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Title Orthodontic Tooth Movement Is an Alternative to Vertical Bone Augmentation to Provide Bone Dimensions Adequate for Implant Placement
Clinical Question For patients with a missing mandibular second bicuspid with vertical alveolar ridge deficiency, how does orthodontic distalization of the mandibular first bicuspid compare to vertical bone augmentation procedures in terms of regenerating vertical bone height sufficient for implant placement?
Clinical Bottom Line For patients with a missing mandibular second bicuspid with vertical alveolar ridge deficiency, both treatment options (orthodontic distalization of the mandibular first bicuspid and vertical bone augmentation procedures) are effective in regenerating vertical bone height sufficient for implant placement. Current literature does not support the use of one treatment option over the other.
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) 24582025Eliasova/201455 patients with 71 missing mandibular second premolarsRetrospective study
Key resultsThe results of the study show that the mean increase in alveolar ridge height was 1.1 mm with a maximum of 3.9 mm. Twenty patients with 25 edentulous sites had implants placed after orthodontic treatment with 0.07 mm mean reduction of bone height at 5 years follow-up. Current literature supports that orthodontic tooth movement creates edentulous sites with stable vertical and horizontal bone height adequate for implant placement.
#2) 14718886Gunduz/200432 year old male with bilateral missing mandibular first molarsCase report
Key resultsThis study reports that orthodontic tooth movement created an edentulous site with vertical and horizontal bone dimensions adequate for implant placement. In this case report, the comparison between the pre-treatment and post-treatment CT scans showed a vertical increase in the alveolar ridge by a minimum of 2.2 mm and a maximum of 5.2 mm.
#3) 30667522Urban/2019678 patients in 36 included studiesMeta-Analysis
Key resultsVertical ridge augmentation is one the most challenging procedures for bone regeneration in implant dentistry, primarily due to technique sensitivity and a high complication rate. The systematic review demonstrated that vertical ridge augmentation by distraction osteogenesis, guided bone regeneration and block grafting is effective in treating deficient alveolar ridges keeping in mind the high rate of associated complications. The study showed that guided bone regeneration seemed to be the approach most frequently used by dentists; however, there is lack of evidence to support the use of one technique over the other.
Evidence Search (("Dental Implants"[Mesh]) AND "Osteogenesis"[Mesh]) AND "Tooth Movement Techniques/methods"[Mesh]
Comments on
The Evidence
There is no current evidence comparing the two treatment techniques; moreover, most studies evaluating bone regeneration using orthodontic tooth movement are retrospective studies or case reports, i.e., low-level evidence. In the systematic review, most of the studies reviewed were case series (24 investigations) and comparative studies (10 investigations). For the retrospective study and the systematic review, the methods and results are clearly presented, with large sample sizes and appropriate use of statistical analysis. The systematic review was conducted according to PRISMA guidelines; however, there was high heterogeneity between studies. It is also important to note that outcome measurements varied widely, both among the cited studies and among the included studies in the systematic review. For example, alveolar bone height was assessed via panoramic radiographs or intraorally using a periodontal probe leading to inconsistency in measurements between studies. Only one case report used conventional CT to assess bone height (Gunduz et al., 2004). Due to the heterogeneity of vertical bone augmentation procedures and since vertical alveolar ridge deficiency is a common finding complicating implant placement, further research, preferably randomized controlled trials using more accurate bone measurement modalities, are required to detect differences in vertical bone regeneration, if they exist, between these techniques.
Applicability Placement of dental implants is becoming a part of daily practice and is highly requested by many patients. Since vertical alveolar ridge deficiencies complicating implant placement are a common finding and a challenging problem, it is important to identify the most predictable bone regeneration method. Moreover, since the literature currently lacks evidence to support the use one technique over the other, it seems reasonable to present orthodontic tooth movement as an alternative treatment option for implant site preparation.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Orthodontics) (Periodontics)
Keywords Orthodontics, tooth movement, vertical bone augmentation, dental implants
ID# 3381
Date of submission: 06/11/2019spacer
E-mail heddaya@livemail.uthscsa.edu
Author Belal Heddaya
Co-author(s) e-mail
Faculty mentor/Co-author Brent J. Callegari, DDS, MS
Faculty mentor/Co-author e-mail callegari@uthscsa.edu
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