Mandibular Molar Uprighting Using Skeletal Anchorage: A Novel Approach

Maintaining Hygiene in Orthodontic Miniscrews: Patient Management and Protocols-A Literature Review

BACKGROUND

Oral hygiene is crucial for the success of orthodontic therapy involving temporary anchoring devices like miniscrews. Plaque buildup, exacerbated by orthodontic appliances, causes inflammation that can undermine treatment outcomes. Individualized prevention plans based on patient risk factors are essential. This review emphasizes the importance of oral hygiene in orthodontic therapy with miniscrews, identifies optimal devices for ensuring long-term stability, and explores protocols for high-risk patients.

MATERIALS AND METHODS

A comprehensive search was conducted on two primary databases, PubMed and Google Scholar, for relevant articles on oral hygiene and inflammation. Fourteen articles meeting the inclusion criteria were selected, covering topics such as "orthodontic miniscrew", "miniscrew and laser", "miniscrew and mouthwash", "electric toothbrush", and "GBT".

RESULTS

Inflammation can compromise miniscrew stability by damaging surrounding bone. Miniscrews of 10 mm length have lower failure rates due to better bone contact and stability. Chlorhexidine reduces inflammation risk and inhibits epithelialization around the implant head. Laser therapy enhances miniscrew stability and reduces inflammation. Chitosan effectively suppresses inflammatory mediators and prevents microorganism adhesion. Both sonic and roto-oscillating electric toothbrushes remove plaque effectively, with roto-oscillating brushes showing superior results. The Guided Biofilm Therapy (GBT) protocol offers professional hygiene benefits similar to traditional methods, with improved patient engagement and motivation.

CONCLUSIONS

Home oral hygiene maintenance is paramount for preventing inflammatory complications. Professional interventions such as diode laser usage, particularly in adult patients with a history of periodontitis or underlying systemic conditions, can mitigate orthodontic therapy failure risks. The GBT protocol fosters a more comfortable and participatory professional hygiene experience for patients, promoting better oral health awareness and compliance.

Characteristics of Spatial Changes in Molars and Alveolar Bone Resorption among Patients with Loss of Mandibular First Molars: A CBCT-Based Morphometric Study

OBJECTIVES

To investigate the characteristics of spatial changes in molars and alveolar bone resorption among patients with loss of mandibular first molars.

METHODS

A total of 42 CBCT scans of patients with missing mandibular first molars (3 males, 33 females) and 42 CBCT scans of control subjects without loss of mandibular first molars (9 males, 27 females) were evaluated in this cross-sectional study. All images were standardized using the mandibular posterior tooth plane with Invivo software. The following indices regarding alveolar bone morphology were measured, including alveolar bone height, bone width, mesiodistal and buccolingual angulation of molars, overeruption of maxillary first molars, bone defects, and the capability of molar mesialization.

RESULTS

The vertical alveolar bone height in the missing group was reduced by 1.42 ± 0.70 mm, 1.31 ± 0.68, and 1.46 ± 0.85 mm on the buccal, middle, and lingual side, respectively (no differences among the three sides; p > 0.05). Alveolar bone width was reduced the greatest at the buccal CEJ level and the least at the lingual apex level. Mandibular second molar mesial tipping (with mean of the mesiodistal angulation = 57.47 ± 10.34°) and lingual tipping (with mean of the buccolingual angulation = 71.75 ± 8.34°) were observed. The mesial and distal cusps of maxillary first molars were extruded by 1.37 mm and 0.85 mm, respectively. Buccal and lingual defects of alveolar bone occurred at the CEJ, mid-root, and apex levels. Through 3D simulation, the second molar cannot be successfully mesialized into the missing tooth position, and the difference between the available and required distances for mesialization was the greatest at the CEJ level. The duration of tooth loss was significantly correlated with the mesio-distal angulation (R = -0.726, p < 0.001), buccal-lingual angulation (R = -0.528, p < 0.001) and the extrusion of the maxillary first molar (R = -0.334, p < 0.05).

CONCLUSION

Both vertical and horizontal resorption of alveolar bone occurred. Mandibular second molars exhibit mesial and lingual tipping. Lingual root torque and uprighting of the second molars are needed for the success of molar protraction. Bone augmentation is indicated for severely resorbed alveolar bone.

Comparison between orthodontic and surgical uprighting of mandibular molars: a systematic review

OBJECTIVES

To evaluate and compare the efficiency of orthodontic treatment and surgical uprighting of first and second mandibular molars.

MATERIALS AND METHODS

An electronic literature search in PubMed, Science Direct, Embase, Scopus, Web of Science, Cochrane Library, LILACS, and Google Scholar, as well as a hand search was conducted by two independent researchers to identify relevant articles up to January 2022. In addition, a manual search was done that included article reference lists, grey literature, and dissertations. The risk of bias of the included prospective and retrospective studies was assessed with the Risk Of Bias Tool In Non-randomized Studies of Interventions (ROBINS-I) assessment tool.

RESULTS

A total of six nonrandomized clinical trials (non-RCT) evaluating the efficiency of mandibular molar orthodontic and/or surgical uprighting were included. The quality analysis showed certain defects of the Non-RCTs included and, according to the criteria used, the majority of the articles were judged to be of moderate quality.

CONCLUSIONS

Based on the evidence, orthodontic and surgical uprighting appear to be effective treatment methods for mandibular molars. Surgical uprighting may be associated with more complications than orthodontic uprighting. However, the existing literature on the subject is limited, heterogeneous, and methodologically limited. Therefore, the outcomes should be interpreted carefully.