ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Limited Evidence to Support Surgical Intervention Accelerates Tooth Movement and Reduces Treatment Time
Clinical Question In a patient with malocclusion, does surgical treatment increase the rate of tooth movement and shorten treatment time, compared to conventional orthodontic treatment?
Clinical Bottom Line There is limited evidence to support surgical treatment increases the rate of tooth movement and reduces the duration of treatment, as compared to conventional orthodontic treatment.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 25072362Gkantidis/20147 StudiesSystematic Review
Key results7 studies investigated invasive surgical corticotomy treatment for accelerated orthodontic tooth movement with varying levels of risk biases. The studies reported accelerated tooth movement for canine retraction in a first premolar extraction space using surgical corticotomy procedure compared to the control during the first month of retraction. The authors question the effectiveness of the surgical intervention over time, citing a rapid decline in tooth movement rate after the second month. The overall quality of evidence supporting surgical corticotomy intervention is low.
#2) 24680025Hoogeveen/20144 StudiesSystematic review of randomized trials
Key results4 studies investigated invasive surgical corticotomy-facilitated orthodontics using conventional orthodontic treatment as a control group for comparison. Authors found that all the studies claimed accelerated tooth movement following surgery. Authors conclude, however, that there is limited evidence to support surgical treatment significantly reduces the duration of treatment as compared to conventional orthodontic treatment.
Evidence Search Accelerated tooth movement, corticotomy Filters: Systematic Reviews; Meta-Analysis
Comments on
The Evidence
Validity: Gkantidis et al searched PubMed, EMBASE, Google scholar beta, and all Cochrane Databases for randomized controlled trials and controlled clinical trials. Two authors independently assessed 52 articles using inclusion criteria, resulting in 18 eligible studies available for the systematic review. 7 studies addressed the clinical question. Hoogeveen et al searched PubMed, Embase, and Cochrane databases for randomized controlled trials, controlled clinical trials, and cases series with 5 or more patients. Two authors independently assessed 45 articles using inclusion criteria, resulting in 18 eligible studies for the systematic review. 4 studies addressed the clinical question. Perspective: Based on two systematic reviews of surgical orthodontic intervention studies, there is limited evidence to suggest that invasive surgical procedures can accelerate tooth movement. Gkantidis et al caution further, stating that “the duration of the accelerating effect is also questionable, as well as the effect in total treatment time.” At present, they do not recommend surgical corticotomy as a routine procedure. Hoogeveen et al conclude that there is limited evidence to support surgical treatment significantly reduces the duration of treatment as compared to conventional orthodontic treatment. The authors point out, that “to date, no prospective studies have compared overall treatment time and treatment outcome with those of a control group.”
Applicability Many patients present with a desire to complete their orthodontic treatment faster than conventional treatment modalities. There is limited evidence to support surgical treatment significantly reduces the duration of treatment as compared to conventional orthodontic treatment. As there is no cost-benefit analysis available, “it is difficult to determine if any reduction in treatment duration would outweigh the extra cost of the surgical procedure.” Due to varying invasive surgical methodologies, limited number of random controlled trial studies, small numbers of patients per study, and in general, a lack of comparison to conventional orthodontic treatment, additional research is required to strengthen the claim that surgical orthodontic treatment can increase the rate of tooth movement and shorten treatment time.
Specialty/Discipline (Orthodontics)
Keywords Corticotomy, treatment time, accelerated tooth movement, orthodontics
ID# 2815
Date of submission: 03/20/2015spacer
E-mail marrsj@livemail.uthscsa.edu
Author Jeffrey M. Marrs
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Clarence C. Bryk, DDS, MS
Faculty mentor/Co-author e-mail BRYKC@uthscsa.edu
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