sensitivity during orthodontic treatment.
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Affiliation(s)
- A. Golež
- University of Ljubljana, Faculty of Medicine, Institute of Physiology, Zaloska Cesta 4, Ljubljana, Slovenia
- Orthos Institute, Vilharjev podhod 18, Ljubljana, Slovenia
- Corresponding author. University of Ljubljana, Faculty of Medicine, Institute of Physiology, Zaloska Cesta 4, Ljubljana, Slovenia.
| | - M. Ovsenik
- Orthos Institute, Vilharjev podhod 18, Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Department of Orthodontics and Dentofacial Orthopaedics, Hrvatski trg 6, Ljubljana, Slovenia
| | - K. Cankar
- University of Ljubljana, Faculty of Medicine, Institute of Physiology, Zaloska Cesta 4, Ljubljana, Slovenia
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Dhar S, Singh G, Mishra M, Gaur A. A Prospective Study on Autotransplantation of Mandibular Third Molars With Complete Root Formation. Craniomaxillofac Trauma Reconstr 2022; 15:340-349. [PMID: 36387317 PMCID: PMC9647379 DOI: 10.1177/19433875211055600] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Study Design Autotransplantation, if possible, is a viable option for replacing a missing tooth when a donor tooth is available. The most typical tooth transplant is the transfer of a third molar to a first molar site. No immune reaction results from transplants of this nature. It restores the proprioceptive function and normal periodontal healing; thus, the patient can have a natural chewing feeling and natural biological response. Objective This study aims to evaluate the prognosis of autotransplanted mandibular third molar and also to evaluate the cost effectiveness of the treatment performed when compared to the other treatment modalities for prosthetic rehabilitation. Methods A prospective study was done in the Department of Oral & Maxillofacial Surgery, Sardar Patel Post Graduate Institute of Dental & Medical Sciences, Lucknow, UP, India, with over 20 patients to evaluate the prognosis of autotransplanted mandibular third molars with complete root formation after atraumatic extraction of first or second mandibular molar, which were randomly selected irrespective of race, sex, caste, and socio-economic status. Regular clinical and radiographical examinations were performed over a period of 1 year and the patients were assessed for pain, swelling, infection, dry socket, periodontal pocket depth, ankylosis, root resorption, tooth mobility, and level of buccal bone in relation to cementoenamel junction (CEJ). Results Eighteen out of 20 transplants were successful; only 2 mandibular transplants were extracted because of abnormal horizontal and axial mobility and the reason of failure was attributed to fact that the roots of transplant were short and conical and there was lack of alveolar bone height at the recipient site in one patient, while root resorption was the reason for failure of transplant in the other patient. Conclusions This study assessed the efficacy of autotransplantation of molars and the viability of the procedure to replace unrestorable molar teeth; it also supports the hypothesis that transplantation of a mandibular third molar for replacement of a lost or seriously damaged molar tooth could be a reasonable alternative.
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Affiliation(s)
- Shishir Dhar
- Department of Dentistry/Oral &
Maxillofacial Surgery, Government Medical College, Saharanpur, UP, India
| | - Gaurav Singh
- Department of Oral & Maxillofacial
Surgery, Sardar Patel Post Graduate Institute Of Dental
& Medical Sciences, Lucknow, UP, India
| | - Madan Mishra
- Department of Oral & Maxillofacial
Surgery, Sardar Patel Post Graduate Institute Of Dental
& Medical Sciences, Lucknow, UP, India
| | - Amit Gaur
- Department of Oral & Maxillofacial
Surgery, Sardar Patel Post Graduate Institute Of Dental
& Medical Sciences, Lucknow, UP, India
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Inferior alveolar nerve preservation during resection and reconstruction of the mandible for benign tumors as a factor improving patient's quality of life. J Craniomaxillofac Surg 2022; 50:393-399. [DOI: 10.1016/j.jcms.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 01/06/2022] [Accepted: 02/27/2022] [Indexed: 11/18/2022] Open
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Atala-Acevedo C, Abarca J, Martínez-Zapata MJ, Díaz J, Olate S, Zaror C. Success Rate of Autotransplantation of Teeth With an Open Apex: Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2017; 75:35-50. [DOI: 10.1016/j.joms.2016.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/06/2016] [Indexed: 10/21/2022]
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Almpani K, Papageorgiou SN, Papadopoulos MA. Autotransplantation of teeth in humans: a systematic review and meta-analysis. Clin Oral Investig 2015; 19:1157-79. [DOI: 10.1007/s00784-015-1473-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 04/05/2015] [Indexed: 11/29/2022]
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Primary canine auto-transplantation: a new surgical technique. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:158-69. [DOI: 10.1016/j.oooo.2014.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 06/03/2014] [Accepted: 07/07/2014] [Indexed: 11/19/2022]
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Nagori SA, Bhutia O, Roychoudhury A, Pandey RM. Immediate autotransplantation of third molars: an experience of 57 cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:400-7. [DOI: 10.1016/j.oooo.2014.05.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 05/12/2014] [Indexed: 12/21/2022]
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Huth KC, Nazet M, Paschos E, Linsenmann R, Hickel R, Nolte D. Autotransplantation and surgical uprighting of impacted or retained teeth: A retrospective clinical study and evaluation of patient satisfaction. Acta Odontol Scand 2013; 71:1538-46. [PMID: 23638808 DOI: 10.3109/00016357.2013.775667] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES This retrospective clinical study aimed to determine the success rate of autotransplanted impacted or retained teeth along with a patient satisfaction survey and to analyze the influence of relevant clinical and radiographic parameters. SUBJECTS AND METHODS Fifty-seven teeth (37 canines, 10 molars, seven premolars, three incisors) in 45 patients (median 15 years) were evaluated over a mean of 1.6 years. The success criteria were pocket probing depth ≤3.5 mm, mobility grade ≤ II, Periotest ≤30 and complete alveolar bone healing. The influencing parameters were oral hygiene, smoking, periodontal screening index, occlusal/proximal contacts, horizontal position, dental age, pulp obliteration and degree of displacement. Furthermore, bone height was measured. RESULTS The overall success rate was 74%, along with a high patient satisfaction. The survival rate was 96% after a mean follow-up of 1.6 years. The favorable factors were proper oral hygiene, non-smoking, good general periodontal condition, proximal contacts and pulp obliteration. An increase in or maintenance of bone level was found in 96%. CONCLUSIONS Autotransplantation of impacted or retained teeth is an appropriate treatment, if orthodontic alignment has failed, especially in growing patients.
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Jafarzadeh H, Abbott PV. Review of pulp sensibility tests. Part I: general information and thermal tests. Int Endod J 2010; 43:738-62. [DOI: 10.1111/j.1365-2591.2010.01754.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Autotransplantation is a reliable treatment option for the replacement of missing teeth; however, there is a wide variation in reported survival rates. The purpose of this study was to evaluate the success and survival rate of premolar autotransplantation and to underline the importance of autotransplantation in the treatment of missing teeth. We present the treatment and follow-up of 63 premolar autotransplants in 44 patients. After transplantation under local anaesthesia, radiological and clinical follow-up showed a survival rate of 100%, ie all premolars were still functional. We conclude that autotransplantation of premolars is a reliable treatment method especially for agenesis. It is not difficult to perform and is aesthetically superior and more cost-effective than other treatments, especially when orthodontic alignment is necessary.
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Affiliation(s)
- G Mensink
- Oral and Maxillofacial Surgery, Leiden University Medical Center, Leiden, 2300 RC, Netherlands
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Bauss O, Zonios I, Rahman A. Root Development of Immature Third Molars Transplanted to Surgically Created Sockets. J Oral Maxillofac Surg 2008; 66:1200-11. [DOI: 10.1016/j.joms.2007.12.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 09/26/2007] [Accepted: 12/12/2007] [Indexed: 10/22/2022]
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Tanaka T, Deguchi T, Kageyama T, Kanomi R, Inoue M, Foong KWC. Autotransplantation of 28 Premolar Donor Teeth in 24 Orthodontic Patients. Angle Orthod 2008; 78:12-9. [DOI: 10.2319/120706-495.1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Accepted: 02/01/2007] [Indexed: 11/23/2022] Open
Abstract
Abstract
Objective: To test the null hypothesis that premolar autotransplantation is not successful for orthodontic patients.
Materials and Methods: In the present study, 28 premolar transplants from 24 orthodontic patients were associated with orthodontic treatment. At a routine 3-month appointment, patients underwent a dental radiograph and a chair-side observation for periodontal problems. Three sets of dental radiographs were taken by one dental assistant using a custom holder at: preoperation (T0), 2 year postoperation (T1), and retention (T2) (4- to 14-year follow-up observation) stages. All transplants were conducted in a one-phase operation by one operator (Dr Inoue). Recipient sites were: ten for missing maxillary canines, nine for maxillary centrals and laterals, eight for lower second premolar, and five for other missing premolar sites. All recipients maintained the retained primary tooth with a socket.
Results: The success ratio of all 28 transplants was 100%, although four transplants shorter than a 4-year period of observation were omitted. Two transplant patients, one with a medical history of histiocytosis and the other with a history of osteomyelitis of the maxilla without a recipient socket, were also excluded from this study. Eleven of 22 premolar transplants had a root canal treatment (RCT), four of which had RCT within 2 years after the operation.
Conclusions: The null hypothesis was rejected. The success ratio of premolar transplants was 100%.
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Affiliation(s)
- Tadasu Tanaka
- a Graduate PhD student, Graduate School (Unit of Orthodontics) and Institute for Oral Science, Matsumoto Dental University School of Dentistry, Nagano, Japan
| | - Toshio Deguchi
- b Professor and Head, Graduate School (Unit of Orthodontics) and Institute for Oral Science, Matsumoto Dental University School of Dentistry, Nagano, Japan. Professor, Orthodontic Postgraduate Program, Department of Preventive Dentistry, National University of Singapore and Hospital, Faculty of Dentistry, Singapore
| | - Toru Kageyama
- c Associate Professor, Graduate School (Unit of Orthodontics) and Institute for Oral Science, Matsumoto Dental University School of Dentistry, Nagano, Japan
| | | | - Masahiro Inoue
- e Associate Professor, Department of Oral Implantology, Osaka Dental University, Osaka, Japan
| | - Kelvin W. C. Foong
- f Associate Professor, Orthodontic Postgraduate Program, Department of Preventive Dentistry, National University of Singapore and Hospital, Faculty of Dentistry, Singapore
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Akkocaoglu M, Kasaboglu O. Success rate of autotransplanted teeth without stabilisation by splints: a long-term clinical and radiological follow-up. Br J Oral Maxillofac Surg 2005; 43:31-5. [PMID: 15620771 DOI: 10.1016/j.bjoms.2004.08.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2004] [Indexed: 11/20/2022]
Abstract
The purpose of this retrospective study was to assess the results after a follow-up of 10 years of autotransplantation of canines and third molars without the use of any apparatus for stabilisation. A total of 96 teeth were transplanted and 83 were successful (86%). The technique is easy, reliable, and effective.
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Affiliation(s)
- Murat Akkocaoglu
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hacettepe University, Turkey.
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