RESIDENTS' JOURNAL REVIEW

ARTICLES SELECTED AND REVIEWED BY:
SENIOR RESIDENTS, DEPARTMENT OF
ORTHODONTICS, UNIVERSITY OF
WASHINGTON, SEATTLE
Greg Huang, Department Chair, and
Anne-Marie Bollen, Program Director
Systematic review of intraoral splints for
treating TMD
Fricton J, Look JO, Wright E, Alencar FG Jr, Chen H,
Lang M, Ouyang W, Velly AM. Systematic review and
meta-analysis of randomized controlled trials
evaluating intraoral orthopedic appliances for
temporomandibular disorders. J Orofac Pain
2010;24:237-54.

Success of maxillary canine

autotransplantation I ntraoral orthopedic appliances have historically been
used to manage temporomandibular disorders
(TMD). Despite their long and widespread use, there is
Patel S, Fanshawe T, Bister D, Cobourne MT.
Survival and success of maxillary canine still controversy about their efficacy for treatment of
autotransplantation: a retrospective investigation. TMD pain. The aim of this systematic review and
Eur J Orthod 2010; e-pub, September 2010. meta-analysis was to assess the efficacy of intraoral or-
thopedic appliances to reduce pain in TMD patients
compared with a placebo, no treatment, or other treat-
S ome treatment options for impacted maxillary ca-
nines can lead to unfavorable outcomes. Autotrans-
plantation is an option that involves atraumatic surgical
ments as reported in randomized controlled trials
(RCTs). The investigators searched the literature and
found 44 RCTs of intraoral orthopedic appliances for
removal of the canine and reimplantation into a previ-
treating TMD. Ten of these were suitable for meta-
ously created socket. The aim of this study was to eval-
analysis. Seven RCTs compared hard stabilization appli-
uate survival and success rates after autotransplantation
ances with nonoccluding appliances intended to act as
of maxillary permanent canines with closed apices. The
a placebo control. Meta-analysis showed an odds ratio
sample consisted of 49 patients (mean age at transplan-
of 2.45, indicating that pain reduction occurred more
tation, 21.8 years), who had autotransplantation of im-
often in the stabilization appliance group than in the
pacted maxillary canines. The sample was divided into 2
controls. Three RCTs compared hard stabilization appli-
categories: 63 autotransplanted maxillary canines with
ances with no treatment, and an odds ratio of 2.14 dem-
no controls and 27 unilateral transplanted canines
onstrated a positive net effect with the stabilization
with a nontransplanted canine on the contralateral
appliances, although it was not statistically significant.
side as a control. Success was determined by using the
Studies comparing intraoral appliances with other treat-
following criteria: survival, mobility, probing pocket
ments, including self-care, acupuncture, physical medi-
depth, gingival bleeding, vitality, color, internal and ex-
cine, short-term behavioral therapies, and some
ternal inflammatory resorption, bone level, and signs of
pharmacologic treatments found that each has some
pathology. Thirty-eight percent of the sample was con-
evidence of equal efficacy to appliances, and these treat-
sidered successful, and the overall survival rate was 83%,
ments can be considered as initial or concurrent treat-
with an average duration of 14.5 years (range, 1.4-27.8
ment for TMD. The authors concluded that hard
years). In the case control sample, the transplanted teeth
stabilization appliances when adjusted properly have
had unfavorable differences compared with the non-
good evidence of modest efficacy in the treatment of
transplanted teeth for probing pocket depth, gingival
TMD pain when compared with nonoccluding appli-
bleeding, vitality, and color, all of which were statisti-
ances and no treatment, and are at least equally as effec-
cally significant. The results of this study indicate that
tive as alternative treatments. Other types of appliances
autotransplanted canines with closed apices have a low
have some evidence of efficacy in reducing TMD pain,
complete success rate but can have a favorable survival
but the potential for adverse events with these appli-
rate over the long term. The technique should be consid-
ances is higher.
ered as an interim measure to maintain bone level before
Reviewed by Jake DaBell
placement of implants in patients who are unwilling to
undergo lengthy orthodontic treatment to align ectopic
canines.
Reviewed by Brienne Roloff-Chiang

7
8 Resident's journal review
Effects of facemask therapy on profile
changes in Class III subjects
Kilic N, Catal G, Kiki A, Oktay H. Soft tissue profile
changes following maxillary protraction in Class III
subjects. Eur J Orthod 2010;32:419-24.
P rotraction of the maxilla by using a facemask is a com-
mon treatment for Class III malocclusions with maxil-
lary retrusion and mandibular prognathism. Most studies
on soft-tissue response to maxillary protraction (MP) ap-
pliances have included maxillary expansion, but there
has been limited research on MP focusing on soft-tissue
profile changes without maxillary expansion. The aim of
this study was to investigate soft-tissue profile changes in-
duced by MP only. The treatment group consisted of 24
girls (mean age, 12.69 6 1.08 years) with maxillary retru-
sion or a combination of maxillary retrusion and mandib-
ular protrusion resulting in concave profiles. The control
group (15) had Class I occlusion and was matched for
age and sex. MP therapy consisted of a Petit-type face-
mask with 400 to 500 g of force applied to the maxillary
canines. The appliance was worn for at least 14 hours
per day until a positive overjet was achieved. Linear and
angular measurements were taken on the T1 and T2 lateral
cephalometric radiographs. The Student t test was used to
compare changes between groups. This study showed sig-
nificantly greater anterior movement in the maxilla, upper
lip, and superior sulcus, with greater proclination of the
maxillary incisors in the treatment group than in the con-
trol group. There was also downward and backward move-
ment of the mandible, lower lip, and soft-tissue pogonion.
There was mandibular incisor retroclination. According to
this study, the improvement in facial profile predomi-
nantly resulted from maxillary soft-tissue changes and
mandibular hard-tissue changes. These results allowed
the authors to conclude that concave facial profiles of
the subjects were corrected by anterior movement of the
maxilla resulting in increased fullness of the upper lip.
The concave skeletal profiles were corrected mainly by
backward and downward rotation of the mandible.
Reviewed by Thomas Houlihan
Role of preoperative orthodontics in
correcting Class III malocclusions
Wang YC, Ko EW, Huang CS, Chen YR, Takano-
Yamamoto T. Comparison of transverse
dimensional changes in surgical skeletal Class III
patients with and without presurgical orthodontics.
J Oral Maxillofac Surg 2010;68:1807-12.
T raditionally, dental compensations in patients un-
dergoing orthognathic surgery have been addressed
January 2011  Vol 139  Issue 1 American Journal of Orthodontics and Dentofacial Orthopedics
with a period of preoperative orthodontics. Specifically,
with skeletal Class III malocclusions in the transverse di-
mension, there is frequently a severe buccolingual tilt of
the posterior teeth that might introduce occlusal interfer-
ences after surgical correction of the jaw position. Some
have suggested that preoperative orthodontic treatment
is inefficient, and that the adjustment of arch width and
tooth movement can be achieved more efficiently during
or after orthognathic surgery. The aim of this study was
to test the hypothesis that the transverse dimensional
changes in patients with a skeletal Class III malocclusion
undergoing surgical-orthodontic treatment with a phase
of preoperative orthodontics were the same as those with-
out preoperative orthodontic treatment. Retrospectively,
36 adult patients with a Class III skeletal malocclusion
were selected. The 2 groups compared were the surgery-
first (SF) group and the orthodontics-first (OF) group
with 18 patients each. Posteroanterior cephalometric ra-
diographs were compared at different time points to deter-
mine changes in the inclination of canines and molars.
Only the maxillary canine before surgery (T1) and the
mandibular molars at T0 (initial), T1, and T2 (immediately
after surgery) showed a significant difference between the
2 groups. The authors came to the following conclusions:
(1) changes in molar and canine inclinations showed buc-
cal tilting of the mandibular molars and maxillary canines
and lingual tilting of the maxillary molars and mandibular
canines; (2) inclination changes of canines and molars
demonstrated no significant differences with or without
a phase of preoperative orthodontics; and (3) inclination
changes of the canines and molars during treatment
showed similar trends in the SF and OF groups.
Reviewed by Alfonso Navarrete
Randomized controlled trial of
postorthodontic stability
Edman Tynelius G, Bondemark L, Lilja-Karlander E.
Evaluation of orthodontic treatment after one year
of retention—a randomized controlled trial. Eur J
Orthod 2010;32:542-7.
S tability can determine the overall success of ortho-
dontic treatment. Choosing the best retention
method has always been a topic of interest. After re-
viewing the literature, the Cochrane Collaboration
group reached the conclusion that there is no evidence
concerning the most appropriate retention strategy af-
ter orthodontic treatment. Therefore, they suggested
that future research regarding retention should include
true randomization, reporting of dropouts, adequate
Resident's journal review
sample-size calculation, and a minimum of 3 months
offollow-up. The aim of this study was to use random-
ized controlled trial methodology to evaluate and com-
pare 3 retention methods. Seventy-five patients with
a mean age of 14.4 years were randomized into 3 reten-
tion methods: (1) a vacuum-formed retainer in the maxilla
and bonded canine-to-canine retainer in the mandible
(group V-CTC), (2) a vacuum-formed retainer in the max-
illa combined with stripping of the 10 interproximal sur-
faces of the mandibular anterior teeth (group V-S), and
(3) a prefabricated positioner covering the teeth in the
maxilla and mandible (group P). Each group was measured
American Journal of Orthodontics and Dentofacial Orthopedics
9
for Little’s irregularity index, intercanine and intermolar
width, arch length, overjet, and overbite. Dental casts of
these patients were measured after removal of the ortho-
dontic appliances and 1 year after the beginning of reten-
tion. Small significant differences were found between the
V-CTC and V-S groups regarding overbite, mandibular in-
tercanine width, and mandibular arch length. Two patients
did not cooperate in group P. The authors concluded that,
on a short-term basis after 1 year of retention, all 3 reten-
tion methods were successful in retaining the orthodontic
treatment results.
Reviewed by Enrique Reyes Retana
January 2011  Vol 139  Issue 1