Commentary: A Translational Medicine Approach to Tooth Transplantation.

The autogenous tooth transplantation approach to replace missing teeth has been in use for a long time. Different surgical techniques have been developed to improve prognosis and longevity of transplanted teeth with complete root formation. Many factors reportedly affected short- and long-term success of the procedure: complications such as ankylosis and root resorption up to the tooth exfoliation have occurred frequently. Several studies have appeared on this issue over the years. However, outcomes of transplantations have not yet been conclusively determined as no randomized clinical trials have been published on this issue, and their effectiveness has been evaluated only in observational studies. On the other hand, interesting information from specific experimental studies on the healing pattern of the interface between the root surface and alveolar bone in the replantation/transplantation model, and from non-related studies dealing with mechanically induced periodontal trauma, has been available and potentially useful since the 1970s to 1980s. However, this information has not been incorporated into clinical literature regarding tooth autotransplantation. This commentary aims to show how information from related and unrelated experimental models was translated to a clinical setting and led to a novel approach, successfully applied, in the autotransplantation of a multirooted tooth with completed root formation.

Expansion of maxillary arches with crossbite: a systematic review of RCTs in the last 12 years.

The aim of this study was to review recent randomized clinical trials (RCTs) dealing with the effectiveness of various modalities of orthopaedic/orthodontic expansion of maxillary arches with crossbite and the associated 6 month post retention stability. The study selection criteria included RCTs involving subjects with maxillary deficiency with crossbite, with no limits of age. The authors searched the following electronic databases from 1999 to January 2011: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, LILACS, and WEB of SCIENCE. The search strategy resulted in 12 articles meeting the inclusion criteria. Most of the studies did not meet major methodological requirements; some studies were not relevant because of small sample size, possible bias and unaccounted for confounding variables, lack of blinding in measurements, and deficient statistical methods. Treatment outcomes were different depending on the appliance used, tooth tissue-borne/tooth-borne expanders, bonded semi-rapid maxillary expansion (SRME), or rapid maxillary expansion (RME); in any case, methodological flaws prevent any sound conclusion. Stable results have been measured at the 6 month follow-up after removal of the retention plate in the treated groups in the maxillary intermolar and intercanine distances. Long-term stability results should be assessed. The Consolidated Standards of Reporting Trials (CONSORT) Statement could be helpful in improving the reporting of RCTs.

Multiple bilateral impactions in an adolescent girl.

This article describes a patient whose permanent canines and premolars had not erupted at age 14 years, although their root formation was complete, with closed apices. Surgical and orthodontic treatment was planned to correct the multiple impactions. The orthodontic traction used 5 strategic teeth and allowed for the eruption of all 12 impacted teeth. The surgical-orthodontic treatment of many impacted teeth yielded good esthetic and periodontal results, as shown by the patient's satisfaction and the periodontal probing 2 years after the treatment. Multiple impacted teeth are a rare eruption disturbance that requires early detection: no signs of a genetic syndrome or an endocrine disorder had been found, or failure to move along the eruption path, which is a characteristic of another syndrome, primary failure of eruption.

Randomized clinical trials in orthodontics: reality, dream, or nightmare?

Randomized controlled trials (RCTs) are considered the highest level in the hierarchy of evidence for treatment effectiveness. However, RCTs have also been criticized for various shortcomings. The purpose of this article was to review the most common criticisms against RCTs and answer them based on the principles of scientific inquiry, so that orthodontists can build their evidence-based practice on the best scientific research. In the era of evidence-based medicine, designing RCTs is the challenge for researchers in orthodontics.

Factors associated with the duration of forced eruption of impacted maxillary canines: a retrospective study.

INTRODUCTION: More information is needed to better predict the duration, cost, success rate, and incidence of complications when treating impacted maxillary canines. The aim of this study was to identify factors that affect the number of visits required to complete the canine forced eruption phase. METHODS: Data from diagnostic and treatment notes and radiographs of 87 consecutive adult and adolescent patients were analyzed by stepwise regression analysis. RESULTS: The results indicated a strong direct correlation of the number of visits with the patient's age (P < .0001), the distance between the canine cusp tip and the occlusal plane (P <.0001), and the zone (P = .0058); mesially located cusps required more visits. A weaker inverse correlation was found with the beta angle (P = .0289), that is, and the angle between the canine and lateral incisor axes. No significant correlation was found with other variables, including sex and several linear and angular measurements made on panoramic and sagittal radiographs. CONCLUSIONS: Age, distance from the canine cusp tip to the occlusal plane, zone, and beta angle appear to provide a rather accurate estimate (R2 = 0.42) of the number of visits needed to complete the forced eruption phase. This information allows for a prediction that might be sufficient to give the patient correct information and to estimate the final cost of the treatment.