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Kobylyanskyy O, Schwarz L, Rausch MA, Kobylyanska A, Andrukhov O, Rausch-Fan X. Changes in the alveolar bone morphology among different patterns of incisor inclination during the alignment phase in orthodontic treatment without premolar extraction. Orthod Craniofac Res 2024; 27:645-655. [PMID: 38520046 DOI: 10.1111/ocr.12781] [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: 12/11/2023] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE The present study investigated bone remodelling in the upper and lower incisor regions depending on the inclination pattern during the alignment phase of orthodontic treatment (OT). MATERIALS AND METHODS This prospective clinical study included 71 patients undergoing OT without premolar extraction. Cone beam computed tomography scans were taken before and after the alignment phase and the changes in the inclination, alveolar bone height (ABH) and bone thickness (BT) at levels 2, 3, 4, 6, 8 and 9 mm starting from the cementoenamel junction (CEJ) were determined. RESULTS Teeth were divided into 'Retroinclination' (lingual crown inclination <0°), 'Proclination-low' (buccal crown inclination between 0° and 5°), or 'Proclination-high' (buccal crown inclination >5°). The alignment phase of OT resulted in ABH loss. The highest ABH loss in the maxilla was observed on the buccal side in the 'Proclination-high' and was 0.71 mm. ABH loss by 1.1 mm was observed in the mandible on the lingual side in the 'Retroinclination' group. The most significant changes in BT by up to 2 mm were observed at levels 6, 8 and 9 mm and these changes exhibited a moderate to strong correlation with the alterations in the inclination of individual incisors. At levels 2, 3 and 4 mm, the highest decrease in BT by up to 0.83 mm was observed on the palatal side of upper incisors in the 'Proclination-high' group. CONCLUSION The direction and amount of tooth inclination partially determine changes in the bone parameters during the alignment phase.
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Affiliation(s)
- Oleksandr Kobylyanskyy
- Center for Clinical Research, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
- International School of Progressive Orthodontics, Kyiv, Ukraine
- Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Linda Schwarz
- Division of Orthodontics, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Marco Aoqi Rausch
- Division of Orthodontics, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | | | - Oleh Andrukhov
- Competence Center for Periodontal Research, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Xiaohui Rausch-Fan
- Center for Clinical Research, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
- Clinical Division of Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
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Antonarakis GS, Alkisti Z, Stavros K, Catherine G. Periodontal considerations during orthodontic intrusion and extrusion in healthy and reduced periodontium. Periodontol 2000 2024. [PMID: 38831560 DOI: 10.1111/prd.12578] [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: 10/17/2023] [Revised: 04/30/2024] [Accepted: 05/13/2024] [Indexed: 06/05/2024]
Abstract
In patients with advanced periodontal disease, pathological tooth migration may occur, which may require subsequent orthodontic treatment for both aesthetic and functional purposes. When planning orthodontic treatment mechanics, intrusive or extrusive forces are frequently indicated. Understanding tissue reactions during these movements is essential for clinicians when devising a comprehensive orthodontic-periodontal treatment plan. This knowledge enables clinicians to be fully aware of and account for the potential effects on the surrounding tissues. The majority of our understanding regarding the behavior of periodontal tissues in both healthy and compromised periodontal conditions is derived from animal studies. These studies offer the advantage of conducting histological and other assessments that would not be feasible in human research. Human studies are nevertheless invaluable in being able to understand the clinically relevant response elicited by the periodontal tissues following orthodontic tooth movement. Animal and human data show that in dentitions with reduced periodontal support, orthodontic intrusion of the teeth does not induce periodontal damage, provided the periodontal tissues do not have inflammation and plaque control with excellent oral hygiene is maintained. On the contrary, when inflammation is not fully controlled, orthodontic intrusion may accelerate the progression of periodontal destruction, with bacterial plaque remnants being displaced subgingivally, leading to further loss of attachment. Orthodontic extrusion, on the other hand, does not seem to cause further periodontal breakdown in dentitions with reduced periodontal support, even in cases with deficient plaque control. This is attributed to the nature of the tooth movement, which directs any plaque remnants coronally (supragingivally), reducing the risk of adverse effects on the periodontal tissues. This specific type of tooth movement can be leveraged to benefit periodontal conditions by facilitating the regeneration of lost hard and soft periodontal tissues in a coronal direction. As a result, orthodontic extrusion can be employed in implant site development, offering an advantageous alternative to more invasive surgical procedures like bone grafting. Regardless of the tooth movement prescribed, when periodontal involvement is present, it is essential to prioritize periodontal therapy before commencing orthodontic treatment. Adequate plaque control is also imperative for successful outcomes. Additionally, utilizing light orthodontic forces is advisable to achieve efficient tooth movement while minimizing the risk of adverse effects, notably root resorption. By adhering to these principles, a more favorable and effective combined orthodontic-periodontal approach can be ensured. The present article describes indications, mechanisms, side effects, and histological and clinical evidence supporting orthodontic extrusion and intrusion in intact and reduced periodontal conditions.
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Affiliation(s)
- Gregory S Antonarakis
- Division of Orthodontics, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Zekeridou Alkisti
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Kiliaridis Stavros
- Division of Orthodontics, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Orthodontics and Dentofacial Orthopaedics, University of Bern, Bern, Switzerland
| | - Giannopoulou Catherine
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Sadek MM, Gaber RM. Alveolar bone changes around maxillary incisors after intrusion and retraction with controlled tipping versus bodily movement : A retrospective cone-beam computed tomography study. J Orofac Orthop 2024; 85:79-93. [PMID: 37672129 DOI: 10.1007/s00056-023-00493-z] [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: 09/07/2022] [Accepted: 07/11/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE To compare the effect of maxillary incisor intrusion and retraction with controlled tipping (CT) versus bodily movement (BM) in extraction cases on alveolar bone height and thickness, using cone-beam computed tomography (CBCT). Correlations between changes in alveolar dimensions and crown or root retraction, incisor inclination, and intrusion were also investigated. MATERIALS AND METHODS In all, 144 incisors of 36 women were retrospectively evaluated. All patients were treated with anterior intrusion and retraction with either controlled tipping (CT) (group 1) or bodily movement (BM) (group 2). CBCT scans were taken before and after retraction and intrusion and measurements of alveolar bone height and thickness at the level of mid-root and root apex were measured. The prevalence of dehiscence was also calculated. RESULTS Labial bone thickness (BT) increased at the level of the root apex with increased total BT in the CT group (p < 0.05). The BM group showed decreased palatal BT. Significant vertical bone loss with an increased incidence of dehiscences occurred on the palatal side in both groups. Changes in palatal bone area was negatively correlated with the amount of root apex retraction, while the total BT at the level of root apex was positively correlated with amount of intrusion. CONCLUSIONS Bodily retraction can result in reduced palatal bone dimensions and an increase risk of iatrogenic sequelae following anterior retraction in extraction cases. Vertical bone loss and an increased incidence of dehiscences is to be expected following anterior retraction. Careful attention must be paid to the bone boundary conditions to avoid moving the incisors out of the alveolar housing.
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Affiliation(s)
- Mais Medhat Sadek
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates.
- Department of Orthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt.
| | - Ramy M Gaber
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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Al-Warafi LA, Al-Worafi NA, Al-Aroomi MA, Alhashimi N, Alsomairi MAA, Al-Rokhami RK, Chen X, Alhammadi MS. Alveolar bone changes following bi-maxillary vertical molars' movements using clear aligners. BMC Oral Health 2023; 23:326. [PMID: 37231473 DOI: 10.1186/s12903-023-03028-5] [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: 01/31/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE This study aimed to assess the alveolar bone changes following maxillary and mandibular molars' intrusion and extrusion movements using Clear Aligners using Cone-Beam Computed Tomography (CBCT). MATERIALS AND METHODS This is a retrospective clinical study in which 24 adult patients with pre-designed selection criteria and a mean age of 31.1 + 9.9 years were enrolled. The alveolar bone changes around one hundred thirty-three maxillary and mandibular molars intruded or extruded by Clear Aligners therapy were analyzed from CBCT using Invivo 6.0 software. Intra- and inter-examiner reliability analysis was performed using the intra-class correlation coefficient (ICC) and Cronbach's Alpha statistics. The paired t-test was used to analyze significant differences before and after treatment (T0-T1). The significance level was considered at P < 0.05. RESULT The patients were divided into two groups: extrusion (48.9%, n = 65 molars' root) and intrusion (51.1%, n = 68 molars' root) group. There was a significant decrease in the alveolar bone changes in the buccal surface of the mandibular right and left 1st molars in the extrusion group (-1.05 ± 0.97, -0.76 ± 1.12 mm, respectively) and the maxillary left 2nd molars in intrusion group (-0.42 ± 0.77 mm), and the lingual surface of intrusion of the mandibular left 1st molar (-0.64 ± 0.76 mm). Comparing the mean maxillary and mandibular changes (T0-T1) of both studied groups showed that the buccal alveolar bone changes for the left 1st and right 2nd molars showed a significant difference in extrusion and intrusion groups, respectively. CONCLUSIONS The buccal alveolar bone changes is considered the most affected surface following maxillary and mandibular molars' intrusion and extrusion movements using clear aligners, with mandibular molars being more affected than the maxillary ones.
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Affiliation(s)
- Leena Ali Al-Warafi
- Department of Stomatology, The First Affiliated Hospital of Xi'an JiaotongUniversity, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Naseem Ali Al-Worafi
- Department of Orthodontics, School of Stomatology, China Medical University, Shenyang, China
| | - Maged Ali Al-Aroomi
- Department of Oral and maxillofacial surgery, Faculty of dentistry, IBB University, IBB, Yemen
| | - Najah Alhashimi
- College of Dental Medicine, Chief of orthodontics division at Hamad Medical Corporation, Qatar University, Doha, Qatar
| | - Majedh Abdo Ali Alsomairi
- Department of Stomatology, The First Affiliated Hospital of Xi'an JiaotongUniversity, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Remsh Khaled Al-Rokhami
- Department of Orthodontics, School of Stomatology, China Medical University, Shenyang, China
| | - Xi Chen
- Department of Stomatology, The First Affiliated Hospital of Xi'an JiaotongUniversity, Xi'an, 710061, Shaanxi, People's Republic of China.
| | - Maged Sultan Alhammadi
- Division of Orthodontics and Dentofacial Orthopedics, Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
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Alam F, Chauhan AK, Sharma A, Verma S, Raj Y. Comparative cone-beam computed tomographic evaluation of maxillary incisor intrusion and associated root resorption: Intrusion arch vs mini-implants. Am J Orthod Dentofacial Orthop 2023; 163:e84-e92. [PMID: 36635144 DOI: 10.1016/j.ajodo.2022.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Various literature has verified that apical root resorption is a common adverse effect of orthodontic treatment, particularly intrusion. Conventional radiographic techniques underestimated root lengths and overestimated tooth lengths. Cone-beam computed tomography (CBCT) is a useful diagnostic tool to detect orthodontically induced external apical root resorption. This prospective study aimed to compare maxillary incisor intrusion and associated root resorption via CBCT. METHODS Thirty patients aged 16-23 years, having a deepbite of 6-8 mm and excessive gingival display on smiling, were divided into 2 groups: group 1, with 15 patients who were treated with Burstone intrusion arch, and group 2 with 15 patients who were treated with mini-implants applying 100 g of intrusive force for 4 months with activation done every 4 weeks. During this 4-month study period, no treatment was performed other than the intrusion of incisors. CBCT scans were obtained before and after the intrusion phase of treatment to compare the amount of intrusion and associated root resorption among both groups. RESULTS No significant difference was found in mean incisor intrusion between groups 1 and 2 (P = 0.772), with slightly more proclination of incisors in group 1, resulting in a significant (P = 0.018) increase in the vertical change of incisal edge in group 1. A statistically significant difference was found in root resorption among both groups (P = 0.004), with more root resorption in group 2. CONCLUSIONS The results of this study indicate intrusion with both the intrusion systems using appropriate intrusive forces is effective in opening the bite with slightly more external apical root resorption in the mini-implant group.
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Affiliation(s)
- Fatima Alam
- Department of Orthodontics and Dentofacial Orthopaedics, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India.
| | - A K Chauhan
- Department of Orthodontics and Dentofacial Orthopaedics, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Anil Sharma
- Department of Orthodontics and Dentofacial Orthopaedics, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Santosh Verma
- Department of Orthodontics and Dentofacial Orthopaedics, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Yukti Raj
- King George's Medical University, Lucknow, Uttar Pradesh, India
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Kalina E, Grzebyta A, Zadurska M. Bone Remodeling during Orthodontic Movement of Lower Incisors-Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15002. [PMID: 36429721 PMCID: PMC9691226 DOI: 10.3390/ijerph192215002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 06/15/2023]
Abstract
The tooth movement in the alveolus is possible due to bone remodeling. This process could be the risk factor for the formation of gingival recessions-the most common side effects of orthodontic therapy. Gingival recessions are found 5.8-11.5% more frequently among the orthodontically treated patients. What is more, anterior mandibular teeth are the ones most prone to gingival recession dehiscences and fenestrations. The aim of this narrative review was to evaluate, based on CBCT (Cone beam computed tomography) scans, the changes in the alveolar bone of lower incisors in adolescent and adult patients after orthodontic tooth movements. From the pool of 108 publications, a total of 15 fulfilled the criteria of this review. Both retrospective and prospective longitudinal studies-using CBCT or CT (Computed Topography) and evaluating alveolar bone changes in mandibular incisors during orthodontic treatment performed before and after teeth movement-were included. In the group of growing patients, either proclination or retroclination of mandibular incisors led to increase of the distance from CEJ (cementoenamel junction) to marginal bone crest. The difference in bone loss was greater on the lingual side of the incisors in both types of tooth movement. The results were similar for adults patients. The thickness of the alveolar bone was reduced after proclination (total bone thickness) among growing and non-growing patients and retraction (lingual and buccal) of lower anterior teeth in the group of growing patients. The only improvement was measured for buccal thickness of mandibular incisor in bimaxillary protrusion patients treated with extraction therapy. The control of retraction movement (more root than crown movement) enhanced preservation on bone height and thickness. In order to minimize possible deterioration and place teeth in the center of alveolus, CBCT monitoring and scrupulous clinical evaluation are recommended.
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Yang CYM, Atsawasuwan P, Viana G, Tozum TF, Elshebiny T, Palomo JM, Sellke T, Elnagar MH. Cone‐Beam
Computed Tomography Assessment of Maxillary Anterior Alveolar Bone Remodeling in Extraction and
Non‐Extraction
Orthodontic Cases Using Stable
Extra‐Alveolar
Reference. Orthod Craniofac Res 2022; 26:265-276. [PMID: 36104955 DOI: 10.1111/ocr.12609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore alveolar cortical positional change in response to tooth movement in extraction and non-extraction orthodontic cases, using cone-beam computed tomography (CBCT) and stable extra-alveolar references. MATERIALS AND METHODS The pre-treatment (T1) and post-treatment (T2) CBCT scans of 25 extraction (EXT) and matched 25 non-extraction (Non-EXT) orthodontic cases were imported into Dolphin Imaging 3D, and oriented uniformly. Sagittal and axial CBCT cross-sections were traced using customized software-generated guides. The displacement of teeth and alveolar bone cortices were automatically measured using the palatal plane (PP) and the line perpendicular to PP and passing Sella as reference. Intra- and inter-group differences between T1 and T2 were analysed. Subjects were also superimposed three-dimensionally using Geomagic Control X for qualitative analysis of cortical remodelling. RESULTS The EXT group showed incisor retraction, while the Non-EXT group exhibited statistically significant incisor anterior tipping (P < .05). In EXT, both the labial and palatal cortices are resorbed. Non-EXT showed labial cortex anterior modelling, and statistically significant palatal cortex resorption (P < .05). In both groups, statistically significant decrease in total and palatal alveolar widths, increase in labial widths, and palatal dehiscence were observed. Comparatively, EXT showed significantly more incisal total and palatal width decrease and palatal vertical bone loss. CONCLUSION Labial cortical remodelling was shown to follow anterior tooth movement, but the palatal cortical response to incisor retraction and labial cortical remodelling in general remained inconclusive. Narrowing of the alveolar housing and palatal dehiscence were observed regardless of extraction following orthodontic treatment.
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Affiliation(s)
- Chih Yau Michael Yang
- Department of Orthodontics, College of Dentistry University of Illinois Chicago Chicago Illinois USA
| | - Phimon Atsawasuwan
- Department of Orthodontics, College of Dentistry University of Illinois Chicago Chicago Illinois USA
| | - Grace Viana
- Department of Orthodontics, College of Dentistry University of Illinois Chicago Chicago Illinois USA
| | - Tolga F. Tozum
- Department of Periodontics, College of Dentistry University of Illinois Chicago Chicago Illinois USA
| | - Tarek Elshebiny
- Department of Orthodontics, School of Dental Medicine Case Western Reserve University Cleveland Ohio USA
| | - Juan Martin Palomo
- Department of Orthodontics, School of Dental Medicine Case Western Reserve University Cleveland Ohio USA
| | - Terry Sellke
- Department of Orthodontics, College of Dentistry University of Illinois Chicago Chicago Illinois USA
| | - Mohammed H. Elnagar
- Department of Orthodontics, College of Dentistry University of Illinois Chicago Chicago Illinois USA
- Department of Orthodontics, Faculty of Dentistry Tanta University Tanta Egypt
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Shafizadeh M, Tehranchi A, Shirvani A, Motamedian SR. Alveolar bone thickness overlying healthy maxillary and mandibular teeth: A systematic review and meta-analysis. Int Orthod 2021; 19:389-405. [PMID: 34366263 DOI: 10.1016/j.ortho.2021.07.002] [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: 05/30/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To systematically review and meta-analyse the Alveolar Bone Thickness (ABT) overlying healthy teeth. The secondary objective was to review the association of ABT with gender, age, and smoking. MATERIALS AND METHODS The PubMed, Embase, Scopus, ProQuest, Web of Science, and Cochrane Library databases were searched up to July 2020. English articles (sample size≥10) which had used CT or CBCT to measure the ABT at clearly defined reference points were included. The maximum likelihood approach meta-analysis was used to estimate the means (95% CIs). RESULTS A total of 68 articles were included. The meta-analysis results were as follows: In the anterior maxilla, the mean labial plate thickness ranged from 0.42-1.75mm, while it was thicker for the posterior teeth (0.78-4.31mm). The palatal plate thickness ranged from 0.97-8.13mm. In the anterior mandible, the thickness of labial and lingual plates ranged from 0.4-3.71mm and 0.38-5.44mm, respectively. The alveolar bone was thicker for the posterior teeth both at the labial (0.66-6.31mm) and lingual (2.31-7.77mm) sides. Meta-regression revealed a significant relationship between gender and ABT at several points. There was a controversy regarding the association of ABT with age. No significant difference was evidenced between smokers and non-smokers. CONCLUSIONS This study presents a clear image of the alveolar bone structure. Since it has pooled ABT values from various populations, outcomes could be acknowledged as global averages. Therefore, it could provide perspective for several dental procedures, including orthodontic treatments and immediate implant placement.
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Affiliation(s)
- Marziyeh Shafizadeh
- Dentofacial Deformities Research Centre, Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran
| | - Azita Tehranchi
- Dentofacial Deformities Research Centre, Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran
| | - Armin Shirvani
- Department of Orthodontics, School of Dentistry, Dental Research Centre, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran
| | - Saeed Reza Motamedian
- Dentofacial Deformities Research Centre, Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran; Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran.
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Sun Q, Lu W, Zhang Y, Peng L, Chen S, Han B. Morphological changes of the anterior alveolar bone due to retraction of anterior teeth: a retrospective study. Head Face Med 2021; 17:30. [PMID: 34271939 PMCID: PMC8284009 DOI: 10.1186/s13005-021-00277-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/23/2021] [Indexed: 11/21/2022] Open
Abstract
Backgroud To analyze the morphological changes of the anterior alveolar bone after the retraction of incisors in premolar extraction cases and the relationship between incisor retraction and remodeling of the alveolar base represented by points A and B displacements. Methods Pre- (T0) and post-treatment (T1) lateral cephalograms of 308 subjects in the maxilla and 154 subjects in the mandible who underwent the orthodontic treatment with extraction of 2 premolars in upper or lower arches were included. Alveolar bone width and height in both the maxillary and mandible incisor area were measured at T0 and T1 respectively. By superimposing the T0 and T1 cephalometric tracings, changes of points A and B, and the movement of the incisors were also measured. Then the correlation between incisor movement and the displacements of points A and B was analyzed. Results The alveolar bone width (ABW) showed a significant decrease in both maxilla and mandible (P < 0.001) except the labial side of the mandible (P > 0.05). The alveolar bone height (ABH) showed a significant increase in the labial side of maxilla and a significant decrease in the lingual side of maxilla and mandible. A strong positive correlation was verified between incisor movement and position changes of points A and B in both horizontal and vertical directions. Conclusions Anterior alveolar bone width and height generally decreased after orthodontic treatment. Incisor retraction led to significant position changes of points A and B. The decrease of anterior alveolar bone due to significant incisor retraction should be taken into account in treatment planning.
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Affiliation(s)
- Qiannan Sun
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Wenhsuan Lu
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Yunfan Zhang
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Liying Peng
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Si Chen
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China.
| | - Bing Han
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China.
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Hong SY, Shin JW, Hong C, Chan V, Baik UB, Kim YH, Chae HS. Alveolar bone remodeling during maxillary incisor intrusion and retraction. Prog Orthod 2019; 20:47. [PMID: 31867679 PMCID: PMC6926139 DOI: 10.1186/s40510-019-0300-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/12/2019] [Indexed: 11/27/2022] Open
Abstract
Background Maxillary incisor protrusion is a prevalent dental deformity and is often treated by upper incisor intrusion and retraction. The mechanical loading triggers the resorption and apposition of the bone. Alveolar bone remodeling is expected to follow orthodontic tooth movement in a one-to-one relationship. However, in many cases, the outcomes are different. Alveolar bone might still remain thick causing lip protrusion and other aesthetic problems after treatment. Additional corrective procedures such as alveoloplasty. On the other hand, if the labial bone becomes too thin, periodontal problems like gingival recession might occur. The unpredictability of the treatment result and the risk of requiring corrective procedures pose significant challenges to both the providers and patients. The aim of this study is to determine factors that can help to predict the alveolar bone reaction before maxillary incisor intrusion and retraction. Methods The cohort included 34 female patients (mean age 25.8 years) who were diagnosed with skeletal class II malocclusion with upper incisor protrusion. These patients underwent extraction and orthodontic treatment with upper incisor intrusion and retraction. Lateral cephalograms at pre-treatment and post-treatment were taken. Linear and angular measurements were analyzed to evaluate the alveolar bone changes based on initial conditions. Results The study found that the relative change, calculated as change in alveolar bone thickness after treatment divided by the initial alveolar thickness, was inversely correlated with the initial thickness. There was a significant increase of labial alveolar bone thickness at 9-mm apical from cementoenamel junction (B3) (P < 0.05) but no statistically significant change in the thickness at other levels. In addition, the change in angulation between the incisor and alveolar bone was inversely correlated with several initial angulations: between the initial palatal plane and upper incisor angle, between the initial palatal plane and upper incisor labial surface angle, and between the initial palatal plane and bone labial surface angle. On the other hand, the change in labial bone thickness was neither significantly correlated with the initial thickness nor significantly correlated to the amount of retraction. Conclusion The unpredictability of alveolar bone remodeling after upper incisor intrusion and retraction poses significant challenges to treatment planning and patient experience. The study showed that the initial angulation between the incisor and alveolar bone is correlated with the change in angulation after treatment, the initial thickness of the alveolar bone was correlated with the relative change of the alveolar bone thickness (defined as change in thickness after treatment divided by its initial thickness), and the amount of intrusion was correlated with the alveolar bone thickness change at 9-mm apical from the cementoenamel junction after treatment. The results of the present study also revealed that the change in labial alveolar bone thickness was neither significantly correlated with the initial thickness nor significantly correlated to the amount of retraction.
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Affiliation(s)
- Seok Yoon Hong
- Department of Orthodontics, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, South Korea
| | - Jeong Won Shin
- Department of Orthodontics, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, South Korea
| | - Christine Hong
- Division of Orthodontics. School of Dentistry, University of California, San Francisco, CA, USA
| | - Vania Chan
- School of Dentistry, University of California, Los Angeles, CA, USA
| | - Un-Bong Baik
- Department of Orthodontics, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, South Korea
| | - Young Ho Kim
- Department of Orthodontics, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, South Korea
| | - Hwa Sung Chae
- Department of Orthodontics, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, South Korea.
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Zhang F, Lee SC, Lee JB, Lee KM. Geometric analysis of alveolar bone around the incisors after anterior retraction following premolar extraction. Angle Orthod 2019; 90:173-180. [PMID: 31769701 DOI: 10.2319/041419-266.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate changes in shape and alterations in thickness and vertical marginal bone levels of the alveolar bone around the maxillary and mandibular incisors before and after orthodontic treatment with premolar extraction using geometric morphometric analysis. MATERIALS AND METHODS Thirty-six patients with Class I bialveolar protrusion who underwent orthodontic treatment with premolar extraction were included. Cone-beam computed tomographic scans were obtained from the patients before and after treatment. Five fixed landmarks and 70 semilandmarks were used to represent the morphology of the alveolar bone around the maxillary and mandibular incisors. The coordinates of the landmarks of the alveolar bones were generated by Procrustes fit. The labial and lingual alveolar bone thicknesses around the maxillary and mandibular incisors and vertical marginal bone level were assessed quantitatively. RESULTS There was a significant difference in shape change of the alveolar bone before and after treatment. The deformation grid of the thin plate spline showed that the thickness and vertical marginal bone decreased on the lingual side after treatment. Shape changes were greater for the lingual alveolar bone on the mandibular incisor than for the maxillary incisors. CONCLUSIONS Orthodontic treatment with premolar extraction might cause loss of alveolar bone around the maxillary and mandibular incisors. Careful consideration is needed to avoid iatrogenic degeneration of periodontal support around the incisors, particularly in the lingual area.
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de Brito GM, Brito HHDA, Marra GGM, Freitas LRP, Hargreaves BO, Magalhães PAA, Oliveira DD. Pure Mandibular Incisor Intrusion: A Finite Element Study to Evaluate the Segmented Arch Technique. MATERIALS (BASEL, SWITZERLAND) 2019; 12:ma12172784. [PMID: 31470584 PMCID: PMC6748075 DOI: 10.3390/ma12172784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 06/10/2023]
Abstract
Leveling the curve of Spee is a commonly-used strategy to correct deep bites. Although several techniques have been proposed to intrude mandibular incisors (MI), flaring of these teeth is often observed and in many instances undesired. A three-dimensional (3D) finite element model (FEM) was used to locate the ideal point of force application (PFA) to achieve pure MI intrusion with the three-piece arches' technique. It comprised (1) a 0.021 × 0.025 in. stainless steel (SS) wire that passively filled the slots of the canine and premolar brackets and the first and second molar tubes, bilaterally; (2) a 0.0215 × 0.0275 in. SS intrusion base arch (IBA) inserted into the MI brackets, that presented a step down distal to the lateral incisors brackets and a posterior extension arm; (3) titanium-molybdenum tip-back springs designed to apply the intrusion force, fitted inside the first molar gingival tube. Four PFA on the IBA were simulated (FEM 1, 2, 3, and 4). FEM 3 resulted in pure MI and was considered the ideal PFA. FEM1 and 2 showed intrusion and buccal crown flaring of the MI, whereas FEM4 resulted in intrusion and lingual crown flaring of those teeth. Clinicians may consider three-piece arch mechanics to achieve pure MI intrusion. However, they must be aware that when force was applied anteriorly or posteriorly to the ideal PFA, the incisors would incline labially or lingually, respectively.
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Affiliation(s)
- Gabriela Meyge de Brito
- Department of Dentistry, Graduate Program in Orthodontics, Pontifical Catholic University of Minas Gerais, Belo Horizonte 30535-901, Brazil
| | - Hélio Henrique de Araújo Brito
- Department of Dentistry, Graduate Program in Orthodontics, Pontifical Catholic University of Minas Gerais, Belo Horizonte 30535-901, Brazil
| | - Gabriel Goulart Mendes Marra
- Department of Mechanical Engineering, Pontifical Catholic University of Minas Gerais, Belo Horizonte 30535-901, Brazil
| | - Laíze Rosa Pires Freitas
- Department of Dentistry, Graduate Program in Orthodontics, Pontifical Catholic University of Minas Gerais, Belo Horizonte 30535-901, Brazil
| | - Bernardo Oliveira Hargreaves
- Department of Mechanical Engineering, Pontifical Catholic University of Minas Gerais, Belo Horizonte 30535-901, Brazil
| | | | - Dauro Douglas Oliveira
- Department of Dentistry, Graduate Program in Orthodontics, Pontifical Catholic University of Minas Gerais, Belo Horizonte 30535-901, Brazil.
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