ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title No Significant Effects of Inter-proximal Enamel Reduction Found on Caries Risk Assessment in Orthodontics
Clinical Question In patients undergoing orthodontic treatment, does inter-proximal enamel stripping compared to no stripping increase the caries risk during or post-treatment?
Clinical Bottom Line In orthodontic treatment, the inter-proximal enamel reduction does not seem to increase caries risk post-operatively. (See Comments on the CAT below)
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) 16849068Jarjoura/2006Patients received air-motor stripping during orthodontic treatment.Prospective clinical comparison
Key resultsThere was not a significantly greater number of inter-proximal caries found on the surfaces treated with enamel stripping than on the control surfaces. Majority of the caries were on occlusal surfaces.
#2) 21195282Zachrisson/2011Patients received mesiodistal enamel reduction 4 years before clinical examination.Clinical Comparative Study
Key resultsOnly 2.5% new caries lesions were found on the reproximated surfaces compared to 2.4% new lesions on the ungrounded inter-proximal surfaces. There was no increased tooth sensitivity reported.
Evidence Search "Orthodontics"[Mesh] AND "Dental Caries"[Mesh] AND (Interproximal[All Fields] AND reduction[All Fields])
Comments on
The Evidence
In Jarjoura article, a non-randomized controlled trial was performed on 40 patients of mean age 19.5 years. After the orthodontic treatment, 376 surfaces with interproximal enamel reduction and 376 control surfaces within the same subjects were examined for 1 to 6 years for caries activity. The control surfaces and treated surfaces were examined every 6 months by blinded examiners using clinical and radiographic methods. Statistical analysis was performed. No competing interests were reported. In Zachrisson comparative study, 278 reproximated surfaces and 84 ungrounded reference tooth surfaces were examined for new caries lesions 4 to 6 years after the orthodontic treatment. Both control surfaces and reproximated surfaces were treated the same. Adequate follow up was done. All tooth surfaces were examined using bite wing radiographs and clinical exams by blinded dentist. All the carious lesions were graded on the 5-level scale. The author reports no commercial or financial interests in the products or companies described in the article.
Applicability In Jarjoura study, patients from different ethnic background were obtained by interviews and questionnaires. The inter-proximal stripping provided enough space to correct the crowding in these patients. This study is applicable to patients with minor crowding. In Zachrisson study, patients were obtained from the private practice of the first author by using questionnaire about their oral hygiene methods. This study is also applicable to the patients with minor crowding and good oral hygiene.
Specialty/Discipline (Orthodontics)
Keywords Orthodontic appliances, malocclusion, dental caries susceptibility, risk factors, dental instrumentation, Inter-proximal enamel reduction, air abrasion, radiographs, bite wings, dental debonding, orthodontic bracket.
ID# 2285
Date of submission: 04/13/2012spacer
E-mail patelnm@livemail.uthscsa.edu
Author Neha Patel
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?)
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None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Vishnu Raj (San Antonio, TX) on 04/13/2014
A recent systematic review PMID: 24011354 corroborates the clinical bottom line.
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