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| Title |
Molar Intrusion Using Temporary Anchorage Devices (TADs) Is a Viable Option for Closing Anterior Open Bites |
| Clinical Question |
Is intrusion of over-erupted posterior teeth using TADs (temporary anchorage devices) a reasonable alternative to surgical impaction in closing an anterior open bite? |
| Clinical Bottom Line |
Evidence shows that molar intrusion using TADs has been successful in closing an anterior open bite. This is supported by multiple articles showing the success rate of TADs. |
| 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) 21435540 | Deguchi/2011 | 30 adults with skeletal open bite | Cohort study | | Key results | One of the most important results in this study was the retention between the mini-implant population (n=15) and the group that did not get implants (n=15). The peer assessment rating (PAR) score for retention for the non-implant group was 5.5 ± 2.8 and for the implant group it was 4.4 ± 2.9. This was no significant difference in retention between the groups. | | #2) 17029531 | Xun/2007 | 12 patients (mean age=18.7 yrs) with anterior open bite | Case series | | Key results | The anterior open bite in the patient pool was successfully treated in an average of 7 months using TADs, which the authors concluded was a simple, minimally invasive procedure. The results showed that the overbite increased by 4.2 mm, and the maxillary and mandibular first molars were intruded by an average of 1.8 mm and 1.2 mm respectively. This intrusion caused the mandibular plane angle to be decreased (2.3 degrees) as well as the anterior facial height (1.8 mm mean). | | #3) 15264651 | Erverdi/2004 | 10 patients aged 17-23 years with anterior open bite | Case series | | Key results | The results showed that the use of skeletal anchorage in the form of TADs was shown to be effective for molar intrusion. The correction of the molar intrusion "was achieved with a clockwise rotation of the mandible (an average of 1.7° [P < .01]), maxillary molar intrusion (an average of 2.6 mm [P < .01]), maxillary incisor retroclination and extrusion (an average of 9.6° [P < .01]), and extrusion of 1.1 mm (P < .01)." | |
| Evidence Search |
("surgical procedures, operative"[MeSH Terms] OR ("surgical"[All Fields] AND "procedures"[All Fields] AND "operative"[All Fields]) OR "operative surgical procedures"[All Fields] OR "surgical"[All Fields]) AND ("tooth, impacted"[MeSH Terms] OR ("tooth"[All Fields] AND "impacted"[All Fields]) OR "impacted tooth"[All Fields] OR "impaction"[All Fields]) AND anterior[All Fields] AND ("open bite"[MeSH Terms] OR ("open"[All Fields] AND "bite"[All Fields]) OR "open bite"[All Fields])
TADS;[All Fields] AND anterior[All Fields] AND ("open bite"[MeSH Terms] OR ("open"[All Fields] AND "bite"[All Fields]) OR "open bite"[All Fields])
|
Comments on
The Evidence |
Two of the three articles listed above were case series, which is not as definitive as other types of evidence due to the lack of control/comparison groups. However, the cohort study provided does show some more solid information due to the fact that the patients were followed up for 2 years. More research needs to be done to provide a conclusive answer to whether TADs are the better option for molar intrusion as compared to surgical impaction. Also, none of the three studies used randomly selected patient pools, which is a source of possible bias. |
| Applicability |
The use of TADs is a reasonably priced and less invasive alternative compared to surgery. The cohort study by Deguchi did show that a possibility of relapse is something that could impact results. This is due to tongue thrusting or other habits that the patient may or may not have had before the study. |
| Specialty/Discipline |
(Oral Surgery) (Orthodontics) |
| Keywords |
Anterior open bite; temporary anchorage devices; TADs; molar intrusion
|
| ID# |
2993 |
| Date of submission: |
03/14/2016 |
| E-mail |
SolomonA@livemail.uthscsa.edu |
| Author |
Adam Solomon |
| 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 |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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