Corticotomies as a surgical procedure to accelerate tooth movement during orthodontic treatment: A systematic review

BACKGROUND: One of the main aims of orthodontists is to reduce the treatment time as much as possible, particularly in view of the rise in demand for orthodontic treatment among adult patients. The objective of this systematic review was to examine the effectiveness of corticotomy as a surgical procedure that accelerates orthodontic tooth movement, together with its possible adverse effects. MATERIAL AND METHODS: A systematic review of articles in 4 databases, Pubmed, Cochrane, Scopus and Embase, complemented by a manual search, identified 772 articles. The duplicates were eliminated and a critical reading of titles and abstracts led to the rejection of articles that did not meet the objectives of the review, leaving 69. After reading the full text of these articles, 49 were excluded because they did not meet the inclusion criteria. On applying the CONSORT criteria as a quality filter, a further 4 were eliminated due to low quality. Finally, 16 articles (4 systematic reviews and 12 controlled trials) were reviewed. RESULTS: All the studies agree that corticotomy prior to orthodontic treatment accelerates dental movement, reducing the treatment time. With regard to side-effects, no periodontal damage was found, although this was only studied in the short term. CONCLUSIONS: The evidence regarding the results of corticotomy is limited, given the small number of quality clinical studies available. Before this procedure is included as a routine practice in dental surgeries, studies of higher methodological quality are required, studying a greater number of individuals and examining the possible long-term adverse effects and the cost/benefit of the procedure

Satisfaction and quality of life with palatal positioned implants in severely atrophic maxillae versus conventional implants supporting fixed full-arch prostheses

BACKGROUND: To evaluate satisfaction and quality of life in patients with palatal positioned implants supporting fixed full-arch prostheses to rehabilitate edentulous maxillae with horizontal atrophy and compare them with conventional well-centered implants placed in non-atrophic supporting fixed full-arch prostheses. MATERIAL AND METHODS: A clinical retrospective study was performed of patients that were rehabilitated with full-arch fixed implant-supported maxillary prostheses and had a minimum follow-up of 5 years after implant loading. Patients were divided into 2 groups: patients with class IV maxilla according to Cawood and Howell and treated with palatal positioned implants (test) and with class III maxilla and treated with implants well-centered in the alveolar ridge and completely surrounded by bone (control). Ten-cm visual analogue scales (VAS) (range 1-10) and the OHIP-14 (Oral Health Impact Profile) questionnaire were used respectively to estimate patient satisfaction and quality of life after implant therapy. Statistical analysis was performed applying Mann-Whitney Test using alpha set at 0.05. RESULTS: Mean global and specific satisfaction - except for self-esteem - were superior for the test group than the control group, although differences were not statistically significant. Regarding quality of life, the reported incidence of problems was lower in the test group for all the studied ítems except for 'problems at work'. However, differences were not statistically significant in any case. CONCLUSIONS: Despite the limitations of the study (retrospective and nonrandomized design) the results suggest that the prosthesis design needed to rehabilitate palatally positioned implants (more coverage of palate) does not lead to lower satisfaction and quality of life of patients, compared to patients treated with implants placed centered and conventional design prostheses that do not cover the palate

Satisfaction and quality of life with palatal positioned implants in severely atrophic maxillae versus conventional implants supporting fixed full-arch prostheses.

BACKGROUND: To evaluate satisfaction and quality of life in patients with palatal positioned implants supporting fixed full-arch prostheses to rehabilitate edentulous maxillae with horizontal atrophy and compare them with conventional well-centered implants placed in non-atrophic supporting fixed full-arch prostheses. MATERIAL AND METHOD: A clinical retrospective study was performed of patients that were rehabilitated with full-arch fixed implant-supported maxillary prostheses and had a minimum follow-up of 5 years after implant loading. Patients were divided into 2 groups: patients with class IV maxilla according to Cawood and Howell and treated with palatal positioned implants (test) and with class III maxilla and treated with implants well-centered in the alveolar ridge and completely surrounded by bone (control). Ten-cm visual analogue scales (VAS) (range 1-10) and the OHIP-14 (Oral Health Impact Profile) questionnaire were used respectively to estimate patient satisfaction and quality of life after implant therapy. Statistical analysis was performed applying Mann-Whitney Test using alpha set at 0.05. RESULTS: Mean global and specific satisfaction--except for self-esteem--were superior for the test group than the control group, although differences were not statistically significant. Regarding quality of life, the reported incidence of problems was lower in the test group for all the studied items except for 'problems at work'. However, differences were not statistically significant in any case. CONCLUSION: Despite the limitations of the study (retrospective and nonrandomized design) the results suggest that the prosthesis design needed to rehabilitate palatally positioned implants (more coverage of palate) does not lead to lower satisfaction and quality of life of patients, compared to patients treated with implants placed centered and conventional design prostheses that do not cover the palate.

Palatal positioned implants in severely atrophic maxillae versus conventional implants to support fixed full-arch prostheses: controlled retrospective study with 5 years of follow-up

BACKGROUND: To evaluate soft tissue conditions and bone loss around palatal positioned implants supporting fixed full-arch prostheses to rehabilitate edentulous maxillae with horizontal atrophy and compare them with conventional well-centered implants placed in non-atrophic maxillae after a minimum follow-up of 5 years. MATERIAL AND METHODS: A clinical retrospective study was performed of patients that were rehabilitated with full-arch fixed implant-supported maxillary prostheses and had a minimum follow-up of 5 years after implant loading. Patients were divided into 2 groups: patients with class IV maxilla according to Cawood and Howell and treated with palatal positioned implants (test) and with class III maxilla and treated with implants well-centered in the alveolar ridge and completely surrounded by bone (control). The following variables were assessed: age, sex, frequency of toothbrushing, smoking, type of prosthesis, type of implant, implant success, amount of buccal keratinized mucosa, buccal retraction, probing depth, plaque index, modified bleeding index, presence of mucositis or peri-implantitis and peri-implant bone loss. Statistical analysis was performed applying Chi2 Test and Student's t-test using alpha set at 0.05.RESULTS:A total of 57 patients were included: 32 patients with 161 palatal positioned implants (test) and 25 patients with 132 well centered implants (control). No statistically significant differences were found regarding age, sex and smoking, but test group patients reported a significantly higher frequency of daily toothbrushing. Implant success rates were 96.9% for test group implants and 96.0% for control group implants. Peri-implant mucosa retraction was significantly higher in the control group than in the test group (p=0,017). No significant differences were observed either for all the other assessed clinical parameters or for peri-implant bone loss.Conclusions: Despite its limitations the outcomes of the present study suggest that palatal positioned implants may be a good treatment alternative for patients with severe horizontal maxillary alveolar bone atrophy. Palatal positioned implants presented similar success rates, soft tissue conditions and peri-implant bone loss than well-centered implants placed completely surrounded by bone in non-atrophic ridges

Palatal positioned implants in severely atrophic maxillae versus conventional implants to support fixed full-arch prostheses: Controlled retrospective study with 5 years of follow-up.

BACKGROUND: To evaluate soft tissue conditions and bone loss around palatal positioned implants supporting fixed full-arch prostheses to rehabilitate edentulous maxillae with horizontal atrophy and compare them with conventional well-centered implants placed in non-atrophic maxillae after a minimum follow-up of 5 years. MATERIAL AND METHODS: A clinical retrospective study was performed of patients that were rehabilitated with full-arch fixed implant-supported maxillary prostheses and had a minimum follow-up of 5 years after implant loading. Patients were divided into 2 groups: patients with class IV maxilla according to Cawood and Howell and treated with palatal positioned implants (test) and with class III maxilla and treated with implants well-centered in the alveolar ridge and completely surrounded by bone (control). The following variables were assessd: age, sex, frequency of toothbrushing, smoking, type of prosthesis, type of implant, implant success, amount of buccal keratinized mucosa, buccal retraction, probing depth, plaque index, modified bleeding index, presence of mucositis or peri-implantitis and peri-implant bone loss. Statistical analysis was performed applying Chi2 Test and Student's t-test using alpha set at 0.05. RESULTS: A total of 57 patients were included: 32 patients with 161 palatal positioned implants (test) and 25 patients with 132 well centered implants (control). No statistically significant differences were found regarding age, sex and smoking, but test group patients reported a significantly higher frequency of daily toothbrushing. Implant success rates were 96.9% for test group implants and 96.0% for control group implants. Peri-implant mucosa retraction was significantly higher in the control group than in the test group (p=0,017). No significant differences were observed either for all the other assessed clinical parameters or for peri-implant bone loss. CONCLUSIONS: Despite its limitations the outcomes of the present study suggest that palatal positioned implants may be a good treatment alternative for patients with severe horizontal maxillary alveolar bone atrophy. Palatal positioned implants presented similar success rates, soft tissue conditions and peri-implant bone loss than well-centered implants placed completely surrounded by bone in non-atrophic ridges.

Palatal positioning of implants in severely atrophic edentulous maxillae: five-year cross-sectional retrospective follow-up study.

PURPOSE: To evaluate the 5-year outcome of a previously reported case series of patients with severely atrophic maxillae treated with palatally positioned implants and fixed full-arch rehabilitations. MATERIALS AND METHODS: A retrospective cross-sectional clinical study of patients treated between January 2000 and January 2004 with palatally positioned implants was carried out. The parameters evaluated at the 5-year follow-up visit were: implant success rate, peri-implant soft-tissue conditions, biological and prosthetic post-loading complications, radiographic peri-implant marginal bone loss, and patient satisfaction. RESULTS: A total of 33 patients with 151 palatally positioned implants were included in the study; 15 patients had received cemented prostheses and 18 had received screwed full-arch prostheses. The success rate for palatally positioned implants after 5 years was 98.7%. Average peri-implant mucosa retraction was 0.39 ± 0.94 mm and the average probing depth was 2.89 ± 0.77 mm. Plaque Index was 0 in 63.1% of the implants, 1 in 18.8%, 2 in 8.7%, and 3 in 9.4%. The modified Bleeding Index was 0 in 71.1%, 1 in 14.1%, and 2 in 14.8%. Mucositis was found in 5.2% of the implants and none had peri-implantitis. Prosthetic complications occurred in 12.1% of the cases. Average peri-implant marginal bone loss was 1.03 ± 1.28 mm. General patient satisfaction averaged 8.2 ± 1.8 according to a 10-point visual analog scale, and good quality of life was reported by most patients. CONCLUSIONS: Palatally positioned implants were found to be an adequate treatment for patients with severely atrophic maxillae. A high implant success rate, good peri-implant soft tissue stability, low marginal bone loss, high patient satisfaction and few complications were registered.

Rehabilitation of the atrophic maxilla with tilted implants: review of the literature.

We review the evidence-based literature on the use of tilted implants in the rehabilitation of patients with maxillary atrophy. Studies from 1999 to 2010 on patients with atrophic maxilla rehabilitated with tilted implants were reviewed. Clinical series with at least 10 patients rehabilitated using tilted implants and a follow-up of at least 12 months after prosthetic load were included. Case reports and studies with missing data were excluded. In each study the following was assessed: surgical technique, prosthesis type, timing of implant loading, success rate and marginal bone loss of tilted and axial implants, complications and patient satisfaction level. Thirteen studies were included, reporting a total of 782 tilted and 666 axial implants in 319 patients. Success rates went from 91.3% to 100% for axial implants and from 92.1% to 100% for tilted implants; radiographic marginal bone loss went from 0.4 mm to 0.92 mm in tilted implants and from 0.35 mm to 1.21 mm in axial implants. No statistically significant differences were found in any of the studies. No surgical complications and only minor prosthetic complications were reported. High patient satisfaction was found with all types of prosthesis (full-arch fixed, partial fixed and overdentures) placed over tilted implants. The literature on tilted implants shows that implants placed with this technique, both used alone and combined with axially placed implants, and rehabilitated with different prosthetic options have high success rates, minimal complications and high patient satisfaction. However, lack of homogeneity among studies and relatively short follow-up periods for most studies make necessary more studies.

Oral rehabilitation with tilted dental implants: a metaanalysis.

OBJECTIVE: To compare the course of patients treated with tilted implants versus those treated conventionally with axial implants, analyzing the success rate and marginal bone loss. MATERIAL AND METHODS: A PubMed search was made using the key words "tilted implants ", "angled implants ", "angulated implants ", "inclined implants " and "maxillary atrophy. " A review was made of the articles published between 1999-2010. The inclusion criteria were the use of tilted implants, clinical series involving at least 10 patients, and a minimum follow-up of 12 months after prosthetic loading. The exclusion criteria were isolated clinical cases, studies with missing data, and publications in languages other than English or Spanish. The metaanalysis finally included 13 articles: 7 retrospective studies and 6 prospective studies. RESULTS: On analyzing the success rate in the retrospective studies, two reported a higher success rate with tilted implants; one a higher success rate with axial implants; and two reported similar success rates with both implants. On analyzing the success rate in the prospective studies, two reported a higher success rate with tilted implants; two a higher success rate with axial implants; and two reported similar success rates with both implants. On examining marginal bone loss, three studies reported greater bone loss with axial implants and one with tilted implants. CONCLUSIONS: There was no evidence of differences in success rate between tilted and axial implants in either the prospective or retrospective studies subjected to review. The marginal bone loss observed with the tilted and axial implants likewise proved very similar. It thus can be deduced that tilted implants exhibit the same evolutive behavior as axial implants.

Rehabilitation of atrophic posterior maxilla with zygomatic implants: review.

The objective of this study was to review the published literature to evaluate treatment success with zygomatic implants in patients with atrophic posterior maxilla. Studies from 1987 to 2010 were reviewed. In each study, the following were assessed: indications for treatment, number of patients, number of implants, length and diameter of the implants, surgical technique, prosthetic rehabilitation, success rate, complications, and patient satisfaction. Sixteen studies were included, with a total of 941 zygomatic implants placed in 486 patients. The follow-up periods ranged from 12 to 120 months. Three different surgical techniques were used to place zygomatic implants: intrasinus implants with the classic sinus window technique, the sinus slot technique, and extrasinus zygomatic implants. The most common restoration used was fixed prosthesis, with either delayed loading after 3-6 months (89%-100% success) or immediate loading (96.37%-100% success). The weighted average success rate was 97.05%, and the most frequent complication was maxillary sinusitis. The general level of patient satisfaction was high. Zygomatic implants have a high success rate and constitute a suitable alternative to treat severe posterior maxillary atrophy.