Title

Alveolar Implants Used For Canine Retraction

Clinical Question

In an orthodontic patient requiring extractions, are alveolar implants an effective choice for accelerated canine retraction compared to traditional orthodontic anchorage methods?

Clinical Bottom Line

Alveolar implants are an effective choice for canine retraction; however the evidence supporting acceleration when compared to traditional orthodontic anchorage resulted in conflicting information. (See Comments on the CAT below)

Best Evidence

PubMed ID	Author / Year	Patient Group	Study type (level of evidence)
18617099	Upadhyay/2008	40 patients (mean age, 17.5 years; SD, 3.2 years with extractions of all four 1st premolars	RCT
Key results	Canine retraction may be accelerated, but it is not clinically or statistically significant.
18617100	Thiruvenkatachari/ 2008	Patient Group 12 patients ages 16-22 years old scheduled for extraction of all 4 first molars	clinical trial
Key results	Results implants are effective in canine retraction and produce accelerated canine retraction

Evidence Search

Search "space closure rate" Limits: EnglishSearch "rate" Limits: Search ("Orthodontics"[Mesh] AND "Dental Implants"[Mesh]) AND "Orthodontic Space Closure"[Mesh] Limits: Search ("Orthodontics"[Mesh] AND "Dental Implants"[Mesh]) AND "Orthodontic Space Closure"[Mesh] AND "retraction" AND "rate" Limits:

Comments on
The Evidence

There are few studies researching the rate of canine retraction provided by alveolar implants on human subjects. Of the two articles that I found, the ”best evidence” was a randomized control trial which concluded that the retraction rate might be accelerated, but that it was not “statistically or clinically significant”. The second article which was, a clinical trial concluded that implants produced faster rates of canine retraction. One difference that I found interesting between the two studies was that the study by Upadhyay M, was randomized and blinded. The subjects were randomly put into one of two groups (implants or control group). In this study average canine retraction for each group as a whole was compared. In the study by Thiruvenkatachari, B. there was no randomization or blinding. Each patient was treated with the two different methods (right quadrant one method and left quadrant traditional molar anchorage method). The average canine retraction was compared in each individual, and then the resulting differences were averaged. The first study was less likely to be influenced by practitioner bias, however, the second study seems less likely to be influenced by biological differences between individuals. Dr. Anthony and I talked about the rate limitations of biological factors and the methods of the studies. The molar anchorage method produces a space closure that consists of both anterior movement of the molars and posterior movement of the anterior teeth; while the method using mini-implants produces only posterior retraction. Neither study changed the biological factors that are the true rate limiting step in canine retraction. Thus, it would seem relevant to choose one method over the other based on the treatment needs of the patient rather than the rate of movement (i.e. retraction produced by alveolar implants can produce a greater amount of retraction due to space closure being achieved by retraction only and would be a good treatment choice when maximum retraction is needed.

Applicability

This information would be applicable to orthodontic patients requiring retraction of teeth as alveolar implants are minimally invasive and offer an increased canine retraction over traditional molar anchorage methods of retraction.

Specialty

(General Dentistry) (Orthodontics) (Pediatric Dentistry)

Keywords

Orthodontics, dental implants, orthodontic space closure, retraction

ID#

610

Date of submission

04/07/2010

E-mail

martincl@livemail.uthscsa.edu

Author

Cami Martin

Co-author(s)

Co-author(s) e-mail

Faculty mentor

Ravikumar Anthony, BDS, MDS, MS

Faculty mentor e-mail

ANTHONYR@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?)

None available

Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)

by Yousef Almugla (San Antonio, TX) on 08/27/2013
I conducted a PubMed search on this topic on August, 2013 and found two more recent publications: PMID: 21299412 and 20386216 . These systematic review and RCT studies suggested that Implants provide better anchorage than traditional orthodontic anchorage methods but no differences in the retraction time were noted between the two methods. However more RCTs are required to provide sound recommendation. These studies further augment the conclusion of this CAT.