Bone dehiscence formation during orthodontic tooth movement through atrophic alveolar ridges.

OBJECTIVES: To test the null hypothesis that there is no difference in bone dehiscence formation before and after orthodontic tooth movement through an atrophic alveolar ridge. MATERIAL AND METHODS: This longitudinal retrospective study evaluated pretreatment and posttreatment cone-beam computed tomography imaging of 15 adult patients. Twenty-five teeth were moved through the atrophic alveolar bone, whereas 25 teeth not subjected to translational movement were considered controls. The distances between the cementoenamel junction and the alveolar bone crest were assessed at the mesial, distal, buccal, and lingual surfaces of all of these teeth. Data were compared using the Wilcoxon test. The Spearman correlation test and multivariate linear regression analysis were also performed. RESULTS: In general, crestal bone height was reduced around 0.5 mm in all groups in every direction. Median buccal dehiscence increased significantly (+2.25 mm) (P < .05) in teeth moved through the atrophic ridge. Control teeth also had buccal crest loss (+0.83 mm), but this was not statistically different from that of the experimental teeth. Lingual dehiscence increased significantly for the experimental (+0.17 mm) and control (+0.65 mm) groups. Mesial bone height decreased more in the control group (-0.44mm) than in the experimental group (-0.14mm). There was moderate correlation between amount of tooth movement and alveolar bone loss. CONCLUSIONS: The null hypothesis was rejected as dehiscence increased after tooth movement through an atrophic alveolar ridge, mainly in the buccal plate.

One-phase or two-phase orthodontic treatment?

Data sourcesMedline, Embase, Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), LILACS, BBO, ClinicalTrials.gov, the National Research Register and Pro-Quest Dissertation Abstracts and Thesis database.Study selectionRandomised controlled trials (RCTs) and controlled trials (CCTs) in children under 11 years at the beginning of treatment for interventions including; interceptive extractions, space maintenance, crossbite correction and habit dissuasion were considered.Data extraction and synthesisTwo reviewers independently extracted data and assessed study quality using the Cochrane Risk of Bias tool. Meta-analysis was possible for 11 comparisons.ResultsTwenty-two studies (18 RCTs, three CCTs) were included with 20 being considered to be at low or unclear risk of bias. For Class II correction in the short-term, meta-analyses demonstrated a statistically significant reduction in ANB (-1.4 degrees, 95 CI: -2.17, -0.64) and overjet (-5.81mm, 95 CI: -6.37, -5.25) with both functional appliances and headgear versus control. For Class II correction in the long-term, however, statistical significance was not found for the same outcomes. Treatment duration was prolonged with both functional appliances (6.85 months, 95 CI: 3.24, 10.45) and headgear (12.47 months, 95 CI: 8.67, 16.26) compared to adolescent treatments. Meta-analyses were not possible for comparisons of other interceptive treatments due to heterogeneity and methodological limitations. The overall quality of the evidence based on the GRADE assessment suggested that the level of evidence was low to moderate.ConclusionsThe results suggest a lack of evidence to prove that early treatment carries additional benefit over and above that achieved with treatment commencing later; however, this does not imply that early treatment is ineffective. The additional cost and burden to the patient, parent and clinician may, therefore, generally negate early treatment. Further trials of high quality of evidence are required assessing the effectiveness of interceptive treatment for a range of occlusal problems, particularly those not known to hinge on growth potential, with long-term follow up to ascertain whether short-term effects are maintained once growth has ceased and to delineate the effects of intervention timing on the overall treatment duration.

Topical nonsteroidal anti-inflammatory medications for treatment of temporomandibular joint degenerative pain: a systematic review.

AIMS: To evaluate the efficacy of topical nonsteroidal anti-inflammatory drugs (NSAID) to relieve temporomandibular joint (TMJ) degenerative joint disease (DJD) pain. METHODS: A search of the literature was made using electronic databases complemented with a manual search. Clinical trials comparing topical NSAID with either placebo or an alternative active treatment to treat TMJ DJD pain were identified. Outcomes evaluated were pain reduction/pain control and/or incidence of side effects. RESULTS: A single study (double-blind randomized placebo-controlled trial) with 20 patients was identified that evaluated the efficacy of a topically prepared NSAID over a 12-week duration, measuring functional pain intensity, voluntary and assisted mouth opening, pain disability index, and a brief pain inventory analysis. This study revealed a pain intensity decrease within treatment groups but no significant difference between treatment groups. CONCLUSION: Presently, there is insufficient evidence to support the use of topically applied NSAID medications to palliate TMJ DJD pain.