Is periodontal phenotype modification therapy beneficial for patients receiving orthodontic treatment? An American Academy of Periodontology best evidence review

BackgroundOrthodontic treatment can greatly impact the periodontium, especially in dentitions with a thin periodontal phenotype. Orthodontic tooth movement can result into iatrogenic sequelae to these vulnerable anatomic conditions, such as development and exacerbation of bony dehiscence or fenestration defects, which can manifest loss of periodontal support and gingival recession (GR). This systematic review aimed to investigate whether periodontal phenotype modification therapy (PhMT) involving hard tissue augmentation (PhMT- b) or soft tissue augmentation (PhMT- s) has clinical benefits for patients undergoing orthodontic treatment.MethodsAn electronic search was performed in two major databases for journals published in English language from January 1975 to January 2019 and a hand search of printed journals was also performed to identify human clinical trials reporting clinical and radiographic outcomes of patients receiving orthodontic treatment with or without hard and soft tissue augmentation procedures. Data were extracted and organized into tables for qualitative assessment.ResultsEight studies were identified evaluating the outcomes of PhMT in patients undergoing orthodontic therapy. Six studies evaluated patients receiving PhMT- b via corticotomy- assisted orthodontic therapy (CAOT) and simultaneous bone augmentation while the other two received PhMT- s before tooth movement. No studies investigated PhMT- b alone without CAOT and most studies focused on the mandibular anterior decompensation movements. There was high heterogeneity in the study design and inconsistency of the reported outcomes; therefore, a meta- analysis was not performed. Evidence at this moment supports CAOT with hard tissue augmentation accelerated tooth movement. However, only two studies provided direct comparison to support that CAOT with PhMT- b reduced the overall treatment time compared with conventional orthodontic treatment. No periodontal complications or evidence of severe root resorption were reported for both groups. Four studies provided radiographic assessment of the PhMT- b and demonstrated increased radiographic density or thicker facial bone after the treatment. Two studies reported an expanded tooth movement. One study reported an increase in keratinized tissue width post- CAOT plus PhMT- b, while another study with a 10- year follow- up showed a lower degree of relapse using the mandibular irregularity index when compared with conventional tooth movement alone.Two studies examined the effect of PhMT- s before orthodontic treatment. Unfortunately, no conclusions can be drawn because of the limited number of studies with contradicting outcomes.ConclusionsWithin the limited studies included in this systematic review, PhMT- b via particulate bone grafting together with CAOT may provide clinical benefits such as modifying periodontal phenotype, maintaining or enhancing facial bone thickness, accelerating tooth movement, expanding the scope of safe tooth movement for patients undergoing orthodontic tooth movement. The benefits of PhMT- s alone for orthodontic treatment remain undetermined due to limited studies available. However, PhMT- b appears promising and with many potential benefits for patients undergoing orthodontic tooth movement. There is a need for a higher quality of randomized controlled trials or case control studies with longer follow- up to investigate the effects of different grafting materials and surgical sites other than mandibular anterior region.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154653/1/jper10457.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154653/2/jper10457_am.pd

Validation of an intra-oral scan method versus cone beam computed tomography superimposition to assess the accuracy between planned and achieved dental implants: a randomized in vitro study

Computer aided implantology is the safest way to perform dental implants. The research of high accuracy represents a daily effort. The validated method to assess the accuracy of placed dental implants is the superimposition of a pre-operative and a post-operative cone beam computed tomography (CBCT) with planned and placed implants. This procedure is accountable for a biologic cost for the patient. To investigate alternative procedure for accuracy assessment, fifteen resin casts were printed. For each model, six implants were digitally planned and then placed following three different approaches: (a) template guided free hand, (b) static computer aided implantology (SCAI), and (c) dynamic computer aided implantology (DCAI). The placement accuracy of each implant was performed via two methods: the CBCT comparison described above and a matching between implant positions recovered from the original surgical plan with those obtained with a post-operative intraoral scan (IOS). Statistically significant mean differences between guided groups (SCAI and DCAI) and the free hand group were found at all considered deviations, while no differences resulted between the SCAI and DCAI approaches. Moreover, no mean statistically significant differences were found between CBCT and IOS assessment, confirming the validity of this new method

Emerging Regenerative Approaches for Periodontal Reconstruction: Practical Applications From the AAP Regeneration Workshop

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141131/1/cap0040.pd

Emerging Regenerative Approaches for Periodontal Reconstruction: A Consensus Report From the AAP Regeneration Workshop

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141512/1/jpers153.pd

American Academy of Periodontology best evidence consensus statement on modifying periodontal phenotype in preparation for orthodontic and restorative treatment

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154649/1/jper10498.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154649/2/jper10498_am.pd

Bone construction surgery: A case report using recombinant human platelet-derived growth factor-BB

BackgroundThe position and condition of bone largely sets the stage for functional and esthetic implant success. In bone construction surgery, creating a sustainable functional matrix is complex, but necessary, to enable long-term mechanotransduction and maintenance of soft tissue support.MethodsA patient with a severe peri-implantitis ridge defect in the anterior maxilla underwent bone construction surgery simultaneous with implant removal using a composite bone graft (mineralized freeze dried bone allograft + xenograft) enhanced with recombinant human platelet-derived growth factor (rhPDGF-BB). Space maintenance for bone construct immobility and unimpeded wound healing was ensured via a nonresorbable titanium reinforced polytetrafluoroethylene membrane and an absorbable porcine collagen membrane.ResultsPrimary closure was maintained throughout the 6 month healing process at which time implant diagnostics commenced for prosthetically directed implant placement using dynamic navigation and involving soft tissue augmentation. Uncovery was performed 3 months thereafter leading to provisionalization and prosthetic phase completion.ConclusionThis case report highlights a severe maxillary anterior ridge defect secondary to advanced peri-implantitis in a systemically healthy Caucasian male patient. The surgical outcome success, both clinically and radiographically, underscores the complexities of complete regional anatomy rehabilitation after suffering catastrophic and debilitating bone loss from inflammatory peri-implantitis. Further, it demonstrates the importance of incorporating optimized angiogenetic therapeutics to help establish a vascularized functional bone matrix for implant success.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/175501/1/cap10220.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/175501/2/cap10220_am.pd

Cone-beam computed tomography and interdisciplinary dentofacial therapy: An American Academy of Periodontology Best Evidence review focusing on risk assessment of the dentoalveolar bone changes influenced by tooth movement

Background: The aim of this systematic review is to evaluate whether cone‐beam computed tomography (CBCT) imaging can be used to assess dentoalveolar anatomy critical to the periodontist when determining risk assessment for patients undergoing orthodontic therapy using fixed or removable appliances. Methods: Both observational and interventional trials reporting on the use of CBCT imaging assessing the impact of orthodontic/dentofacial orthopedic treatment on periodontal tissues (i.e., alveolar bone) were included. Changes in the alveolar bone thickness and height around natural teeth as well as treatment costs were evaluated. MEDLINE (via PubMed) and EMBASE databases were searched for articles published in the English language, up to and including July 2016, and extracted data were organized into evidence tables. Results: Thirteen studies were included in this systematic review describing the positive or deleterious changes on the alveolar bone surrounding natural teeth undergoing orthodontic tooth movement or influenced by orthopedic forces through fixed appliances. Clinical recommendation summaries presenting the strengths and weaknesses of the evidence in terms of benefits and harms were generated. Conclusions: CBCT imaging can improve the periodontal diagnostic acumen regarding alveolar bone alterations influenced by orthodontic tooth movement and can help determine risk assessment prior to such intervention. Clinicians are also better informed to determine risk assessment and develop preventative or plan interceptive periodontal augmentation (soft tissue and/or bone augmentation) therapies for patients undergoing orthodontic tooth movement. These considerations are recognized as being especially critical for treatment approaches in patients where buccal tooth movement (expansion) is planned in the anterior mandible or involving the maxillary premolars

Surgical Considerations and Decision Making in Surgically Facilitated Orthodontic Treatment/Periodontally Accelerated Osteogenic Orthodontics

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163888/1/cap10116_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163888/2/cap10116.pd

American Academy of Periodontology Best Evidence Consensus Statement on Selected Oral Applications for Cone‐Beam Computed Tomography

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142314/1/jper0939.pd