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Charavet C, Israel N, Oueiss A, Masucci C, Fontas E, Dridi SM. What are the prevalence and risk factors associated with wire syndrome in dental students? A cross-sectional study. Int Orthod 2024; 22:100899. [PMID: 39029177 DOI: 10.1016/j.ortho.2024.100899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/02/2024] [Accepted: 07/04/2024] [Indexed: 07/21/2024]
Abstract
INTRODUCTION Wire syndrome (WS) refers to dental displacements that can be described as aberrant, inaccurate, unexplained, or excessive, on teeth still contained by an intact bonded retainer, without detachment or fracture, leading to evolving dental and periodontal, aesthetic and/or functional consequences. The objective of this study was to define the prevalence rate of mandibular WS and the associated risk factors. METHODS Participants were dental students who had undergone orthodontic treatment and were wearing an intact fixed mandibular retainer. They completed a 20-item questionnaire, after which an extraoral and intraoral clinical examination was conducted. Participants were assigned to either the non-wire syndrome group or the wire syndrome group by two independent practitioners. Univariate and multivariate logistic regression models were used to investigate potential risk factors. RESULTS A total of 59 students (23.4years±1.7years) were included. Among these, 9 students presented with mandibular WS, resulting in a prevalence rate of 15.25% (95% CI: 6.08%-24.43%). Univariate analysis revealed a significant association between a deep labio-mental fold, a concave profile, and a multi-strand round wire, and an excess risk of WS. The odds ratios were 16.5 (95% CI: 1.9-146.8, P=0.01), 6.4 (95% CI: 1.0-41.0, P=0.05), and 9.0 (95% CI: 1.7-48.7, P=0.01), respectively. Multivariate analysis confirmed these significant associations, except for the concave profile. CONCLUSIONS The prevalence rate of wire syndrome was 15.25%. Two risk factors associated with WS were identified: a deep labio-mental fold and a multi-strand round wire retainer.
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Affiliation(s)
- Carole Charavet
- Département d'Orthodontie, Faculté de Chirurgie Dentaire, Université Côte d'Azur, Nice, France; UEC Orthodontie, Pôle Odontologie, CHU de Nice, Nice, France; Laboratoire MICORALIS UPR 7354, Université Côte d'Azur, Nice, France.
| | - Nathan Israel
- Département d'Orthodontie, Faculté de Chirurgie Dentaire, Université Côte d'Azur, Nice, France; UEC Orthodontie, Pôle Odontologie, CHU de Nice, Nice, France
| | - Arlette Oueiss
- Département d'Orthodontie, Faculté de Chirurgie Dentaire, Université Côte d'Azur, Nice, France; UEC Orthodontie, Pôle Odontologie, CHU de Nice, Nice, France
| | - Caterina Masucci
- Département d'Orthodontie, Faculté de Chirurgie Dentaire, Université Côte d'Azur, Nice, France; UEC Orthodontie, Pôle Odontologie, CHU de Nice, Nice, France
| | - Eric Fontas
- Département de la Recherche Clinique et Innovation, Cimiez Hospital, CHU de Nice, Université Côte d'Azur, Nice, France
| | - Sophie Myriam Dridi
- Département de Parodontologie, Faculté de Chirurgie Dentaire, Université Côte d'Azur, Nice, France; UEC Parodontologie, Pôle Odontologie, CHU de Nice, Nice, France
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Charavet C, Israël N, Vives F, Dridi SM. Importance of Early Detection of Wire Syndrome: A Case Series Illustrating the Main Stages of the Clinical Gradient. Clin Pract 2023; 13:1100-1110. [PMID: 37736934 PMCID: PMC10514803 DOI: 10.3390/clinpract13050098] [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: 07/25/2023] [Revised: 08/28/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023] Open
Abstract
(1) Context and Objective: Wire syndrome (WS) refers to dental displacements which can be qualified as aberrant, unexpected, unexplained, or excessive of teeth still contained by an intact orthodontic retainer wire without detachment or fracture, leading to evolving aesthetic and/or functional consequences, both dental and periodontal. The clinical diagnosis of WS in severe cases is often easy. On the other hand, emerging cases must be detected early to stop this evolutionary process as soon as possible, as well as to effectively manage unwanted dental displacements and associated dento-periodontal tissue repercussions. The aim of this retrospective study was to understand the challenges and importance of early diagnosis, highlight the clinical gradient of WS, and clarify the key elements of diagnosis for many practitioners confronted with this type of problem. (2) Materials and Methods: Three cases of increasing complexity were described: the history of wire syndrome, a description of the key elements of its diagnosis, and the final diagnosis itself. (3) Results: Different types and locations of wire syndrome have been observed, from early form to terminal wire syndrome. The three main stages of the clinical gradient are described as follows. In the first case, wire syndrome starting on tooth 41, called the "X-effect" type, was suspected. X-effect wire syndrome on 21, X-effect wire syndrome on 41, and Twist-effect wire syndrome on 33 were diagnosed in the second case, which can be classified as an intermediate case. In the extreme clinical situation of the last case, severe and terminal wire syndrome on tooth 41, the X-effect type, was observed. (4) Conclusions: This case series presents the main stages of the clinical gradient of WS. Although in the case of early WS it is very difficult to identify and/or differentiate it from movements related to a classical relapse phenomenon, the diagnosis of terminal WS is very easy. The challenge for the practitioner is therefore to detect WS as early as possible to stop the iatrogenic process and propose a personalized treatment depending on the severity of clinical signs. The earlier WS is detected, the less invasive the treatment.
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Affiliation(s)
- Carole Charavet
- Département d’Orthodontie, Faculté de Chirurgie-Dentaire, Université Côte d’Azur, 06300 Nice, France;
- UEC d’Orthodontie, Institut de Médecine Bucco-Dentaire, Centre Hospitalier Universitaire de Nice, 06300 Nice, France
- Laboratoire de Microbiologie Orale, Immunothérapie et Santé (MICORALIS) UPR7354, Faculté de Chirurgie-Dentaire, Université Côte d’Azur, 06300 Nice, France
| | - Nathan Israël
- Département d’Orthodontie, Faculté de Chirurgie-Dentaire, Université Côte d’Azur, 06300 Nice, France;
- UEC d’Orthodontie, Institut de Médecine Bucco-Dentaire, Centre Hospitalier Universitaire de Nice, 06300 Nice, France
| | | | - Sophie-Myriam Dridi
- Département de Parodontologie, Faculté de Chirurgie-Dentaire, Université Côte d’Azur, 06300 Nice, France;
- UF de Parodontologie, Institut de Médecine Bucco-Dentaire, Centre Hospitalier Universitaire de Nice, 06300 Nice, France
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Li Q, Li S, Xiao Q, Hu W, Xu L. Clinical investigation of gingival papilla recession after orthodontic treatment in adults. Clin Oral Investig 2023; 27:4425-4432. [PMID: 37289277 DOI: 10.1007/s00784-023-05061-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/06/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the incidence, severity, susceptibility sites of gingival papillary recession (GPR) in adults after orthodontic treatment and the clinical impact of tooth extraction on GPR. METHODS A total of 82 adult patients were recruited and then divided into extraction and non-extraction groups according to whether the orthodontic teeth were extracted (teeth that needed to be extracted when performing orthodontic treatment). The gingival conditions of the two groups of patients before and after treatment were recorded using intraoral photos, and the incidence, severity and predilection sites of GPR after correction were investigated. RESULTS The results indicated that GPR occurred in 29 patients after correction, with an incidence rate of 35.4%. A total of 1648 gingival papillae were recorded among the 82 patients after correction, of which 67 exhibited atrophy, with an incidence of 4.1%. All occurrences of GPR were classified as papilla presence index 2 (PPI 2) (mild). The condition is most likely to occur in the anterior tooth area, especially in the lower incisor area. The results indicated that the incidence of GPR was substantially higher in the extraction group than in the non-extraction group, with the difference statistically significant. CONCLUSION Following orthodontic treatment, adult patients will have a certain proportion of mild GPR, which is more common in the anterior tooth area, especially the lower anterior tooth area.
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Affiliation(s)
- Qi Li
- Department of Orthodontics, Guiyang Hospital of Stomatology, Guiyang, 550002, China
| | - Shuo Li
- Department of Orthodontics, Peking University School and Hospital of Stomatology, No. 22 of Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
| | - Qianwen Xiao
- Department of Orthodontics, Guiyang Hospital of Stomatology, Guiyang, 550002, China
| | - Wei Hu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, No. 22 of Zhongguancun South Avenue, Haidian District, Beijing, 100081, China.
| | - Li Xu
- Department of Periodontology, Peking University School and Hospital of Stomatology, No. 22 of Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
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Jepsen K, Sculean A, Jepsen S. Complications and treatment errors involving periodontal tissues related to orthodontic therapy. Periodontol 2000 2023; 92:135-158. [PMID: 36920050 DOI: 10.1111/prd.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/25/2022] [Accepted: 01/04/2023] [Indexed: 03/16/2023]
Abstract
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.
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Affiliation(s)
- Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
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Charavet C, Vives F, Aroca S, Dridi SM. “Wire Syndrome” Following Bonded Orthodontic Retainers: A Systematic Review of the Literature. Healthcare (Basel) 2022; 10:healthcare10020379. [PMID: 35206992 PMCID: PMC8871980 DOI: 10.3390/healthcare10020379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Background and objective: Tooth movements described as unexplained, aberrant, unexpected, unwanted, or undesirable can occur in the presence of an intact orthodontic retention wire, without detachment or fracture. This iatrogenic phenomenon, known little or not by many practitioners, responsible for significant dental and periodontal complications, both functional and aesthetic, is called “Wire Syndrome” (WS). It is therefore considered an undesirable event of bonded orthodontic retainers, which must be differentiated from an orthodontic relapse. The objective was to perform, for the first time, a systematic review of the literature in order to define the prevalence of WS and to study its associated clinical characteristics. (2) Methods: A systematic review of the literature was performed following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and recommendations using an electronic search strategy on four databases complemented by a manual search. All the prospective and retrospective clinical studies, including case reports and series, written in English or French, clearly mentioning the description, detection, or management of WS were included. Three independent blinding review authors were involved in study selection, data extraction, and bias assessment using the Mixed Methods Appraisal Tool (MMAT). (3) Results: Of 1891 results, 20 articles published between 2007 and 2021 fulfilled the inclusion criteria, with a globally high risk of bias since 16 articles were case report/series. The analysis of each article allowed the highlighting of WS through 13 categories, as follows: prevalence, apparition delay, patient characteristics, arch and tooth involved, families of movements, dental and periodontal consequences, type of wire, risk factors, etiologies, treatment, and preventive approach. (4) Conclusion: This systematic review of the literature elaborated a synthesis on WS, allowing general practitioners, periodontists, and orthodontists to understand this adverse event, to facilitate the diagnostic approach, and to underline preventive measures against WS. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; number CRD42021269297).
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Affiliation(s)
- Carole Charavet
- Université Côte d’Azur, Faculté de Chirurgie Dentaire, Département d’Orthodontie, 06000 Nice, France;
- Centre Hospitalier Universitaire (CHU) de Nice, Pôle Odontologie, UEC Orthodontie, 06000 Nice, France
- Laboratoire MICORALIS UPR 7354, Université Côte d’Azur, 06000 Nice, France;
- Correspondence: or
| | - France Vives
- Université Côte d’Azur, Faculté de Chirurgie Dentaire, Département d’Orthodontie, 06000 Nice, France;
- Centre Hospitalier Universitaire (CHU) de Nice, Pôle Odontologie, UEC Orthodontie, 06000 Nice, France
| | - Sofia Aroca
- Pratique Privée, 75116 Paris, France;
- University of Bern, Department of Periodontology, 3012 Bern, Switzerland
| | - Sophie-Myriam Dridi
- Laboratoire MICORALIS UPR 7354, Université Côte d’Azur, 06000 Nice, France;
- Université Côte d’Azur, Faculté de Chirurgie Dentaire, Département de Parodontologie, 06000 Nice, France
- Centre Hospitalier Universitaire (CHU) de Nice, Pôle Odontologie, UEC Parodontologie, 06000 Nice, France
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Weinberg E, Kolerman R, Kats L, Cohen O, Masri D, Sebaoun A, Slutzkey G. Coronally Advanced Flap with Connective Tissue Graft for Treating Orthodontic-Associated Miller Class III Gingival Recession of the Lower Incisors: A One-Year Retrospective Study. J Clin Med 2022; 11:jcm11010235. [PMID: 35011976 PMCID: PMC8745991 DOI: 10.3390/jcm11010235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/27/2021] [Accepted: 12/31/2021] [Indexed: 12/04/2022] Open
Abstract
(1) Background: To assess the clinical outcome of coronally advanced flap combined with connective tissue graft for the treatment of orthodontic-associated Miller Class III gingival recession of the lower incisors. (2) Methods: This study included 15 patients who had undergone orthodontic treatment prior to development of recession. Measurements of recession depth, recession width, probing depth, and width of keratinized tissue were performed clinically immediately before surgery and after one year. In addition, digital measurements of recession depth, recession width, and root coverage esthetic score were performed on intraoral photographs. (3) Results: Significant reduction was observed for probing depth, recession depth, and recession width at one year, with significant increase in width of keratinized tissue. Mean root coverage was 83 ± 24% for recession depth, while complete root coverage was achieved in 10 out of 21 recessions (48%). The average root coverage esthetic score at 12 months was 7.1 ± 2.6. An interaction was found between initial recession depth and mean root coverage. (4) Conclusions: Within the limitations of this study, our results confirm that combination of coronally advanced flap and connective tissue graft is effective in reducing post-orthodontic Miller Class III recessions of the mandibular incisors, even when the correction of the tooth malposition, is unattainable.
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Affiliation(s)
- Evgeny Weinberg
- Departments of Periodontology and Oral Implantology, Departments of Oral Biology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence:
| | - Roni Kolerman
- Department of Periodontology and Oral Implantology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (R.K.); (O.C.); (A.S.); (G.S.)
| | - Lazar Kats
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Omer Cohen
- Department of Periodontology and Oral Implantology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (R.K.); (O.C.); (A.S.); (G.S.)
| | - Daya Masri
- Rabin Medical Center, Department of Oral and Maxillofacial Surgery, Petach-Tikva 4941492, Israel;
| | - Alon Sebaoun
- Department of Periodontology and Oral Implantology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (R.K.); (O.C.); (A.S.); (G.S.)
| | - Gil Slutzkey
- Department of Periodontology and Oral Implantology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (R.K.); (O.C.); (A.S.); (G.S.)
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