ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Temporary Anchorage Device (TAD) Supported Pontics Prevent Bone Resorption in Young Growing Patients with Missing Maxillary Lateral Incisors
Clinical Question In young growing patients with missing maxillary lateral incisors, do TAD supported pontics, compared to tooth supported FDPs, prevent bone resorption?
Clinical Bottom Line Placing Temporary Anchorage Devices (TADs) in edentulous sites in young growing patients has been shown to prevent bone resorption in the area. This finding is supported by a case study and an in vivo study that demonstrated radiographically and clinically that a TAD supported pontic provided a better quality of alveolar bone and prevented bone resorption.
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) 25127382Wilmes B/20143 patients, 13-14 yo Case series
Key results3 patients aged 13-14 yo presented with missing anterior and posterior teeth. A total of 6 Benefit mini-implants were placed and 4 were followed for 5-6 years radiographically and clinically. The authors found no bone atrophy or local growth inhibition radiographically or clinically.
#2) 25403977Melsen/20144 adult Beagle dogsin vivo animal study
Key resultsThe authors found in their in vivo study that there was a statistically significant increase in bone density and a decrease in ridge atrophy when placing a trans-cortical mini screw in an extraction area (p=0.012). This reduces the need for a longer clinical crown restoration and leads to better quality alveolar bone for the osseointegrated implant. Surgical reconstruction prior to implant placement can be avoided later. Histologically, a higher activity of bone was found at the experimental site.
Evidence Search TADs[All Fields] OR (mini[All Fields] AND implant[All Fields] AND ("bone resorption"[MeSH Terms] OR ("bone"[All Fields] AND "resorption"[All Fields]) OR "bone resorption"[All Fields]) AND orthodontic[All Fields]) AND (, alveolar[All Fields] AND ("bone and bones"[MeSH Terms] OR ("bone"[All Fields] AND "bones"[All Fields]) OR "bone and bones"[All Fields] OR "bone"[All Fields]))
Comments on
The Evidence
The study by Wilmes et al. reported on 3 patient cases in detail and mentioned 21 more in the discussion. In 95% of all their cases the authors were successful in placing a mini-implant supported pontic as a temporary replacement of a missing tooth in the anterior segment. In clinical controls and 2 dimensional radiographs after 3-5 years they couldn’t find any growth inhibition or bone atrophy. Although the study presents radiographically healthy implant beds it lacked the evidence of the bone volume measured by a three dimensional radiographic examination. The second study by Melson et al. was an in-vivo animal study. Although external validity must be considered when evaluating the findings, the results of the current study showed a decrease of bone atrophy in areas where mini-implants were placed through use of a 3-D imaging system. Randomized clinical trials in human subjects are needed to confirm the positive outcomes reported.
Applicability Clinicians should consider use of a mini-implant supported pontic instead of a Maryland bridge or removable appliance to treat growing patients with missing maxillary lateral incisors. The presented treatment modality has a high possibility to save bone structure and appears to result in better bone volume to place an implant when skeletal growth has stopped.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Orthodontics) (Prosthodontics)
Keywords TADS, mini-implants, bone resorption, bone atrophy, missing lateral incisors, tooth supported pontics, adolescence, dental abutments, dental implants, dental restoration, alveolar bone; atrophy; implants
ID# 2964
Date of submission: 12/10/2015spacer
E-mail michael.schulte@ucdenver.edu
Author Michael Schulte
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Ethelyn Thomason, DMD
Faculty mentor/Co-author e-mail ETHELYN.THOMASONLARSEN@UCDENVER.EDU
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