Evaluation of the use of a clinical practice guideline for external apical root resorption among orthodontists.

BACKGROUND: External apical root resorption (EARR) is a frequently observed adverse event in patients undergoing fixed appliance therapy. Assessing the patients' risk during treatment is important, as certain factors are assumed to be associated with an increased likelihood of occurrence. However, their predictive value remains limited, making evidence-based clinical decision-making challenging for orthodontists. To address this issue, the Dutch Association of Orthodontists (NvVO) developed a clinical practice guideline (CPG) for EARR in accordance with the AGREE II instrument (Appraisal of Guidelines for Research and Evaluation II) in 2018. The aim of this study is to get insight into the actual utilization and the practical implementation of the guideline among orthodontists. The hypothesis to be tested was that after its introduction, clinical practice for EARR has changed towards the recommendations in the CPG. OBJECTIVE: To investigate the use of the 2018 clinical practice guidelines for EARR among orthodontists 3 years after its introduction. METHODS: A questionnaire using a 7-point Likert scale was developed concerning four domains of EARR described in the guideline. The questionnaire was piloted, finalised, and then distributed digitally among Dutch orthodontists. REDCap was used for data collection, starting with an invitation email in June 2021, followed by two reminders. Effect was tested by the Mann-Whitney U test, and the influence of demographic variables was analysed. RESULTS: Questionnaires were sent out to all 275 and completed by 133 (response rate 48%); N = 59 females and N = 73 males were included; 81% had their training in the Netherlands, 89% had ≥ 6 years of work experience, and 89% worked in private orthodontic practice. One hundred thirty orthodontists (98.5%) reported changes in clinical practice. The biggest positive change in clinical behaviour regarding EARR occurred if EARR was diagnosed during treatment. Sex, clinical experience, country of specialist training, and working environment of the respondents did not affect clinical practices regarding EARR. CONCLUSIONS: This questionnaire demonstrated that, 3 years after introduction of the guideline, orthodontists improved their self-reported clinical practices to a more standardised management of root resorption. None of the demographic predictors had a significant effect on the results.

Three-dimensional computer-guided implant placement in oligodontia.

BACKGROUND: The aim of computer-designed surgical templates is to attain higher precision and accuracy of implant placement, particularly for compromised cases. PURPOSE: The purpose of this study is to show the benefit of a full three-dimensional virtual workflow to guide implant placement in oligodontia cases where treatment is challenging due compromised bone quantity and limited interdental spaces. PATIENT AND METHODS: A full, digitalized workflow was performed for implant placement in two oligodontia patients. Accuracy was assessed by calculating the coordinates of the entry point (shoulder) and apex (tip) as well as the angular deviation of the planned and actual implants. RESULTS: Implant placement could be well performed with the developed computer-designed templates in oligodontia. Mean shoulder deviation was 1.41 mm (SD 0.55), mean apical deviation was 1.20 mm (SD 0.54) and mean angular deviation was 5.27° (SD 2.51). CONCLUSION: Application of computer-designed surgical templates, as described in this technical advanced article, aid in predictable implant placement in oligodontia where bone quantity is scarce and interdental spaces are limited.

Skeletal anchorage in orthodontics--a review of various systems in animal and human studies.

PURPOSE: The aim of the present investigation was to review and evaluate the current literature on skeletal bone anchorage in orthodontics with regard to success rates of the various systems. MATERIALS AND METHODS: MEDLINE, PubMed, and Cochrane searches (period January 1966 to January 2006, English language) of animal and human studies using skeletal anchorage during orthodontic treatment were scrutinized. A total of 50 relevant articles were identified which investigated various types of implants. RESULTS: Two types of anchorage systems are used in orthodontics: (1) osseointegrated dental implants, including temporary mid-palatal implants. These systems were associated with a wide variety of success rates in animal studies. In human studies, the systems were shown to be reliable, with success rates between 85% and 100% (ie, systems still functioning at the end of the orthodontic treatment). (2) Nonosseointegrated mini-plates and mini-screw anchorage systems. Titanium miniplates were associated with 100% success in animals, and hardly any loss of these mini-plates (bone anchors) were lost due to infection in human studies, with success rates between 91% and 100%. Few long-term studies on nonosseointegrated mini-screws were found, but in animal studies, success rates ranged from 90% to 100%. A success rate of more than 75% in human studies is considered favorable for these orthodontic implants, which confirms the clinical applicability of this type of immediate loading anchor support in orthodontics. CONCLUSIONS: Both animal and human studies revealed that mesiodistal and intrusion movements can be reliably carried out by means of skeletal anchorage devices. A drawback is that animal studies do not reflect the real orthodontic clinical situation; thus, the outcome of these studies should be interpreted with caution. Human studies, however, show that orthodontic forces between 100 and 400 grams can be applied successfully to skeletal anchorage devices. Appropriate treatment strategies need to be confirmed by randomized prospective clinical trials. (More than 50 references).