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Kiran P, Sahoo N, Dash B, Mohanty B, Jena S. Effectiveness of Treating Vertical Maxillary Excess Among Non-growing Adult Patients With Skeletal Anchorage System: A Systematic Review and Meta-Analysis of Case Reports From 2008 to 2023. Cureus 2024; 16:e76625. [PMID: 39881939 PMCID: PMC11777145 DOI: 10.7759/cureus.76625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2024] [Indexed: 01/31/2025] Open
Abstract
Vertical maxillary excess presents a complex challenge in orthodontic treatment, necessitating effective anchorage systems for optimal correction. This research is useful to assess the skeletal anchorage system's (SAS) effectiveness in correcting the vertical maxillary excess among adult patients presenting with gummy smiles. This study includes case reports with English full text and examines the global general adult (18+) human population with vertical maxillary excess (VME). Publications from 2008 to 2023 were considered. The current systematic Review's framework follows patient, intervention, comparison, outcome and (sometimes) time (PICO(T)) criteria. Information sources were PubMed advanced search, Excerpta Medica database (EMBASE) (Elsevier), Web of Science, and Scopus (advanced search). On February 6th, 2024, the last search was carried out utilizing the same databases; the risk of bias was evaluated utilizing the National Institutes of Health (NIH) Quality Assessment Tool. Data synthesis was carried out on their own by the case and classical teams. The Meta XL (v.5.0) program (EpiGear International Pty Ltd., Queensland, Australia) Excel extension for meta-analysis was used. The inverse variance heterogeneity model was applied during the meta-analysis process. I2 and Cochrane's Q statistics were applied to gauge the degree of data heterogeneity. Two hundred fifty-two potential articles were found as a result of the search technique. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a total of 12 studies went through the analysis procedure. All 12 studies (case reports) and a total of 12 participants, including 11 females and one male, were studied from countries like India, the USA, Korea, Japan, China, and Mongolia. The age of patients is between 18 and 36 years. Out of 12 studies, in 11 studies, the orthodontic problem was Class II malocclusion with vertical maxillary excess. The pooled intrusion for the orthodontic treatment was seen, and almost 70% of the studies had a similar range. Only three studies were out of the 95% CI range of the other studies. The heterogeneity among the studies was 97.42%. Findings showed that p was statistically significant (p < 0.0001). The limitation of this study is that this is a systematic review and meta-analysis of case reports.
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Affiliation(s)
- Priti Kiran
- Orthodontics and Dentofacial Orthopaedics, Kalinga Institute of Dental Sciences, Bhubaneswar, IND
| | - Nivedita Sahoo
- Orthodontics and Dentofacial Orthopaedics, Kalinga Institute of Dental Sciences, Bhubaneswar, IND
| | - Bhagabati Dash
- Orthodontics and Dentofacial Orthopaedics, Kalinga Institute of Dental Sciences, Bhubaneswar, IND
| | - Biswaroop Mohanty
- Orthodontics and Dentofacial Orthopaedics, Kalinga Institute of Dental Sciences, Bhubaneswar, IND
| | - Sanghamitra Jena
- Orthodontics and Dentofacial Orthopaedics, Kalinga Institute of Dental Sciences, Bhubaneswar, IND
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Maleki M, Huang B, Mendes VC, Caminiti MF, Finer Y. A Systematic Review and Meta-Analysis Comparing Surgical and Nonsurgical Treatments for Excessive Gingival Display. Dent J (Basel) 2024; 12:154. [PMID: 38920855 PMCID: PMC11203257 DOI: 10.3390/dj12060154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 06/27/2024] Open
Abstract
Excessive gingival display (EGD) is defined as more than 2 mm of gingiva display above the maxillary incisors at maximum smile. Various skeletal, dental, and soft tissue etiological factors for EGD have been suggested. This study assessed the effectiveness and stability of surgical (SX) and nonsurgical (NSX) interventions for correction of EGD through a systematic review and meta-analysis following PRISMA 2020 guidelines. An electronic search of Ovid MEDLINE, EMBASE, CENTRAL, Scopus, Web of Science, and LILACS was conducted (2010-2023). Results were expressed as mean change in gingival display using the random-effects model at 1, 3, 6, and 12-month follow-up. At 1 month, SX and NSX treatments yielded a comparable mean reduction of 3.50 mm (2.13-4.86) and 3.43 mm (2.67-4.19) in gingival display, respectively. However, by 6 months, NSX treatments showed a reduction of 0.51 mm compared to 2.86 mm with SX treatments. SX outcomes remained stable past 6 months, while NSX outcomes partially relapsed at 6 months and returned to baseline levels at 12 months. Notably, NSX treatments were more effective in cases with mild initial EGD, while SX treatments showed a better outcome in severe cases. To draw more robust conclusions regarding the treatment outcomes, future primary studies of greater rigor are required.
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Affiliation(s)
- Mahdis Maleki
- Faculty of Dentistry, University of Toronto, 124 Edward St., Toronto, ON M5G 1G6, Canada; (M.M.); (B.H.); (V.C.M.); (M.F.C.)
| | - Bo Huang
- Faculty of Dentistry, University of Toronto, 124 Edward St., Toronto, ON M5G 1G6, Canada; (M.M.); (B.H.); (V.C.M.); (M.F.C.)
| | - Vanessa C. Mendes
- Faculty of Dentistry, University of Toronto, 124 Edward St., Toronto, ON M5G 1G6, Canada; (M.M.); (B.H.); (V.C.M.); (M.F.C.)
| | - Marco F. Caminiti
- Faculty of Dentistry, University of Toronto, 124 Edward St., Toronto, ON M5G 1G6, Canada; (M.M.); (B.H.); (V.C.M.); (M.F.C.)
| | - Yoav Finer
- Faculty of Dentistry, University of Toronto, 124 Edward St., Toronto, ON M5G 1G6, Canada; (M.M.); (B.H.); (V.C.M.); (M.F.C.)
- Institute of Biomedical Engineering, University of Toronto, 164 College St., Toronto, ON M5S 3E2, Canada
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Martins de Araújo Carneiro V, Roquete MP, Seabra Gomes AM, Marinho MU, Simino de Melo G, Kasabji F, An TL, Nascimento de Sousa D, Meireles Rodrigues JM, Stefani CM, Guimarães MDCM, Rodrigues Ribeiro AC, Soares Andrade CA. Effects of polymethyl methacrylate-based bone cement graft for treating excessive gingival display and its dimensional facial changes: 12-Month clinical study. J Oral Biol Craniofac Res 2024; 14:326-334. [PMID: 38660054 PMCID: PMC11039310 DOI: 10.1016/j.jobcr.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/03/2024] [Accepted: 04/13/2024] [Indexed: 04/26/2024] Open
Abstract
Objective to present a 12-month follow-up with photographic and tomographic analyses of the effect of polymethyl methacrylate-based bone cement graft (PMMA) in gingival exposure (GE) in patients with excessive gingival display (EGD). Methods Twelve patients with EGD were included. The PMMA was surgically placed. A frontal and lateral photograph protocol was performed at baseline (T0), 3 (T3), 6 (T6), and 12 months (T12) post-operatively. Soft tissue cone-beam computed tomography (ST-CBCT) was performed at T0 and T12. Measures included GE, length of the lip vermilion (LLV), lip shape (LS), nose width (NW), filter width (FW), nasolabial angle (NAS) while smiling, and nasolabial angle at rest (NAR). The height, thickness, and volume of the cement graft were also measured in the ST-CBCT. The comparisons were performed by Kruskal-Wallis test at 5 % of significance (p < 0.05). Results The height, thickness, and volume of the PMMA were respectively 12.84 ± 1.59 mm, 3.83 ± 0.53, and 1532.02 ± 532.52 mm3. PMMA significantly decreased GE from 8.33 ± 1.25 mm (T0) to 6.60 ± 0.93 mm (T12) (p < 0.01). NAR was 98.34 ± 9.28° at T0 and increased to 105.13 ± 7.33° at T12; however, the angle value was not statistically different (p = 0.08). LLV, LS, NW, FW, and NAS did not exhibit statistical differences between the baseline and follow-up periods. Conclusions PMMA significantly decreased GE in a 12-month follow-up without influencing adjacent soft tissue anatomical structures.
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Affiliation(s)
- Valéria Martins de Araújo Carneiro
- Faculdade de Ciências da Saúde, Departamento de Odontologia, Universidade de Brasília - Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Mayra Pereira Roquete
- Faculdade de Ciências da Saúde, Departamento de Odontologia, Universidade de Brasília - Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Andressa Meireles Seabra Gomes
- Faculdade de Ciências da Saúde, Departamento de Odontologia, Universidade de Brasília - Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Mônica Umpierre Marinho
- Faculdade de Ciências da Saúde, Departamento de Odontologia, Universidade de Brasília - Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Gabriel Simino de Melo
- Faculdade de Medicina e Odontologia, Departamento de Periodontia, Faculdade São Leopoldo Mandic, Rua Dr. José Rocha Junqueira 13, Campinas, SP, 13045-755, Brazil
| | - Feras Kasabji
- Faculty of Medicine, Department of Public Health and Epidemiology, University of Debrecen, Kassai Út 26, Debrecen, Hajdú-Bihar, H-4028, Hungary
| | - Tien-Li An
- Faculdade de Ciências da Saúde, Departamento de Odontologia, Universidade de Brasília - Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Dircilei Nascimento de Sousa
- Faculdade de Ciências da Saúde, Departamento de Odontologia, Universidade de Brasília - Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - João Marcelo Meireles Rodrigues
- Faculdade de Ciências da Saúde, Departamento de Odontologia, Universidade de Brasília - Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Cristine Miron Stefani
- Faculdade de Ciências da Saúde, Departamento de Odontologia, Universidade de Brasília - Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Maria do Carmo Machado Guimarães
- Faculdade de Ciências da Saúde, Departamento de Odontologia, Universidade de Brasília - Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Ana Clara Rodrigues Ribeiro
- Departamento de Odontologia, Universidade Católica de Brasília – Campus Taguatinga Sul, Taguatinga, Brasília, DF, 71966-700, Brazil
| | - Carlos Alexandre Soares Andrade
- Faculty of Medicine, Department of Public Health and Epidemiology, University of Debrecen, Kassai Út 26, Debrecen, Hajdú-Bihar, H-4028, Hungary
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Lu T, Mei L, Li BC, Huang ZW, Li H. Hybrid treatment of varied orthodontic appliances for a patient with skeletal class II and temporomandibular joint disorders: A case report and review of literature. World J Clin Cases 2024; 12:431-442. [PMID: 38313641 PMCID: PMC10835688 DOI: 10.12998/wjcc.v12.i2.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/11/2023] [Accepted: 12/27/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The relation between orthodontic treatment and temporomandibular disorders (TMDs) is under debate; the management of TMD during orthodontic treatment has always been a challenge. If TMD symptoms occur during orthodontic treatment, an immediate pause of orthodontic adjustments is recommended; the treatment can resume when the symptoms are managed and stabilized. CASE SUMMARY This case report presents a patient (26-year-old, female) with angle class I, skeletal class II and TMDs. The treatment was a hybrid of clear aligners, fixed appliances and temporary anchorage devices (TADs). After 3 mo resting and treatment on her TMD, the patient's TMD symptom alleviated, but her anterior occlusion displayed deep overbite. Therefore, the fixed appliances with TAD were used to correct the anterior deep-bite and level maxillary and mandibular deep curves. After the levelling, the patient showed dual bite with centric relation and maximum intercuspation discrepancy on her occlusion. After careful examination of temporomandibular joints (TMJ) position, the stable bite splint and Invisible Mandibular Advancement appliance were used to reconstruct her occlusion. Eventually, the improved facial appearance and relatively stable occlusion were achieved. The 1-year follow-up records showed there was no obvious change in TMJ morphology, and her occlusion was stable. CONCLUSION TMD screening and monitoring is of great clinical importance in the TMD susceptible patients. Hybrid treatment with clear aligners and fixed appliances and TADs is an effective treatment modality for the complex cases.
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Affiliation(s)
- Tong Lu
- Department of Orthodontics, Nanjing Stomatological Hospital, The Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Li Mei
- Discipline of Orthodontics, Department of Oral Science, Faculty of Dentistry, University of Otago, Dunedin 9016, New Zealand
| | - Bao-Chao Li
- Department of Orthodontics, Nanjing Stomatological Hospital, The Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Zi-Wei Huang
- Department of Orthodontics, Nanjing Stomatological Hospital, The Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Huang Li
- Department of Orthodontics, Nanjing Stomatological Hospital, The Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
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Dynamics, Efficacies, and Adverse Effects of Maxillary Full-Arch Intrusion Using Temporary Anchorage Devices (Miniscrews): A Finite Element Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6706392. [PMID: 36254137 PMCID: PMC9569208 DOI: 10.1155/2022/6706392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 08/27/2022] [Accepted: 09/16/2022] [Indexed: 11/28/2022]
Abstract
Introduction Absolute anchorages obtained from temporary anchorage devices (TADs, miniscrews) considerably facilitate dental movements and make some very difficult movements such as full-arch intrusions possible. Despite the significance of assessing strategies to fully intrude the arch using mini-implants, there is no study in this regard except a few case reports. Therefore, we simulated/tested 4 scenarios. Methods Four maxilla models were created with different miniscrews/appliances: (1) two miniscrews were placed distal to laterals and one in the mid sagittal region. (2) Two mini-implants were inserted in mesial of canines and 2 others between bilateral first and second molars, plus another TAD in the midpalatal area, plus a transpalatal arch (TPA). (3) Two mini-implants were inserted between bilateral canines and first premolars and 2 others between bilateral first and second molars + TPA. (4) Two mini-implants were installed between lateral-and-canine and 2 miniscrews between second premolars and first molars + TPA. Intrusive forces (80 g anterior, 150 g posterior) were exerted using stainless-steel coil springs. Stresses/displacements were measured. Risk of external root resorption was evaluated. Results The highest amounts of incisor/molar intrusion were seen in model 1. Model 2 had fewer intrusions, but its control over undesired movements was greater. Model 4 drastically reduced molar intrusion and considerably increased premolar intrusion. Overall amounts of intrusion were highest in the first 2 models, marking them as proper candidates for cases needing greater intrusion extents. Model 2 may be useful when miniscrew loosening/failure is a concern, while model 1 is recommended when fewer miniscrews are allowed. Overall, the highest and lowest root resorptions might occur in models 1 and 4, respectively. Conclusions Each model showed certain efficacies/drawbacks and thus is recommended for a particular set of cases. Therefore, depending on the diagnosis and treatment plan, one or more of these scenarios might be desirable.
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