ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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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) 21435540Deguchi/201130 adults with skeletal open biteCohort study
Key resultsOne 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) 17029531Xun/200712 patients (mean age=18.7 yrs) with anterior open bite Case series
Key resultsThe 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) 15264651Erverdi/200410 patients aged 17-23 years with anterior open biteCase series
Key resultsThe 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: 03/14/2016spacer
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
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