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Background: Clefts of the lip and palate (CLP) are facial deformities that require multiple surgical procedures during childhood. One of these steps consists of filling the alveolar space with bone graft, traditionally removed from the iliac crest. However, this procedure could be invasive in children. Aim: Here, we aimed to evaluate the outcomes of GlassBONE™ graft, a bioactive glass used as a bone substitute, as an alternative to the deleterious autologous bone graft in children. Materials & methods: Retrospective monocentric study with 17 children aged 7.5 ± 2.2 yo [3.8-13.3 yo] carrying CLP. This technique has been established at La Timone Children hospital (Assistance Publique - Hôpitaux de Marseille) since 2011. Clinical (scar, graft rejection and periodontal status) and radiological (both panoramic radiographs and cone beam-CT) follow-up was conducted one year after the graft. The primary outcome was the reduction of the cleft volume, and secondary was the eruption of the adjacent tooth through the graft. Results: GlassBONE™ permitted a significant reduction in the cleft volume by 42.4 ± 27.7% [0.6-81.1%] (p < 0.0001), corresponding to a filling of 57.6 ± 27.7% of the alveolar cleft. GlassBONE™ is well tolerated, ensuring satifactory clinical results (improvement in both scar and periodontal coverage), as well as the physiological evolution of the germs through the biomaterial. GlassBONE™ appears particularly suitable for small volumes, and we were able to determine a minimum volume of approximtely 0.259 + / - 0.155 cc required for a successful bone fusion. Conclusion: The bioactive glass GlassBONE™ could be safely used in children with small CLP cases, providing satisfactory clinical and radiological results.
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INTRODUCTION: the quantification of tooth movements should be obtained at different specific times and compared at different stages for every orthodontic treatment. These movements are generally measured on teleradiographs or casts. The use of Cone Beam Computed tomography (CBCT) for maxillary superimposition is clearly established in the literature, but not well defined for mandibular superimposition. This study aims to explore and evaluate the accuracy of the mylo-hyoid area as a reference for mandibular Digital Dental Cast (DDC) three-dimensional (3D) superimposition. MATERIALS AND METHODS: the study compared mandibular 3D overlays with profile teleradiographs in 30 patients followed at Nice Saint Roch University Hospital. The molar and incisor coordinates on the 3D superimposition based on the mylo-hyoid area were compared to the ones on the 2D lateral cephalogram. Differences between the two methods of superimposition were assessed using paired t-tests. RESULTS: No statistically significant difference was observed between the lateral cephalogram-based and mandibular DDC superimposition methods in 3D sagittal and vertical displacements of the lower first molars and central incisors. CONCLUSION: The study showed the mylo-hyoid area to be an accurate superimposition landmark for the 3D evaluation of mandibular orthodontic tooth displacement. This method is also applicable for patients with conventional orthodontic treatment records. Other studies should be conducted on larger populations, subgroups (malocclusions, therapeutics) and on the use of an intra-oral camera.
Assuntos
Má Oclusão , Modelos Dentários , Humanos , Cefalometria/métodos , Imageamento Tridimensional/métodos , Mandíbula/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico/métodos , Má Oclusão/diagnóstico por imagem , Má Oclusão/terapiaRESUMO
An increasing number of adult patients are seeking orthodontic treatment and several surgical and non-surgical methods have been developed to reduce the overall treatment time. Two randomized controlled clinical trials, performed in our University Hospital, demonstrated that the piezocision surgery - minimally invasive corticotomies - decreased the overall orthodontic treatment time by 43 % - effect during 4 to 6 months after the surgery - without any further clinical and radiological adverse effects. In addition, the use of a custom-made orthodontic system - brackets and arches - optimized the acceleration in the fine-tuning phase of orthodontic treatment. Finally, the combination of the two techniques is therefore relevant to maximize the reduction of the orthodontic treatment time. Fundamentally, our preclinical studies in rats have highlighted the biological phenomena underlying piezocision with an important bone demineralization and osteoclast recruitment associated with a predominant expression of the RANKL-OPG duo.
La demande des patients adultes pour entreprendre des traitements orthodontiques est en augmentation constante; cependant, la longueur des traitements reste souvent un frein. Dès lors, plusieurs techniques chirurgicales et non chirurgicales ont été mises au point afin de réduire le temps de traitement orthodontique. Deux études cliniques contrôlées randomisées, réalisées au sein de notre hôpital universitaire, ont démontré que la technique de piézocision - corticotomies minimalement invasives - permet de réduire jusqu'à 43 % le temps de traitement orthodontique - au cours des 4 à 6 mois après l'intervention - et ce, sans effets secondaires tant sur le plan clinique que radiologique. De plus, l'utilisation d'un système orthodontique customisé - employant des attaches et des arcs sur mesure - permet d'optimiser l'accélération du déplacement dentaire dans la phase de finition du traitement orthodontique. Finalement, la combinaison des deux techniques est donc pertinente pour maximaliser la réduction du temps de traitement en orthodontie. Par ailleurs, sur le plan fondamental, nous avons étudié, dans des essais précliniques chez le rat, les phénomènes biologiques sous-jacents à la piézocision à savoir une déminéralisation osseuse et un recrutement d'ostéoclastes plus important associés à une expression prédominante du duo RANKL-OPG.
Assuntos
Ortodontia , Piezocirurgia , Adulto , Animais , Humanos , Ortodontia/tendências , Radiografia , Ensaios Clínicos Controlados Aleatórios como Assunto , Ratos , Técnicas de Movimentação DentáriaRESUMO
This randomized controlled trial aimed to evaluate the benefits and clinical outcomes of piezocision, which is a minimally invasive approach to corticotomy that is used in orthodontic treatments. Twenty-four adult patients presenting with mild overcrowdings were randomly allocated to either a control group that was treated with conventional orthodontics or a test group that received piezo-assisted orthodontics. The piezocisions were performed 1 wk week after the placement of the orthodontic appliances. Neither grafting material nor sutures were used. All patients were followed every 2 wk, and archwires were changed only when they were no longer active. The periods required for the completion of the overall orthodontic treatments were calculated, and the periodontal parameters were evaluated at baseline and at the end of the orthodontic treatment. Patient-centered outcomes were assessed with a visual analog scale; analgesic use following the procedures was also recorded. The patient characteristics were similar between the 2 groups. The overall treatment time was significantly reduced by 43% in the piezocision group as compared with the control group. In both groups, periodontal parameters (i.e., recession depth, pocket depth, plaque index, and papilla bleeding index) remained unchanged between the baseline and treatment completion time points. No increase in root resorption was observed in either group. Scars were observed in 50% of the patients in the piezocision group. Analgesic consumption was similar following orthodontic appliance placement and piezocision surgery. Patient satisfaction was significantly better in the piezocision group than in the control group. In these conditions, the piezocision technique seemed to be effective in accelerating orthodontic tooth movement. No gingival recessions were observed. The risk of residual scars might limit the indications for piezocision in patients with a high smile line (ClinicalTrials.gov NCT02590835).
