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| Title |
Skeletal Anchorage Has No Effect on the Duration of Treatment for Mandibular Second Molar Uprighting |
| Clinical Question |
In patients with missing mandibular first molars, what is the difference, if any, on the duration of orthodontic treatment for uprighting of mandibular second molars when using skeletal anchorage (TADs) as compared to traditional orthodontics? |
| Clinical Bottom Line |
There is no clinically significant difference in treatment duration between miniscrews vs. conventional anchorage. In early case studies, conventional anchorage was more efficient than skeletal anchorage, but in a more recent randomized controlled trial, no difference was found between the treatment modalities. However, skeletal anchorage was associated with fewer adverse side effects related to anchorage in all studies cited. |
| 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) 30088562 | Matires/2018 | 20 patients with mesially tipped second molars | Randomized Controlled Trial | | Key results | Of 20 patients with mesially tipped mandibular second molars included in the study, 10 were randomly assigned a standard helical uprighting spring using the canine and premolars as anchorage, and 10 were randomly assigned a miniscrew implant placed between the first and second premolars; both groups were evaluated using CBCT at the beginning and end of a 4 month period. There was no statistically significant difference between degree of mesiodistal inclination achieved during the treatment time; in the miniscrew group was 8.53 ± 2.13 degrees and in the conventional anchorage group it was 9.8 ± 0.5 degrees. However, there was a significant reduction in unwanted side effects when using the miniscrew, such as a reduction in buccal tipping and extrusion of the second molar. | | #2) 18571031 | Leung/2008 | N/A | Narrative Review | | Key results | This narrative review of available literature on the use of miniscrews and plates for orthodontic movement analyzes a number of case studies. In discussing molar uprighting, it was found in case studies dating from 2002-2004 that forces of 50-70 grams were predictably generated from miniscrews immediately after placement, and these produced uprighting in as low as 4 months.
| | #3) 18408269 | Reddy/2008 | 1 patient with impacted mandibular second molar | Case report | | Key results | The case report describes a 12 year old girl with a mesially impacted mandibular second molar causing caries on the distal of the first molar. A push spring was placed and activated every 2 weeks for a 2 month period until uprighting was complete. In addition to the distal rotational force, some unwanted occlusal forces were noted. | |
| Evidence Search |
"molar uprighting"[All Fields] AND ("implant"[All Fields] OR "miniscrew"[All Fields]) |
Comments on
The Evidence |
Validity:
Only one of three studies included is a randomized-controlled trial, while the other two are a narrative review and a case report. The limited number of participants in each of those articles decreases their predictive power. The randomized controlled trial itself only had 20 participants, so further studies in this topic may be necessary before definitive conclusions can be reached. All studies were performed on mandibular second molars, although no distinction was made between whether or not first or third molars were present, and this may present challenges in applying the research to different clinical situations.
Perspective:
Molar uprighting in cases of ectopic eruption is necessary to prevent caries on the distal of first molars, which can lead to pulpal pathologies that require RCT or extraction. In cases of mesial drift of second molars due to previous loss of first molars, it may be necessary to open space for implant placement or to correct the path of draw for FPD placement. Miniscrews are an expensive treatment modality for patients, and if they do not provide an advantage over conventional anchorage mechanisms, it is advantageous to know when they are, or are not, indicated. |
| Applicability |
Miniscrew placement in the randomized control trial was between the roots of first and second premolars, which reduces its applicability to cases in which skeletal anchorage is placed in other locations, like the retromolar pad. Additionally, the scope of the question was limited to the duration of treatment for molar uprighting, but did not take into account the adverse side effects of the treatment modality. While treatment time to achieve an upright molar is comparable, conventional anchorage was associated with an increase in adverse side effects such as molar extrusion, which may lengthen overall treatment time if this requires correction. |
| Specialty/Discipline |
(Orthodontics) |
| Keywords |
molar, uprighting, orthodontics, skeletal anchorage, miniscrew
|
| ID# |
3380 |
| Date of submission: |
04/22/2019 |
| E-mail |
wallachr@livemail.uthscsa.edu |
| Author |
Richard Wallach |
| Co-author(s) |
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| Co-author(s) e-mail |
|
| Faculty mentor/Co-author |
Dr. Brent Callegari |
| Faculty mentor/Co-author e-mail |
callegari@livemail.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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