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Li N, Wang CJ, Wang Y, Chen D, Yang M, Li H. Three-dimensional finite element analysis of retracting pathological migration of the right upper central incisor with a clear aligner. Comput Methods Biomech Biomed Engin 2023:1-8. [PMID: 37936535 DOI: 10.1080/10255842.2023.2279011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/23/2023] [Indexed: 11/09/2023]
Abstract
We aimed to explore the best orthodontic step distance of the right upper central incisor with mild, moderate, and severe pathological displacement achieved via a clear aligner. Three-dimensional models of maxilla-tooth-periodontal ligament clear aligner of the right upper central incisors with five different steps of 0.1, 0.125, 0.15, 0.165, 0.25 mm and three different alveolar bone heights were established via finite element analysis. We analysed the changing trends in initial displacement, the periodontal ligament, the alveolar bone, and apical stress of right upper central incisor. In the process of retraction, the right upper central incisor a movement trend of the crown deviating from the distal root to the mesial, and with the decrease of the height of the alveolar bone and the increase of the displacement, the crown would appear distal labial torsion with a deepening trend of vertical overlay.The maximum stress distribution of the periodontal ligament and alveolar bone showed a positive correlation. The overall stress distribution of the periodontal ligament and apical stress increased with decrease of alveolar bone height and the increase of alveolar bone displacement. In patients with mild, moderate, and severe pathological displacement of the right upper central incisor, the best step distance of anterior tooth retraction is 0.165, 0.15, and 0.125 mm, respectively.
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Affiliation(s)
- Na Li
- Silk Crossing Clinic, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Department of Stomatology, North Sichuan Medical College, Nanchong, China
| | - Chun Juan Wang
- Chongqing Key Laboratory of Oral Diseases and Biomedicine, Chongqing Municipal Key Laboratory of Stomatological Biomedical Engineering, Chongqing, China
| | - Yu Wang
- Department of Stomatology, North Sichuan Medical College, Nanchong, China
| | - DingGen Chen
- Silk Crossing Clinic, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Department of Stomatology, North Sichuan Medical College, Nanchong, China
| | - Min Yang
- Department of Stomatology, North Sichuan Medical College, Nanchong, China
| | - HuiQin Li
- Department of Stomatology, North Sichuan Medical College, Nanchong, China
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Isola G, Nucera R, Damonte S, Ugolini A, De Mari A, Migliorati M. Implant Site Changes in Three Different Clinical Approaches: Orthodontic Extrusion, Regenerative Surgery and Spontaneous Healing after Extraction: A Systematic Review. J Clin Med 2022; 11:6347. [PMID: 36362575 PMCID: PMC9655824 DOI: 10.3390/jcm11216347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/10/2022] [Accepted: 10/20/2022] [Indexed: 09/16/2023] Open
Abstract
Both surgical and non-surgical techniques are employed for implant site development. However, the efficacy of these methods has not been thoroughly evaluated and compared. This systematic review aims to compare the biologic, functional and esthetic outcomes of three different approaches before implant placement in both the maxillary and mandibular arches: orthodontic extrusion, regenerative surgery and spontaneous healing after extraction. The systematic research of articles was conducted up to January 2020 in Medline, Scopus and the Cochrane Library databases. Studies were selected in a three-stage process according to the title, the abstract and the inclusion criteria. The methodological quality and the risk of bias of the included studies were evaluated using ROBINS-I tools for non-randomized studies, Rob 2.0 for RCT. Quality evaluation of case reports was performed using CARE guidelines. Through the digital search, 1607 articles were identified, and 25 of them were included in the systematic review. The qualitative evaluation showed a good methodological quality for RCT, sufficient for non-randomized studies and poor for case reports. Based on the available results, both orthodontic extrusion and regenerative surgery allowed the development of the implant site with satisfying esthetic and functional outcomes. Studies about the spontaneous healing of the extraction socket showed resorption of the edentulous ridge, which complicated the implant insertion. No study referred to failures or severe complications. Most of the studies reported only qualitative results. The present systematic review demonstrated that there is a substantial lack of data and evidence to determine which of the presented methods is better for developing a future implant site. Both surgical and non-surgical procedures appear effective in the regeneration of hard tissue, whereas not all the techniques can improve soft tissue volume, too. The orthodontic technique simultaneously enhances both hard and soft tissue.
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Affiliation(s)
- Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95123 Catania, Italy
| | - Riccardo Nucera
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Orthodontics, University of Messina, 98100 Messina, Italy
| | - Silvia Damonte
- Department of Orthodontics, Genova University, 16100 Genova, Italy
| | | | - Anna De Mari
- Department of Orthodontics, Genova University, 16100 Genova, Italy
| | - Marco Migliorati
- Department of Orthodontics, Genova University, 16100 Genova, Italy
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Huang G, Yang M, Qali M, Wang TJ, Li C, Chang YC. Clinical Considerations in Orthodontically Forced Eruption for Restorative Purposes. J Clin Med 2021; 10:5950. [PMID: 34945246 PMCID: PMC8706734 DOI: 10.3390/jcm10245950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 11/24/2022] Open
Abstract
For restorations on teeth involving invasion of the supracrestal tissue attachment (biological width), as well as for lack of ferrule effect, crown lengthening is required for long-term periodontal health and success of the restoration. In the same fashion, site development is often necessary prior to implant placement in order to provide optimal peri-implant soft and hard tissue architecture conducive to future esthetics and function. Orthodontic extrusion, also known as forced eruption, has been developed and employed clinically to serve the purposes of increasing the clinical crown length, correcting the periodontal defect, and developing the implant site. In order to provide comprehensive guidance on the clinical usage of this technique and maximize the outcome for patients who receive the dental restoration, the currently available literatures were summarized and discussed in the current review. Compared to traditional crown lengthening surgery, forced eruption holds advantages of preserving supporting bone, providing improved esthetics, limiting the involvement of adjacent teeth, and decreasing the negative impact on crown-to-root ratio compared to the traditional resective approach. As a non-invasive and natural technique capable of increasing the available volume of bone and soft tissue, forced eruption is also an attractive and promising option for implant site development. Both fixed and removable appliances can be used to achieve the desired extrusion, but patient compliance is a primary limiting factor for the utilization of removable appliances. In summary, forced eruption is a valuable treatment adjunct for patients requiring crown lengthening or implant restorations. Nonetheless, comprehensive evaluation and treatment planning are required for appropriate case selection based upon the known indications and contraindications for each purpose; major contraindications include inflammation, ankylosis, hypercementosis, vertical root fracture, and root proximity. Further studies are necessary to elucidate the long-term stability of orthodontically extruded teeth and the supporting bone and soft tissue that followed them.
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Affiliation(s)
- Grace Huang
- Department of Orthodontics, Harvard School of Dental Medicine, Boston, MA 02115, USA;
| | - Min Yang
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (M.Y.); (M.Q.)
- Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Mohammad Qali
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (M.Y.); (M.Q.)
- Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Tun-Jan Wang
- Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Chenshuang Li
- Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Yu-Cheng Chang
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (M.Y.); (M.Q.)
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Glass Ionomer Subgingival Matrix Technique to Restore a Tooth with Severe Root Resorption for Implant Site Development. Case Rep Dent 2020; 2020:6676764. [PMID: 33299614 PMCID: PMC7704198 DOI: 10.1155/2020/6676764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/16/2020] [Indexed: 11/20/2022] Open
Abstract
Here, we present the multidisciplinary, patient-specific management of a patient with severe external root resorption and bone loss in a maxillary anterior tooth. The tooth was provisionally noninvasively restored with glass ionomer subgingival matrix in preparation for forced orthodontic extrusion, papillary preservation, and implant placement. This approach enables clinicians to control infection within and around the resorbed tooth and then to use it as an anchor for slow forced tooth eruption to correct bone and mucogingival deformities. Aesthetic and functional outcomes were clinically and radiographically satisfactory. The advantages and disadvantages of this technique are discussed.
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Predictability of a New Orthodontic Extrusion Technique for Implant Site Development: A Retrospective Consecutive Case-Series Study. ScientificWorldJournal 2020; 2020:4576748. [PMID: 32372885 PMCID: PMC7187725 DOI: 10.1155/2020/4576748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/13/2019] [Indexed: 11/17/2022] Open
Abstract
In clinical daily practice, there are situations in which implant sites have vertical and/or horizontal bone defects and often we must improve their morphology and dimensions before fixture insertion. It is crucial to carefully evaluate the surgical site as regards the characteristics of both hard and soft tissues. The orthodontic extrusion technique can be used for nonsurgical augmentation of the implant site as an alternative to traditional regenerative/reparative surgical therapies. The orthodontic extrusion is based on a biological mechanism that uses the portion of periodontal ligament, still present on the root before the tooth extraction, for the increase of hard and soft tissues. In the literature, there is no evidence of common guidelines for this technique but only tips based on personal experience and/or previous studies. The aim of this study was to investigate and to validate the reliability of a new orthodontic extrusion technique (MF Extrusion Technique, by Dr. Mauro Fadda) by means of a retrospective consecutive case-series study. After we have done a review of the literature, we evaluated the X-rays of twelve consecutively treated patients before the orthodontic extrusion (T0) and after the stabilization period (T1), in order to quantify, by two different measurements, area and linear, the bone gain obtained by the application of the new technique. All the patients examined showed a significant increase in bone areas with an average value of 31.575 mm2. The linear bone gain had an average value of 4.63 mm. Data collected were statistically analysed by the Wilcoxon signed-rank test. The results obtained both from area and linear measurements at T0 and at T1 times showed that there was a statistically significant bone gain with p < 0.01.
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Implementation of orthodontic extraction for pre-implant soft tissue management: A systematic review. Int Orthod 2019; 17:20-37. [PMID: 30770331 DOI: 10.1016/j.ortho.2019.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This systematic review aims to define the recommendations allowing an optimized clinical implementation for orthodontic extraction as a pre-implant soft tissue management procedure. MATERIALS AND METHODS A digital search was performed in the Cochrane Library, PubMed, Scopus, and DOSS databases; a pre-screening was conducted according to the title and summary of the articles. After a complete reading, only the articles meeting all of our inclusion criteria were selected, and a second search, this time manual, was performed within their references. The selected articles were then analysed according to twelve parameters. RESULTS Thirty-nine articles were included. Despite low statistical evidence in the available literature, some principal guidelines, which seem generally accepted by the scientific community, could be highlighted based on this analysis. However, no ideal clinical protocol could be established. CONCLUSIONS Orthodontic extraction is an efficient procedure for pre-implant soft tissue management, however, further studies are needed to establish full clinical recommendations and optimize its clinical implementation.
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Assessment of Intraobserver and Interobserver Agreement of a New Classification System for Retrograde Periimplantitis. IMPLANT DENT 2016; 25:817-824. [PMID: 27540842 DOI: 10.1097/id.0000000000000470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Retrograde periimplantitis (RPI) is the inflammatory disease that affects the apical part of an osseointegrated implant while the coronal portion of the implant sustains a normal bone-to-implant interface. The aim of the current study was to assess the intraexaminer and interexaminer reliability of a proposed new classification system for RPI. MATERIALS AND METHODS After thorough electronic literature search, 56 intraoral periapical radiographs (IOPA) of implants with RPI were collected and were classified by 2 independent reviewers as per the new classification system into one of the 3-mild, moderate, and advanced-classes based on the amount of bone loss from the apex of the implant to the most coronal part as a percentage of the total implant length. The IOPAs were assessed twice by the same examiners and both were blinded to each other's observations. RESULTS The intraobserver agreement ranged from 0.85 to 0.91, which falls under the category of almost perfect agreement. The interexaminer agreement was found to be 0.83, also considered as almost perfect agreement. CONCLUSION The proposed classification shows good intraexaminer and interexaminer reliability and can be used for treatment planning and prognosis in cases of RPI.
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Shah R, Thomas R, Kumar ABT, Mehta DS. A Radiographic Classification for Retrograde Peri-implantitis. J Contemp Dent Pract 2016; 17:313-21. [PMID: 27340166 DOI: 10.5005/jp-journals-10024-1847] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Retrograde peri-implantitis (RPI) is an inflammatory disease that affects the apical part of an osseointegrated implant, while the coronal portion of the implant sustains a normal bone-to-implant interface. It is a diagnostic and therapeutic dilemma for implantologists. There is lack of a standard classification system and a definite treatment algorithm for the same. This article aims to introduce a classification system for RPI based on the radiographic amount of bone loss around an implant apex. MATERIALS AND METHODS A search of PubMed database was conducted with the keywords "retrograde peri-implantitis" and "implant periapical lesion." Preoperative intraoral periapical (IOPA) radiographs of implants with RPI in case reports/case series were compiled. A total of 54 lOPAs from 36 articles were compiled and were assessed. RESULTS Three different classes were proposed. The amount of bone loss from the apex of the implant to the most coronal part of radiolucency was calculated as a percentage of the total implant length and classified into one of the three classes: Mild, moderate, and advanced. Treatment options and prognosis have been suggested for each class. CONCLUSION The proposed classification may allow for an easy and reproducible radiographic assessment of the RPI lesion and may serve as a guideline to prognosis and treatment planning.
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Affiliation(s)
- Rucha Shah
- Lecturer, Department of Periodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India, Phone: +917676279879, e-mail:
| | - Raison Thomas
- Department of Periodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - A B Tarun Kumar
- Department of Periodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - Dhoom Singh Mehta
- Department of Periodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India
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Han JY. A comparative study of combined periodontal and orthodontic treatment with fixed appliances and clear aligners in patients with periodontitis. J Periodontal Implant Sci 2015; 45:193-204. [PMID: 26734489 PMCID: PMC4698945 DOI: 10.5051/jpis.2015.45.6.193] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/07/2015] [Indexed: 12/19/2022] Open
Abstract
Purpose With the increasing prevalence of orthodontic treatment in adults, clear aligner treatments are becoming more popular. The aim of this study was to evaluate the effect of orthodontic treatment on periodontal tissue and to compare orthodontic treatment with fixed appliances (FA) to clear aligner treatment (CAT) in periodontitis patients. Methods A total of 35 patients who underwent orthodontic treatment in the Department of Periodontology were included in this study. After periodontal treatment with meticulous oral hygiene education, patients underwent treatment with FA or CAT, and this study analyzed patient outcomes depending on the treatment strategy. Clinical parameters were assessed at baseline and after orthodontic treatment, and the duration of treatment was compared between these two groups. Results The overall plaque index, the gingival index, and probing depth improved after orthodontic treatment (P<0.01). The overall bone level also improved (P=0.045). However, the bone level changes in the FA and CAT groups were not significantly different. Significant differences were found between the FA and CAT groups in probing depth, change in probing depth, and duration of treatment (P<0.05). However, no significant differences were found between the FA and CAT groups regarding the plaque index, changes in the plaque index, the gingival index, changes in the gingival index, or changes in the alveolar bone level. The percentage of females in the CAT group (88%) was significantly greater than in the FA group (37%) (P<0.01). Conclusions After orthodontic treatment, clinical parameters were improved in the FA and CAT groups with meticulous oral hygiene education and plaque control. Regarding plaque index and gingival index, no significant differences were found between these two groups. We suggest that combined periodontal and orthodontic treatment can improve patients’ periodontal health irrespective of orthodontic techniques.
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Affiliation(s)
- Ji-Young Han
- Department of Periodontology, Division of Dentistry, Hanyang University College of Medicine, Seoul, Korea
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de Molon RS, de Avila ED, de Barros-Filho LAB, Ricci WA, Tetradis S, Cirelli JA, Borelli de Barros LA. Reconstruction of the Alveolar Buccal Bone Plate in Compromised Fresh Socket after Immediate Implant Placement Followed by Immediate Provisionalization. J ESTHET RESTOR DENT 2015; 27:122-35. [PMID: 26037327 DOI: 10.1111/jerd.12154] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this clinical report was to reestablish the buccal bone wall after immediate implant placement. The socket defect was corrected with autogenous bone, and a connective tissue graft was removed from the maxillary tuberosity to increase the thickness, height, and width of the buccal bone and gingival tissue followed by immediate provisionalization of the crown during the same operation. CLINICAL CONSIDERATIONS A 66-year-old patient presented with a hopeless maxillary left central incisor with loss of the buccal bone wall. Atraumatic, flapless extraction was performed, and an immediate implant was placed in the extraction socket followed by preparation of an immediate provisional restoration. Subsequently, immediate reconstruction of the buccal bone plate was performed, using the tuberosity as the donor site, to obtain block bone and connective tissue grafts, as well as particulate bone. Finally, immediate provisionalization of the crown followed by simple sutures was performed. Cone-beam computed tomography and periapical radiographs were taken before and after surgery. After 4 months, the final prosthetic crown was made. After a 2-year follow-up, a satisfactory aesthetic result was achieved with lower treatment time and morbidity. CONCLUSION This case demonstrates the effective use of immediate reconstruction of the buccal bone wall for the treatment of a hopeless tooth in the maxillary aesthetic area. This procedure efficiently promoted harmonious gingival and bone architecture, recovered lost anatomical structures with sufficient width and thickness, and maintained the stability of the alveolar bone crest in a single procedure. CLINICAL SIGNIFICANCE If appropriate clinical conditions exist, immediate dentoalveolar restoration may be the most conservative means of reconstructing the buccal bone wall after immediate implant placement followed by immediate provisionalization with predictable healing and lower treatment time.
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Affiliation(s)
- Rafael Scaf de Molon
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, 90095, USA.,Department of Diagnosis and Surgery, School of Dentistry at Araraquara, Univ Estadual Paulista-UNESP, Araraquara, SP, Brazil
| | - Erica Dorigatti de Avila
- Department of Dental Materials and Prosthodontics, School of Dentistry at Araraquara, Univ Estadual Paulista-UNESP, Araraquara, SP, Brazil
| | | | - Weber Adad Ricci
- Department of Social Dentistry, School of Dentistry at Araraquara, Univ Estadual Paulista-UNESP, Araraquara, SP, Brazil
| | - Sotirios Tetradis
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, 90095, USA.,Molecular Biology Institute, UCLA, Los Angeles, CA, 90095, USA
| | - Joni Augusto Cirelli
- Department of Diagnosis and Surgery, School of Dentistry at Araraquara, Univ Estadual Paulista-UNESP, Araraquara, SP, Brazil
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Hochman MN, Chu SJ, Tarnow DP. Orthodontic extrusion for implant site development revisited: A new classification determined by anatomy and clinical outcomes. Semin Orthod 2014. [DOI: 10.1053/j.sodo.2014.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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