Effects of different splinting times on surgically extruded teeth with a crown-root fracture: A randomized controlled trial.

BACKGROUND/AIM: Clinical studies evaluating the splinting time for surgically extruded teeth with crown-root fractures are lacking. The aim of this study was to compare 2-week splinting versus functional splinting times after surgical extrusion. MATERIAL AND METHODS: Children aged 8-13 years who presented with crown-root fractures were included. Surgical extrusion was performed, and teeth were splinted either for 2 weeks or until normal Periotest values were achieved (functional splinting time). The outcome measures were tooth mobility, tooth loss, root resorption, marginal bone resorption and ankylosis. Measurements were taken at baseline, weekly after splint removal, and after 1, 3, 6 and 12 months. RESULTS: Nineteen patients were included in the analysis. Surgically extruded teeth splinted for 2 weeks showed significantly higher mobility directly after splint removal and at 1 month after splinting compared with the functional splinting time group. The mean differences for horizontal Periotest values were 14.96 (95% confidence interval: 8.52, 21.39) and 6.63 (95% confidence interval: 0.25, 13), respectively. The vertical Periotest values were 10.47 (95% confidence interval: 1.95, 18.99) and 4.81 (95% confidence interval: -1.57, 11.18), respectively. At the 3-, 6- and 12-month follow-up intervals, there were no statistically significant differences between the groups. One tooth in the 2-week splinting group was lost. None of the teeth had ankylosis, marginal bone resorption or root resorption. CONCLUSIONS: Although both groups showed neither statistical nor clinically significant differences after 12 months, there was a significant difference immediately after splint removal, with greater tooth mobility in the 2-week splinting group. Thus, a functional splinting time (4-6 weeks) can be suggested for better healing and optimal stability to allow placement of the final restoration directly after splint removal.

Fixed orthodontic treatment has an insignificant effect on clinical attachment level.

Data sources Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, Web of Knowledge, Virtual Health Library, Google Scholar and ISRCTN registry databases.Study selection Randomised controlled trials (RCTs) and prospective or retrospective non-randomised clinical trials on periodontal healthy human patients receiving comprehensive fixed appliance treatment were considered.Data extraction and synthesis Two reviewers independently extracted data and assessed risk of bias using either the Cochrane tool for RCTs or the ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tool for non-randomised studies. A Paule-Mandel random-effects meta-analyses was conducted for clinical attachment loss. Results Nine prospective non-randomised trials involving a total of 335 periodontally healthy patients were included. The patients' average age was 22.6 years (range 11.4 - 42.1 years). Seven of the nine studies were assessed as being at moderate risk of bias. Orthodontic treatment was associated with a mean clinical attachment loss of 0.11 mm (95 %CI: 0.12 mm gain to 0.34 mm loss; P = 0.338, I2 = 99.6%), which was neither statistically nor clinically significant.Conclusions The findings suggest that orthodontic treatment might have little or no clinically relevant detrimental effect on the clinical attachment levels of patients.

The Effect of Membrane Coverage on the Resorption of Autogenous Intraoral Block Grafts in Horizontal Ridge Augmentation: A Systematic Review of Literature and Meta-Analysis: Inevitability or an Iatrogenic Vulnerability?

BACKGROUND: Autogenous intraoral block grafting is the gold standard augmentation technique for moderate-to-severe horizontal ridge deficiency. However, the graft undergoes variable resorption during healing that might jeopardize the outcome of the procedure. Several studies hypothesized that covering the graft with a membrane decreases the amount of graft resorption, but this effect is not established in the literature. OBJECTIVE: The objective of this study is to assess the clinical value of covering intraoral block grafts with membranes in horizontal ridge augmentation regarding graft resorption (primary outcome), graft success, net bone gain, and complications (secondary outcomes). DATA SOURCES: Till August 2017, the review team conducted an electronic search including PubMed, EMBASE, Cochrane, and LILACS databases; we also identified other articles through hand searching. The search terms included alveolar ridge augmentation, bone transplantation, block graft, guided bone regeneration, membranes, resorbable membrane, and nonresorbable membrane. STUDY SELECTION: The review included human randomized controlled trials, controlled clinical trials, cohort studies, and case-control studies in English that compared membrane coverage to no membrane coverage of autogenous intraoral block grafts and reported the amount of graft resorption after > 3-month follow-up. STUDY APPRAISAL: Two authors independently assessed the risk of bias using the Cochrane risk of bias tool, and the third reviewer was the judge in case of conflict. DATA EXTRACTION: Two authors independently filled the effective practice and organization of care form for data extraction, and the third reviewer revised the data. DATA SYNTHESIS: The statistical method of choice was the generic inverse variance, and the results were pooled using random-effect models, with the effect size measure being mean difference (MD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes. RESULTS: The review members screened 2266 records; we excluded 2231 records by the title and abstract and screened 35 full-text records for eligibility, from which we excluded 32 articles for certain reasons (the most common were a different comparison and excluded study design). Three randomized controlled trials were included in the quantitative and qualitative analyses of this review, providing the data for 41 participants with 49 sites. Data analysis showed a statistically significant potential benefit of membrane coverage in decreasing the amount of graft resorption of intraoral block grafts (MD: -1.20 mm, 95% confidence interval [CI]: -2.11 to -0.30, P = .009). There was no statistically significant benefit from the use of membranes regarding graft success (RR: 1.02, 95% CI: 0.89-1.17, P = .79) and net bone gain (MD: 0.46, 95% CI: -0.16 to 1.09, P = .15). The use of membranes did not show a statistically significant increase in the incidence of complications (RR: 1.80, 95% CI: 0.55-5.96, P = .33). The reviewers judged all the studies as of fair quality regarding the risk of bias. CONCLUSION: The use of membranes decreased the graft resorption, but there was no difference regarding graft success and net bone gain. The use of membranes did not increase complications. Furthermore, properly conducted studies should be used to justify the adjunctive use of barrier membranes with block grafts.

Spontaneous re-eruption, surgical or orthodontic extrusion: What is the choice for intrusive luxation in permanent teeth?

Data sourcesMedline, Embase, the US Clinical Trials and ISRCTN Registry databases.Study selectionTwo reviewers independently selected studies. Interventional and observational studies comparing the outcomes of orthodontic or surgical re-position of intrusive luxation of permanent teeth compared with spontaneous re-eruption were considered.Data extraction and synthesisTwo reviewers abstracted data and assessed study quality using the Cochrane Risk of Bias tool. Periodontal and pulpal outcomes after treatment were compared using risk ratios (RR) with 95% confidence intervals (CI) and meta-analysis conducted.ResultsEight studies involving a total of 440 patients were included. All of the studies were considered to be at high risk of bias. A meta-analysis of four studies comparing surgical re-positioning vs spontaneous re-eruption suggested no significant difference RR = 1.30 (95% CI; 0.90-1.88) P = 0.16. Meta-analyses were also performed for secondary outcomes and other sub-groups.ConclusionsWhile the review suggests that spontaneous re-eruption should be the treatment of choice the quality of the available evidence is poor.

Unclear if non-surgical adjuncts accelerate orthodontic treatment.

Data sourcesCochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, LILACS, the metaRegister of Controlled Trials, the US National Institutes of Health Trials Register and the WHO International Clinical Trials Registry Platform.Study selectionRandomised controlled trials of orthodontic treatment using fixed appliances along with non-surgical adjunctive interventions to accelerate tooth movement.Data extraction and synthesisTwo reviewers independently selected studies, abstracted data and assessed risk of bias. Meta-analysis was not possible.ResultsTwo studies involving a total of 111 patients were included, both were at high risk of bias. The studies compared the use of Tooth Masseuse and OrthoAccel with conventional treatment mechanics. Using OrthoAccel with 30 Hz at 0.25 N for 20 minutes daily produced a higher rate of maxillary canine distalisation in comparison to the control group (MD 0.37 mm/month; 95% CI -0.07 to 0.81; P = 0.05). Whilst this difference suggested 50% faster tooth movement using the vibrational appliance, the absolute differences were marginal and deemed clinically unimportant. Similar levels of non-serious adverse effects were reported in the intervention and control groups with a risk ratio of 0.96 (95% CI 0.32 to 2.85). Overall, the quality of the evidence was very low and therefore we cannot rely on the findings.ConclusionsThere is very little clinical research concerning the effectiveness of non-surgical interventions to accelerate orthodontic treatment. The available evidence is of very low quality and so it is not possible to determine if there is a positive effect of non-surgical adjunctive interventions to accelerate tooth movement. Although there have been claims that there may be a positive effect of light vibrational forces, results of the current studies do not reach either statistical or clinical significance. Further well-designed and rigorous RCTs with longer follow-up periods are required to determine whether non-surgical interventions may result in a clinically important reduction in the duration of orthodontic treatment, without any adverse effects.

Socioeconomic indicators and traumatic dental injury.

DATA SOURCES: PubMed, ISI, LILACS, Cochrane Library and Embase databases were searched. STUDY SELECTION: Epidemiological studies (cross-sectional, case-control, cohort clinical trials) addressing possible associations between socioeconomic indicators (eg mother's schooling, household income, number of children, type of school) and traumatic dental injury in the primary dentition were considered. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently selected studies. with study quality being assessed using the Newcastle-Ottawa Scale (NOS). Data were extracted for categorical variables considered risk factors for TDI and recorded based on the distribution and frequency of TDI among children exposed to risk factors vs the frequency among children not exposed to risk factors. Meta-analysis was undertaken. RESULTS: Sixteen studies (15 cross-sectional studies and one cohort study) were included. A wide range of socioeconomic indicators were investigated including; parents' schooling, parents' employment status, home ownership, having changed address in the previous year, income, family structure, number of residents in the home, number of children in the family, type of school and socioeconomic status. Children from families with household income less than two times average salary (US$ 592) (OR: 0.77; 95% CI: 0.66-0.90) or more than three times the average salary (US$ 888) (OR: 0.76; 95% CI: 0.65-0.89) had a significantly lower chance of having TDI in the primary dentition. TDI was not associated with socioeconomic status (high vs low - OR: 0.77; 95% CI: 0.43-1.36; high vs medium - OR: 1.03; 95% CI: 0.72-1.48; medium vs low - OR: 0.70; 95% CI: 0.42-1.19), house ownership (owned vs rented - OR: 1.28; 95% CI: 0.98-1.66), mother's schooling (OR: 0.89; 95% CI: 0.74-1.08), or father's schooling (OR: 1.01; 95% CI: 0.62-2.74). CONCLUSIONS: The scientific evidence demonstrates that socioeconomic indicators are not associated with TDI in the primary dentition. The evidence of an association between a low income and TDI is weak. In general, studies had low risk of bias. Further prospective cohort studies are needed to confirm this association.

Large overjet may double the risk of dental trauma.

DATA SOURCES: Medline/PubMed, SCOPUS and Google Scholar. DATA EXTRACTION AND SYNTHESIS: Studies were split according to the type of teeth and the overjet threshold used, thus obtaining three subsets; primary teeth - overjet threshold 3-4 mm; permanent teeth - overjet threshold 3-4 mm and permanent teeth - overjet threshold 6 ± 1 mm. Pooled odds ratios for TDI were estimated for each dataset. RESULTS: Fifty-four studies were included involving patients from five continents. The adjusted pooled odds ratios were 2.31 (95%CI; 1.01-5.27) for primary teeth with 3-4 mm overjet; 2.01 (95%CI; 1.39-2.91) for permanent teeth with 3-4 mm overjet and 2.24 (95%CI; 1.56-3.21) for permanent teeth with 6 ± 1 mm overjet. CONCLUSIONS: The present meta-analysis of observational studies showed that large overjet may double or even triple the risk for TDI to anterior primary and permanent teeth and that, at global level, large overjet is partly responsible for 100-300 million TDIs.

Fluoride releasing sealants may possess minimal cariostatic effect on adjacent surfaces.

DESIGN: Randomised controlled trial. INTERVENTION: Children with at least two sound permanent first molars and the presence of at least one sound distal surface of adjacent second primary molar were eligible. Children were randomised into three groups. In group one first permanent molars were sealed with a high-viscosity glass ionomer cement (GIC group; n = 926), group two received a resin-based fluoride containing sealant (RBF group; n = 923) and group three a resin-based sealant without fluoride (RB group; n = 927). Two examiners blind to group allocation conducted examinations at 30 months. Sealant retention and caries at D1-D3 levels was assessed. Bitewing radiographs were taken. OUTCOME MEASURE: Caries prevalence and incidence rate ratios were calculated. RESULTS: Two thousand seven hundred and seventy-six children were enrolled; the number of dropouts were similar in each group (GIC group; n = 75), (RBF group; n = 67), (RB group; n = 77). The prevalence of affected surfaces was significantly lower in the GIC (p = .03) and FRB groups (p = .04). Fewer new caries developed on the distal surfaces of the second primary molars in the GIC group than in the other two groups. Incidence rate ratios (IRRs) were: 0.70 (95% CI: 0.50, 0.68; p < .01) for GIC vs. RB; 0.89 (95% CI: 0.89, 1.28; p = .10) for GIC vs. FRB and 0.79 (95% CI: 0.53, 1.04; p = .005) for FRB vs RB. Partial sealant loss was higher in the GIC group (76 molars; 2.95%), compared with FRB (52 molars; 1.41%), RB group (50 molars;1.35%). CONCLUSIONS: Fluoride-releasing sealants (high-viscosity GIC and fluoride RB) were demonstrated to provide protection against caries on the distal surface of second primary molars. This preventive strategy might contribute to maintaining the integrity of the mesial surfaces of the first permanent molars.

No clear evidence of superiority regarding pulp medicaments in primary molars.

DATA SOURCES: Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, the Web of Science, OpenGrey, the US National Institutes of Health Trials Register and the World Health Organization (WHO) Clinical Trials Registry Platform. STUDY SELECTION: Two reviewers independently selected studies. Randomised controlled trials comparing different pulp interventions combining a pulp treatment technique and a medicament in primary teeth were considered. DATA EXTRACTION AND SYNTHESIS: Data abstraction and risk of bias assessment were carried out independently by two reviewers. The primary outcomes were clinical failure and radiological failure, as defined in trials, at six, 12 and 24 months. Pairwise meta-analysis using fixed-effect models was conducted with statistical heterogeneity being assessed using I2 coefficients. RESULTS: Forty-seven trials involving 3910 teeth were included. All were small single centre studies. The overall level of evidence was low with only one trial having a low risk of bias, 20 a high risk and 26 unclear risk of bias.The 47 trials examined 53 different comparisons: 25 for pulpotomy, 13 for pulpectomy, 13 for direct pulp capping and two comparisons between pulpotomy and pulpectomy.Regarding pulpotomy, 14 trials compared mineral trioxide aggregate (MTA) with formocresol (FC). MTA reduced both clinical and radiological failures at six, 12 and 24 months, although the difference was not statistically significant. MTA also showed favourable results for all secondary outcomes measured, although again, differences between MTA and FC were not statistically significant (with the exception of pathological root resorption at 24 months and dentine bridge formation at six months). MTA showed favourable results compared with calcium hydroxide (CH) (two trials) for all outcomes measured, but the differences were not statistically significant (with the exception of radiological failure at 12 months). When comparing MTA with ferric sulphate (FS) (three trials), MTA had statistically significantly fewer clinical, radiological and overall failures at 24 months. This difference was not shown at six or 12 months.FC was compared with CH in seven trials and with FS in seven trials. There was a statistically significant difference in favour of FC for clinical failure at six and 12 months, and radiological failure at six, 12 and 24 months. FC also showed favourable results for all secondary outcomes measured, although differences between FC and CH were not consistently statistically significant across time points. The comparisons between FC and FS showed no statistically significantly difference between the two medicaments for any outcome at any time point.For all other comparisons of medicaments used during pulpotomies, pulpectomies or direct pulp capping, the small numbers of studies and the inconsistency in results limits any interpretation. CONCLUSIONS: We found no evidence to identify one superior pulpotomy medicament and technique clearly. Two medicaments may be preferable: MTA or FS. The cost of MTA may preclude its clinical use and therefore FS could be used in such situations. Regarding other comparisons for pulpectomies or direct pulp capping, the small numbers of studies undertaking the same comparison limits any interpretation.

Limited evidence suggests standard fluoride toothpaste reduces caries potential in preschool children.

DATA SOURCES: CENTRAL, Medline, Embase, Web of Science, LILACS and BBO databases, the Brazilian database of thesis and dissertations (Banco de Teses CAPES), a Brazilian register of ethically approved projects involving human beings (SISNEP) and two registers of ongoing trials (Current Controlled Trials and Clinical-Trials.gov). Reference lists were also scanned for relevant papers. Study authors were contacted for additional information. STUDY SELECTION: Individual or cluster-randomised or quasi-randomised controlled trials conducted in children under seven were included. DATA EXTRACTION AND SYNTHESIS: Study selection and data abstraction were conducted by two reviewers independently. Risk of bias assessment was undertaken using the Cochrane Collaboration tool. Meta-analyses of prevented fractions (PF) were performed to assess the effect of fluoride toothpaste on the dmft and dmfs. Meta-analyses were also performed to obtain a pooled relative risk (RR) to assess the effect of fluoride toothpastes on the proportion of children developing caries. RESULTS: Eight studies were included. When standard F toothpastes were compared to placebo or no intervention, significant caries reduction at surface (PF = 31%; 95% CI 18-43; 2644 participants in five studies), tooth (PF = 16%; 95% CI 8-25; 2555 participants in one study) and individual (RR = 0.86; 95% CI 0.81-0.93; 2806 participants in two studies) level were observed. Low F toothpastes were effective only at surface level (PF = 40%; 95% CI 5-75; 561 participants in two studies). CONCLUSIONS: Standard F toothpastes are effective in reducing dental caries in the primary teeth of preschool children and thus their use should be recommended to this age group.

Adverse events of surgical extrusion in treatment for crown-root and cervical root fractures: a systematic review of case series/reports.

BACKGROUND: Crown-root and cervical root fractures constitute a restorative challenge due to sub-gingival position of the fracture margin. Surgical tooth extrusion is one of the treatment options. There is uncertainty regarding the prognosis of such treatment modality. OBJECTIVE: To assess adverse events of surgical tooth extrusion in the treatment for crown-root and cervical root fractures in permanent teeth. METHODS: PubMed, Embase, and Google Scholar were searched through 15th of June 2012. Search was limited to English and Arabic languages. Reference list of relevant studies were hand-searched. Grey literature was searched using Open Grey. Two review authors independently extracted data, while only one assessed trial quality using 8-point methodological index for non-randomized studies (MINORS) scale. A sensitivity analysis was performed to exclude studies with suspected patients' duplicates. RESULTS: Eleven case reports and eight case series involving 226 patients with 243 teeth were identified. No randomized controlled trials were found. The mean quality score for all case series was 9 suggesting a fair quality, while that of all case reports was 5 suggesting poor quality. Non-progressive root resorption is the most common finding following surgical extrusion with an event rate of 30% (95% CI 24.6-36.7%). This is followed by low event rates of tooth loss (5%), slight mobility (4.6%), marginal bone loss (3.7%), and progressive root resorption (3.3%). No ankylosis occurred to any extruded tooth, while severe tooth mobility showed negligible overall event rate of 0.4%. CONCLUSION: The available evidence suggests that surgical tooth extrusion is a valid technique in management of crown-root and cervical root fracture of permanent teeth. Minimal adverse events and good prognosis are expected. Further, surgical extrusion can be considered as a treatment option in teeth suffering sub-gingival decay.

No evidence for effectiveness of interventions used to treat displaced permanent anterior teeth.

DATA SOURCES: The Cochrane Oral Health Group Trials register, Cochrane Central Register of Controlled trials (CENTRAL), Medline, Embase, LILACS and Dissertation, Theses and Abstracts databases. STUDY SELECTION: Randomised controlled trials or quasi-randomised controlled trials that included a minimum follow-up period of 12 months.Data extraction and synthesisTwo review authors independently and in duplicate assessed the eligibility of all reports identified in the searches. Authors were contacted for additional information where required. RESULTS: No randomised or quasi-randomised controlled trials were found. CONCLUSIONS: We found no randomised or quasi-randomised trials of interventions to treat displaced luxated permanent front teeth. Current clinical guidelines are based on available information from case series studies and expert opinions. Randomised controlled trials in this area of dental trauma are required to robustly identify the benefits of different treatment strategies.

Effectiveness of MTA pulpotomy in primary molars: a critical assessment of relevant studies.

DATA SOURCES: Medline. STUDY SELECTION: Studies that evaluated the efficacy of MTA as a pulpotomy medicament in primary teeth were included, abstracts, observational studies and case reports were excluded. Only English language studies were considered. DATA EXTRACTION AND SYNTHESIS: Studies were assessed and graded by two reviewers using a weighted criteria based system and a qualitative summary of the evidence provided. RESULTS: Twenty-two studies were included, 17 studies compared MTA with formocresol, four studies compared MTA with calcium hydroxide, ferric sulphate, Portland cement, calcium-enriched mixture cement (CEM) and one study compared white MTA with grey MTA. CONCLUSIONS: Based on the assessment criteria employed, there was no evidence that MTA was better than present materials and techniques as a pulpotomy medicament.

Weak evidence suggests higher risk for bracket bonding failure with self-etch primer compared to conventional acid etch over 12 months.

DATA SOURCES: Medline, Embase, Cochrane Oral Health Group's Trials Register and the Cochrane Central Register of Controlled Trials (CENTRAL). Unpublished data were sought by searching ClinicalTrials.gov, the National Research Register and Pro-Quest Dissertation Abstracts and Thesis database. There were no language restrictions. STUDY SELECTION: Randomised and controlled clinical trials (including split mouth) directly comparing self-etch and acid-etch primers including patients with full-arch, fixed and bonded orthodontic appliances (not banded) with follow-up periods of at least 12 months were included. DATA EXTRACTION AND SYNTHESIS: Two authors abstracted data independently, with disagreements being resolved by a third. The Cochrane Risk of Bias tool was used to assess study quality. A random effects meta-analysis was undertaken. RESULTS: Eleven studies were included in the qualitative summary with five studies contributing to a meta-analysis. These five studies (n =3444 brackets, 1721 acid-etch, 1723 self-etch) had relatively low statistical and clinical heterogeneity. Meta-analysis demonstrated a tendency for a higher risk of failure (odds ratio 1.35; 95% CI, 0.99-1.83; P 5 0.06) with self-etch primers. The use of self-etch techniques was also associated with a small but statistically significant time saving (weighted mean difference 23.2 seconds per bracket; 95% CI, 20.7-25.8; P \0.001). There was insufficient evidence to assess the effect of bonding modality on demineralisation rates. CONCLUSIONS: There is weak evidence indicating higher odds of failure with self-etch primer than acid-etch over 12 months in orthodontic patients, and there is strong evidence that a self-etch primer is likely to result in modest time savings (eight minutes for full bonding) compared with acid-etch.