Residents’ journal review

Two-piece vs 3-piece surgically assisted rapid maxillary expansion

Landes CA, Laudemann K, Petruchin O, Revilla C, Seitz O, Kopp S, et al. Advantages and limits of 3-segment (paramedian) versus 2-segment (median) surgically assisted rapid maxillary expansion (SARME). Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011 Mar 31 [Epub ahead of print]

Transverse maxillary hypoplasia exists in nondysgnathic syndromal, cleft lip and palate patients, or patients with craniofacial syndromes. There is no consensus regarding the surgical technique that should be used when orthodontic rapid maxillary expansion is not an option. The purpose of this article was to document the procedure of 3-segment osteotomy compared with 2-segment osteotomy. Unlike the 2-segment osteotomy, where the osteotomy is performed anteriorly between the central incisors, posterior to the incisive foramen along the nasal septum to the posterior margin of the hard palate, the 3-segment osteotomy is performed bilaterally between the lateral incisors and the canines, continuing to the posterior margin of the palate. The original sample consisted of 98 patients. Some were treated with a novel 3-segment osteotomy and others received the conventional 2-segment procedure for surgically assisted rapid maxillary expansion. Transverse maxillary dental and skeletal expansion, dental tipping, attachment loss, and anterior tooth inclination were evaluated on preoperative and postexpansion models and photographs of 47 of the patients. Greater and more symmetrical expansion, more dental tipping, and more anterior angulation were observed in the 3-segment osteotomy group compared with the 2-segment osteotomy group. These results were statistically insignificant. The median mesial papilla in the 3-segment osteotomy group exhibited a more esthetic outcome, and this was statistically significant. The 3-segment osteotomy, although more invasive, seems to provide a more esthetic result. More research is needed to identify a more stable, periodontally healthier, and symmetrical result with these procedures.

Reviewed by Pinelopi-Kleio Palaska

Tooth autotransplantation for patients with ectopic or missing teeth

Hewitt AB, Gelson W. Autotransplantation of ectopic teeth: a retrospective study of 284 teeth. Oral Surg 2011;4:153-60

Ectopically displaced teeth can be treated by exposure and traction, extraction and orthodontic repositioning, or extraction and prosthodontic replacement. In a growing patient, prosthodontic replacement is not always an option. This retrospective study aimed to examine the long-term outcomes of autotransplanted ectopic teeth in growing patients with respect to pulpal and periodontal healing and survival times, and to determine the usefulness of this technique. The procedure was performed by the same surgeon on 284 ectopic teeth in 235 patients (ages, 9-51 years). The autotransplanted teeth included 254 maxillary canines, 4 mandibular canines, 9 maxillary incisors, 1 mandibular incisor, 5 maxillary premolars, and 11 mandibular premolars. Donor teeth were kept in blood under the mucosal flap to preserve the periodontal ligament cells until immediately before placement. The teeth were fixated via multibond splinting for 3 weeks. Of the survival group, 180 were vital with no root resorption, 57 were nonvital with normal periapical tissues, 36 had normal periapical tissues but needed root canal therapy, 4 had root resorption requiring extraction, and 7 teeth were lost. Excluding teeth lost to follow-up, the survival rates were 98% at 5 years, 97% at 10 years, and 96% after 10 years. Including teeth lost to follow-up, the survival rates were 96%, 65%, and 35% at the same intervals. The authors did not address the differences in survival rates between the 2 groups. This large attrition rate of the sample at the 10-year follow-up should be investigated to draw clinically relevant conclusions. Seventy-two percent of the teeth initially had fully formed apices. The authors found no difference between open and closed apices. They suggested that autogenous tooth transplantation is a valid approach for the management of ectopic teeth when, for clinical or social reasons, exposure and traction is not appropriate.

Reviewed by Amanda Gales Belden Kramer

Tooth autotransplantation for patients with ectopic or missing teeth

Hewitt AB, Gelson W. Autotransplantation of ectopic teeth: a retrospective study of 284 teeth. Oral Surg 2011;4:153-60

Ectopically displaced teeth can be treated by exposure and traction, extraction and orthodontic repositioning, or extraction and prosthodontic replacement. In a growing patient, prosthodontic replacement is not always an option. This retrospective study aimed to examine the long-term outcomes of autotransplanted ectopic teeth in growing patients with respect to pulpal and periodontal healing and survival times, and to determine the usefulness of this technique. The procedure was performed by the same surgeon on 284 ectopic teeth in 235 patients (ages, 9-51 years). The autotransplanted teeth included 254 maxillary canines, 4 mandibular canines, 9 maxillary incisors, 1 mandibular incisor, 5 maxillary premolars, and 11 mandibular premolars. Donor teeth were kept in blood under the mucosal flap to preserve the periodontal ligament cells until immediately before placement. The teeth were fixated via multibond splinting for 3 weeks. Of the survival group, 180 were vital with no root resorption, 57 were nonvital with normal periapical tissues, 36 had normal periapical tissues but needed root canal therapy, 4 had root resorption requiring extraction, and 7 teeth were lost. Excluding teeth lost to follow-up, the survival rates were 98% at 5 years, 97% at 10 years, and 96% after 10 years. Including teeth lost to follow-up, the survival rates were 96%, 65%, and 35% at the same intervals. The authors did not address the differences in survival rates between the 2 groups. This large attrition rate of the sample at the 10-year follow-up should be investigated to draw clinically relevant conclusions. Seventy-two percent of the teeth initially had fully formed apices. The authors found no difference between open and closed apices. They suggested that autogenous tooth transplantation is a valid approach for the management of ectopic teeth when, for clinical or social reasons, exposure and traction is not appropriate.

Reviewed by Amanda Gales Belden Kramer

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Apr 8, 2017 | Posted by in Orthodontics | Comments Off on Residents’ journal review
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