Title |
Temporary Anchorage Device (TAD) Supported Pontics Prevent Bone Resorption in Young Growing Patients with Missing Maxillary Lateral Incisors |
Clinical Question |
In young growing patients with missing maxillary lateral incisors, do TAD supported pontics, compared to tooth supported FDPs, prevent bone resorption? |
Clinical Bottom Line |
Placing Temporary Anchorage Devices (TADs) in edentulous sites in young growing patients has been shown to prevent bone resorption in the area. This finding is supported by a case study and an in vivo study that demonstrated radiographically and clinically that a TAD supported pontic provided a better quality of alveolar bone and prevented bone resorption. |
Best Evidence |
|
PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
25127382 | Wilmes B/2014 | 3 patients, 13-14 yo | Case series | Key results | 3 patients aged 13-14 yo presented with missing anterior and posterior teeth. A total of 6 Benefit mini-implants were placed and 4 were followed for 5-6 years radiographically and clinically. The authors found no bone atrophy or local growth inhibition radiographically or clinically. | 25403977 | Melsen/2014 | 4 adult Beagle dogs | in vivo animal study | Key results | The authors found in their in vivo study that there was a statistically significant increase in bone density and a decrease in ridge atrophy when placing a trans-cortical mini screw in an extraction area (p=0.012). This reduces the need for a longer clinical crown restoration and leads to better quality alveolar bone for the osseointegrated implant. Surgical reconstruction prior to implant placement can be avoided later. Histologically, a higher activity of bone was found at the experimental site. | |
Evidence Search |
TADs[All Fields] OR (mini[All Fields] AND implant[All Fields] AND ("bone resorption"[MeSH Terms] OR ("bone"[All Fields] AND "resorption"[All Fields]) OR "bone resorption"[All Fields]) AND orthodontic[All Fields]) AND (, alveolar[All Fields] AND ("bone and bones"[MeSH Terms] OR ("bone"[All Fields] AND "bones"[All Fields]) OR "bone and bones"[All Fields] OR "bone"[All Fields])) |
Comments on
The Evidence |
The study by Wilmes et al. reported on 3 patient cases in detail and mentioned 21 more in the discussion. In 95% of all their cases the authors were successful in placing a mini-implant supported pontic as a temporary replacement of a missing tooth in the anterior segment. In clinical controls and 2 dimensional radiographs after 3-5 years they couldn’t find any growth inhibition or bone atrophy. Although the study presents radiographically healthy implant beds it lacked the evidence of the bone volume measured by a three dimensional radiographic examination. The second study by Melson et al. was an in-vivo animal study. Although external validity must be considered when evaluating the findings, the results of the current study showed a decrease of bone atrophy in areas where mini-implants were placed through use of a 3-D imaging system. Randomized clinical trials in human subjects are needed to confirm the positive outcomes reported. |
Applicability |
Clinicians should consider use of a mini-implant supported pontic instead of a Maryland bridge or removable appliance to treat growing patients with missing maxillary lateral incisors. The presented treatment modality has a high possibility to save bone structure and appears to result in better bone volume to place an implant when skeletal growth has stopped. |
Specialty |
(General Dentistry) (Oral Surgery) (Orthodontics) (Prosthodontics) |
Keywords |
TADS, mini-implants, bone resorption, bone atrophy, missing lateral incisors, tooth supported pontics, adolescence, dental abutments, dental implants, dental restoration, alveolar bone; atrophy; implants
|
ID# |
2964 |
Date of submission |
12/10/2015 |
E-mail |
michael.schulte@ucdenver.edu |
Author |
Michael Schulte |
Co-author(s) |
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Co-author(s) e-mail |
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Faculty mentor |
Ethelyn Thomason, DMD |
Faculty mentor e-mail |
ETHELYN.THOMASONLARSEN@UCDENVER.EDU |
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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 | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
None available | |