ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Piezocision-Assisted Orthodontic Treatment May Increase Root Resorption
Clinical Question For patients receiving piezocision-assisted orthodontic treatment, is there an increased risk of root resorption?
Clinical Bottom Line Piezocision-assisted orthodontic treatment may increase root resorption when compared to no surgery due to iatrogenic damage from the piezocision instrument itself and from the orthodontic forces placed on the teeth while in the regional acceleratory phenomenon phase initiated by the surgery.
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) 28024782Patterson/201714 patients requiring extraction of maxillary first premolars; 6 male and 8 female (mean age 16 years and 2 months)Split-mouth study
Key resultsBilateral first premolars were scheduled for extraction for orthodontic reasons and assigned to piezocision surgery or no treatment. After piezocision surgery on one side, partial fixed orthodontic appliances were activated. After 4 weeks the teeth were extracted and examined using microcomputed tomography images. There was a statistically significant increase of 44% (P = 0.029) in root resorption on the piezocision teeth when compared to the control teeth. When the iatrogenic root damage from the piezocision surgical procedure itself was included, there was 110% more volumetric root loss in the piezocision group compared to the control group (P = 0.005).
Evidence Search piezocision[All Fields] AND ("root resorption"[MeSH Terms] OR ("root"[All Fields] AND "resorption"[All Fields]) OR "root resorption"[All Fields])
Comments on
The Evidence
Validity: This is the first study to use microcomputed tomography to establish the amount of root resorption after a piezocision surgery. This was a very convincing advantage of this study due to the exactness of the data. Past studies have used traditional 2D radiographic images, which brought the accuracy of the data into question. All 14 patients completed the study and their 28 extracted pre-molars were used in the statistical analysis. While all subjects received a baseline periodontal checkup pretreatment, this baseline was not mentioned in detail and we are expected to assume that all 14 patients had similar periodontal health that did not influence the outcome. The right vs. left side of each subject receiving the surgery was not randomized either. The side of each subject with the least risk of causing adjacent root damage was selected. It should be noted that one clinician, whether it be the orthodontist, periodontist or general dentist, performed each procedure on all of the subjects to ensure consistency. While the split-mouth design of the study definitely improved the power of the study the small sample size is a clear limitation. Perspective: Piezocision surgery and its associated regional acceleratory phenomenon, i.e., the response induced by corticotomy that accelerates tooth movement, will likely be studied further due to the appeal of reducing the amount of time in orthodontic appliances. In my opinion it is worth waiting for further data before piezocision surgery is accepted in any conventional orthodontic planning and treatment. Also, in the study the average subject was around 16 years old. In my opinion a study such as this one should be done on older subjects as well, considering that adults in particular want to decrease their time in orthodontic treatment as it is less common for adults to have orthodontic appliances and braces.
Applicability The majority of patients would like to decrease their time in orthodontic therapy, and piezocision-assisted orthodontic treatment is a method to satisfy that desire. While the amount of root resorption that occurs with piezocision-assisted orthodontics (0.633mm³) may not be clinically relevant in relation to putting these teeth at risk, any additional root resorption should be a concern and a consideration when treatment planning, especially with the variability seen among patients.
Specialty/Discipline (Oral Surgery) (Orthodontics) (Periodontics)
Keywords Piezocision-assisted orthodontics, root resorption, accelerated tooth movement
ID# 3160
Date of submission: 04/05/2017spacer
E-mail harrisa6@livemail.uthscsa.edu
Author Alexander Harris
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Ravikumar Anthony, BDS, MDS, MS
Faculty mentor/Co-author e-mail anthonyr@uthscsa.edu
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