RESIDENTS' JOURNAL REVIEW

ARTICLES SELECTED AND REVIEWED BY:SENIOR RESIDENTS, DEPARTMENT OFORTHODONTICS, UNIVERSITY OFWASHINGTON, SEATTLE

Greg Huang, Department Chair, andAnne-Marie Bollen, Program Director

Success of maxillary canineautotransplantationPatel S, Fanshawe T, Bister D, Cobourne MT.Survival and success of maxillary canineautotransplantation: a retrospective investigation.Eur J Orthod 2010; e-pub, September 2010.

Some treatment options for impacted maxillary ca-nines can lead to unfavorable outcomes. Autotrans-

plantation is an option that involves atraumatic surgicalremoval of the canine and reimplantation into a previ-ously created socket. The aim of this study was to eval-uate survival and success rates after autotransplantationof maxillary permanent canines with closed apices. Thesample consisted of 49 patients (mean age at transplan-tation, 21.8 years), who had autotransplantation of im-pacted maxillary canines. The sample was divided into 2categories: 63 autotransplanted maxillary canines withno controls and 27 unilateral transplanted canineswith a nontransplanted canine on the contralateralside as a control. Success was determined by using thefollowing criteria: survival, mobility, probing pocketdepth, gingival bleeding, vitality, color, internal and ex-ternal inflammatory resorption, bone level, and signs ofpathology. Thirty-eight percent of the sample was con-sidered successful, and the overall survival rate was 83%,with an average duration of 14.5 years (range, 1.4-27.8years). In the case control sample, the transplanted teethhad unfavorable differences compared with the non-transplanted teeth for probing pocket depth, gingivalbleeding, vitality, and color, all of which were statisti-cally significant. The results of this study indicate thatautotransplanted canines with closed apices have a lowcomplete success rate but can have a favorable survivalrate over the long term. The technique should be consid-ered as an interim measure to maintain bone level beforeplacement of implants in patients who are unwilling toundergo lengthy orthodontic treatment to align ectopiccanines.

Reviewed by Brienne Roloff-Chiang

Systematic review of intraoral splints fortreating TMDFricton J, Look JO, Wright E, Alencar FG Jr, Chen H,LangM,OuyangW, Velly AM. Systematic review andmeta-analysis of randomized controlled trialsevaluating intraoral orthopedic appliances fortemporomandibular disorders. J Orofac Pain2010;24:237-54.

Intraoral orthopedic appliances have historically beenused to manage temporomandibular disorders

(TMD). Despite their long and widespread use, there isstill controversy about their efficacy for treatment ofTMD pain. The aim of this systematic review andmeta-analysis was to assess the efficacy of intraoral or-thopedic appliances to reduce pain in TMD patientscompared with a placebo, no treatment, or other treat-ments as reported in randomized controlled trials(RCTs). The investigators searched the literature andfound 44 RCTs of intraoral orthopedic appliances fortreating TMD. Ten of these were suitable for meta-analysis. Seven RCTs compared hard stabilization appli-ances with nonoccluding appliances intended to act asa placebo control. Meta-analysis showed an odds ratioof 2.45, indicating that pain reduction occurred moreoften in the stabilization appliance group than in thecontrols. Three RCTs compared hard stabilization appli-ances with no treatment, and an odds ratio of 2.14 dem-onstrated a positive net effect with the stabilizationappliances, although it was not statistically significant.Studies comparing intraoral appliances with other treat-ments, including self-care, acupuncture, physical medi-cine, short-term behavioral therapies, and somepharmacologic treatments found that each has someevidence of equal efficacy to appliances, and these treat-ments can be considered as initial or concurrent treat-ment for TMD. The authors concluded that hardstabilization appliances when adjusted properly havegood evidence of modest efficacy in the treatment ofTMD pain when compared with nonoccluding appli-ances and no treatment, and are at least equally as effec-tive as alternative treatments. Other types of applianceshave some evidence of efficacy in reducing TMD pain,but the potential for adverse events with these appli-ances is higher.

Reviewed by Jake DaBell

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8 Resident's journal review

Effects of facemask therapy on profilechanges in Class III subjectsKilic N, Catal G, Kiki A, Oktay H. Soft tissue profilechanges following maxillary protraction in Class IIIsubjects. Eur J Orthod 2010;32:419-24.

Protraction of themaxilla by using a facemask is a com-mon treatment for Class III malocclusions with maxil-

lary retrusion and mandibular prognathism. Most studieson soft-tissue response to maxillary protraction (MP) ap-pliances have included maxillary expansion, but therehas been limited research on MP focusing on soft-tissueprofile changes without maxillary expansion. The aim ofthis study was to investigate soft-tissue profile changes in-duced by MP only. The treatment group consisted of 24girls (mean age, 12.696 1.08 years) with maxillary retru-sion or a combination of maxillary retrusion and mandib-ular protrusion resulting in concave profiles. The controlgroup (15) had Class I occlusion and was matched forage and sex. MP therapy consisted of a Petit-type face-mask with 400 to 500 g of force applied to the maxillarycanines. The appliance was worn for at least 14 hoursper day until a positive overjet was achieved. Linear andangularmeasurementswere taken on the T1 and T2 lateralcephalometric radiographs. The Student t test was used tocompare changes between groups. This study showed sig-nificantly greater anterior movement in the maxilla, upperlip, and superior sulcus, with greater proclination of themaxillary incisors in the treatment group than in the con-trol group. There was also downward and backwardmove-ment of the mandible, lower lip, and soft-tissue pogonion.There was mandibular incisor retroclination. According tothis study, the improvement in facial profile predomi-nantly resulted from maxillary soft-tissue changes andmandibular hard-tissue changes. These results allowedthe authors to conclude that concave facial profiles ofthe subjects were corrected by anterior movement of themaxilla resulting in increased fullness of the upper lip.The concave skeletal profiles were corrected mainly bybackward and downward rotation of the mandible.

Reviewed by Thomas Houlihan

Role of preoperative orthodontics incorrecting Class III malocclusionsWang YC, Ko EW, Huang CS, Chen YR, Takano-Yamamoto T. Comparison of transversedimensional changes in surgical skeletal Class IIIpatients with and without presurgical orthodontics.J Oral Maxillofac Surg 2010;68:1807-12.

Traditionally, dental compensations in patients un-dergoing orthognathic surgery have been addressed

January 2011 � Vol 139 � Issue 1 American

with a period of preoperative orthodontics. Specifically,with skeletal Class III malocclusions in the transverse di-mension, there is frequently a severe buccolingual tilt ofthe posterior teeth that might introduce occlusal interfer-ences after surgical correction of the jaw position. Somehave suggested that preoperative orthodontic treatmentis inefficient, and that the adjustment of arch width andtooth movement can be achieved more efficiently duringor after orthognathic surgery. The aim of this study wasto test the hypothesis that the transverse dimensionalchanges in patients with a skeletal Class III malocclusionundergoing surgical-orthodontic treatment with a phaseof preoperative orthodontics were the same as those with-out preoperative orthodontic treatment. Retrospectively,36 adult patients with a Class III skeletal malocclusionwere selected. The 2 groups compared were the surgery-first (SF) group and the orthodontics-first (OF) groupwith 18 patients each. Posteroanterior cephalometric ra-diographs were compared at different time points to deter-mine changes in the inclination of canines and molars.Only the maxillary canine before surgery (T1) and themandibular molars at T0 (initial), T1, and T2 (immediatelyafter surgery) showed a significant difference between the2 groups. The authors came to the following conclusions:(1) changes in molar and canine inclinations showed buc-cal tilting of the mandibular molars and maxillary caninesand lingual tilting of the maxillary molars and mandibularcanines; (2) inclination changes of canines and molarsdemonstrated no significant differences with or withouta phase of preoperative orthodontics; and (3) inclinationchanges of the canines and molars during treatmentshowed similar trends in the SF and OF groups.

Reviewed by Alfonso Navarrete

Randomized controlled trial ofpostorthodontic stabilityEdman Tynelius G, Bondemark L, Lilja-Karlander E.Evaluation of orthodontic treatment after one yearof retention—a randomized controlled trial. Eur JOrthod 2010;32:542-7.

Stability can determine the overall success of ortho-dontic treatment. Choosing the best retention

method has always been a topic of interest. After re-viewing the literature, the Cochrane Collaborationgroup reached the conclusion that there is no evidenceconcerning the most appropriate retention strategy af-ter orthodontic treatment. Therefore, they suggestedthat future research regarding retention should includetrue randomization, reporting of dropouts, adequate

Journal of Orthodontics and Dentofacial Orthopedics

Resident's journal review 9

sample-size calculation, and a minimum of 3 monthsoffollow-up. The aim of this study was to use random-ized controlled trial methodology to evaluate and com-pare 3 retention methods. Seventy-five patients witha mean age of 14.4 years were randomized into 3 reten-tion methods: (1) a vacuum-formed retainer in the maxillaand bonded canine-to-canine retainer in the mandible(group V-CTC), (2) a vacuum-formed retainer in the max-illa combined with stripping of the 10 interproximal sur-faces of the mandibular anterior teeth (group V-S), and(3) a prefabricated positioner covering the teeth in themaxilla andmandible (group P). Each groupwasmeasured

American Journal of Orthodontics and Dentofacial Orthoped

for Little’s irregularity index, intercanine and intermolarwidth, arch length, overjet, and overbite. Dental casts ofthese patients were measured after removal of the ortho-dontic appliances and 1 year after the beginning of reten-tion. Small significant differences were found between theV-CTC and V-S groups regarding overbite, mandibular in-tercaninewidth, andmandibular arch length. Two patientsdid not cooperate in group P. The authors concluded that,on a short-term basis after 1 year of retention, all 3 reten-tion methods were successful in retaining the orthodontictreatment results.

Reviewed by Enrique Reyes Retana

ics January 2011 � Vol 139 � Issue 1