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
PubMed ID Author / Year Patient Group Study type (level of evidence) 24582025 Eliasova/2014 55 patients with 71 missing mandibular second premolars Retrospective study Key results The 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. 14718886 Gunduz/2004 32 year old male with bilateral missing mandibular first molars Case report Key results This 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. 30667522 Urban/2019 678 patients in 36 included studies Meta-Analysis Key results Vertical 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	(General Dentistry) (Oral Surgery) (Orthodontics) (Periodontics)
Keywords	Orthodontics, tooth movement, vertical bone augmentation, dental implants
ID#	3381
Date of submission	06/11/2019
E-mail	heddaya@livemail.uthscsa.edu
Author	Belal Heddaya
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Brent J. Callegari, DDS, MS
Faculty mentor e-mail	callegari@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) None available