Orthodontic Extrusion: Guidelines for Contemporary Clinical Practice.

Orthodontic extrusion (OE) is an orthodontic tooth movement in a coronal direction to modify the tooth position and/or induce changes on the surrounding bone and soft tissue with a therapeutic purpose. Evidence emanating from clinical reports and case series studies indicates that OE is a predictable treatment option to manage a variety of clinical situations. Common indications include traction of impacted teeth, exposure of teeth presenting structural damage to facilitate restorative therapy, treatment of periodontal bony and papillary defects, and implant site development. Unfortunately, there is a paucity of established protocols and guidelines for its application in clinical practice. Controversy exists in regard to the definition of rapid and slow OE, use of circumferential supracrestal fiberotomy, and tooth stabilization protocols during and upon completion of orthodontic movement. This article provides a concise perspective on the topic of OE by discussing key biologic principles and technical aspects that are translated into guidelines for the management of different clinical scenarios.

Combined orthodontic and orthognathic surgical treatment for the correction of skeletal anterior open-bite malocclusion: a systematic review on vertical stability.

PURPOSE: To evaluate vertical stability after combined orthodontic surgical treatment of skeletal anterior open-bite malocclusion. MATERIALS AND METHODS: A literature search was performed to locate studies pertaining to vertical stability after combined orthodontic surgical treatment of skeletal anterior open-bite malocclusion. Data from the identified studies were extracted and assessed for quality. Short-term and long-term changes in the following variables were evaluated: overbite; mandibular plane, palatal plane, and intermaxillary angles; and anterior facial height. RESULTS: Nine studies, all retrospective, were appropriate for inclusion after review. The postoperative follow-up period ranged from 1 to 18 years. A wide variation was present for post-treatment changes and relapse. Dentally, overbite changes showed a wide variation, with more long-term relapse observed in patients after Le Fort I osteotomy. Skeletally, the mandibular plane and intermaxillary angles showed greater long-term relapse after bimaxillary surgery than after Le Fort I osteotomy. The same trend was seen for the post-treatment increase in anterior facial height. In contrast, the palatal plane seemed to remain rather stable. CONCLUSIONS: Vertical relapse is a characteristic in a certain number of patients after combined orthodontic surgical treatments regardless of surgery type. This can be observed dentally by an opening of the bite and skeletally by an increase in the mandibular plane and intermaxillary angles during long-term follow-up. Long-term skeletal relapse seems to be more common after bimaxillary surgery.