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      Three-dimensional assessment of periodontal support of lower incisors for skeletal Class II malocclusion undergoing presurgical orthodontic treatment with different vertical skeletal patterns

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          Abstract

          Background

          The aim of the present study was to compare periodontal support changes during retraction of mandibular anterior teeth for skeletal Class II malocclusion with different facial divergence and to analyze relevant factors influencing bone remodeling by applying three-dimensional (3D) cone-beam computed tomography (CBCT) reconstruction technology.

          Methods

          Forty-eight patients with Class II malocclusion requiring surgical orthodontic treatment enrolled in the study were divided into the hyperdivergent group ( n = 16), normodivergent group ( n = 16) and hypodivergent group ( n = 16) according to their vertical skeletal patterns. Cone-beam computed tomography (CBCT) scans were obtained before treatment (T1) and after presurgical orthodontic treatment (T2). The two-dimensional (2D) alveolar bone morphology, movement of mandibular central incisors and volume of the alveolar bone around incisors were measured on the labial and lingual sides by 3D CBCT reconstruction technology. Statistical analyses were performed with one-way ANOVA, paired t tests and multiple linear regression.

          Results

          During presurgical orthodontic treatment, the alveolar bone height on the labial side of the hyperdivergent group decreased significantly ( P ≤ 0.05), but was maintained in the normodivergent and hypodivergent groups ( P > 0.05). However, the alveolar bone volume, alveolar bone thickness at each level and alveolar bone height on the lingual side decreased significantly for all the groups. Apart from the initial morphometric measurements at T1, the morphology of lingual alveolar bone at T2 was significantly influenced by the direction and amount of tooth movement. Horizontal retraction and vertical protrusion of the root apex were negatively related to the alveolar bone on the lingual side after presurgical orthodontic treatment.

          Conclusion

          For Class II malocclusion patients undergoing presurgical orthodontic treatment, the changes in the periodontal support of the lower central incisors varied in different vertical skeletal patterns. There exists a great periodontal risk of alveolar bone resorption on the lingual side for various vertical types. To avoid alveolar bone deterioration, it is essential to investigate the bone remodeling of patients with different alveolar bone conditions and cautiously plan tooth movement prior to orthodontic treatment. Moreover, 3D measurements based on CBCT construction can provide complementary information to traditional 2D measurements.

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          Most cited references50

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          The anterior alveolus: its importance in limiting orthodontic treatment and its influence on the occurrence of iatrogenic sequelae.

          Delineating the limits of orthodontic treatment in nongrowing individuals is important when making treatment decisions, especially in borderline orthodontic-surgical cases. The labial and lingual cortical plates at the level of the incisor apex may represent the anatomic limits of tooth movement. Cephalometric films of 107 adults were measured to determine the width of alveolar bone anterior and posterior to the incisor apex in each arch. Thin alveolar widths were found both labial and lingual to the mandibular incisors in groups of Class I, II, and III individuals with high SN-MP angle and in a group of Class III average SN-MP individuals. Thin alveolar widths were also found lingual to the maxillary incisors in a Class II high angle group. Clinical cases are presented showing that orthodontic tooth movement may be limited in patients with narrow alveolar bone widths and that these patients are likely to experience increased iatrogenic sequelae.
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            Thickness of the anterior maxillary facial bone wall-a retrospective radiographic study using cone beam computed tomography.

            The purpose of this retrospective radiographic study was to analyze the thickness of the facial bone wall at teeth in the anterior maxilla based on cone beam computed tomography (CBCT) images, since this anatomical structure is important for the selection of an appropriate treatment approach in patients undergoing postextraction implant placement. A total of 125 CBCT scans met the inclusion criteria, resulting in a sample size of 498 teeth. The thickness of the facial bone wall in the respective sagittal scans was measured perpendicular to the long axis of the tooth at two locations: at the crest level (4 mm apical to the cementoenamel junction; MP1) and at the middle of the root (MP2). No existing bone wall was found in 25.7% of all teeth at MP1 and in 10.0% at MP2. The majority of the examined teeth exhibited a thin facial bone wall (< 1 mm; 62.9% at MP1, 80.1% at MP2). A thick bone wall (⋝ 1 mm) was found in only 11.4% of all examined teeth at MP1 and 9.8% at MP2. There was a statistically significant decrease in facial bone wall thickness from the first premolars to the central incisors. The facial bone wall in the crestal area of teeth in the anterior maxilla was either missing or thin in roughly 90.0% of patients. Both a missing and thin facial wall require simultaneous contour augmentation at implant placement because of the well-documented bone resorption that occurs at a thin facial bone wall following tooth extraction. Consequently, radiographic analysis of the facial bone wall using CBCT prior to extraction is recommended for selection of the appropriate treatment approach.
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              Changes in alveolar bone thickness due to retraction of anterior teeth.

              In cases of bimaxillary protrusion, extraction of 4 premolars and orthodontic treatment with retraction of the anterior teeth is a widely used approach. However, there is controversy over whether the changes that occur in the anterior alveolar bone always follow the direction and quantity of tooth movement. Nineteen patients with dentoalveolar bimaxillary protrusion treated by extracting the 4 first premolars were evaluated with lateral cephalograms and computed tomography (CT). Cephalograms and CT scans were made before treatment and 3 months after retraction of the incisors. The measurements of the cephalograms showed that maxillary and mandibular incisors were retracted primarily by controlled tipping of the teeth. For all maxillary and mandibular incisors, we assessed the labial and the lingual alveolar plates at crest level (S1), midroot level (S2), and apical level (S3) for bone-thickness changes during retraction of the maxillary and mandibular anterior segments. In the mandibular arch, the labial bone maintained its original thickness, except the S1 measurements, which showed a significant decrease in bone thickness (P <.001). In the maxillary arch, the labial bone thickness remained unchanged. There were statistically significant decreases in lingual bone width in both arches after retracting the incisors. Some of the patients demonstrated bone dehiscence that was not visible macroscopically or cephalometrically. When tooth movement is limited, forcing the tooth against the cortical bone may cause adverse sequelae. This type of approach must be carefully monitored to avoid negative iatrogenic effects.
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                Author and article information

                Contributors
                weiranli2003@163.com , weiranli@bjmu.edu.cn
                xiaotonglee@hotmail.com
                Journal
                Prog Orthod
                Prog Orthod
                Progress in Orthodontics
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1723-7785
                2196-1042
                18 December 2023
                18 December 2023
                2023
                : 24
                : 45
                Affiliations
                [1 ]GRID grid.11135.37, ISNI 0000 0001 2256 9319, Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, , Peking University School and Hospital of Stomatology, ; 22 Zhongguancun Avenue South, Haidian District, Beijing, 100081 People’s Republic of China
                [2 ]GRID grid.11135.37, ISNI 0000 0001 2256 9319, Department of Oral and Maxillofacial Surgery, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, , Peking University School and Hospital of Stomatology, ; 22 Zhongguancun Avenue South, Haidian District, Beijing, 100081 People’s Republic of China
                [3 ]GRID grid.11135.37, ISNI 0000 0001 2256 9319, Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, , Peking University School and Hospital of Stomatology, ; Haidian District, Beijing, 100081 People’s Republic of China
                [4 ]GRID grid.11135.37, ISNI 0000 0001 2256 9319, Center of Digital Dentistry, Peking University School and Hospital of StomatologyNational Engineering Laboratory for Digital and Material Technology of StomatologyResearch Center of Engineering and Technology for Digital Dentistry of Ministry of HealthBeijing Key Laboratory of Digital Stomatology, , Peking University School and Hospital of Stomatology, ; 22 Zhongguancun Avenue South, Haidian District, Beijing, 100081 People’s Republic of China
                Article
                495
                10.1186/s40510-023-00495-y
                10725860
                38105288
                19800330-4c52-4139-a35b-027d99d33498
                © The Author(s) 2023

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 25 July 2023
                : 5 October 2023
                Funding
                Funded by: New technology and new therapeutics of Peking University School and Hospital of Stomatology of 2022
                Award ID: PKUSSNCT-22A09
                Award Recipient :
                Categories
                Research
                Custom metadata
                © Italian Society of Orthodontics 2023

                cone-beam computed tomography,three-dimensional reconstruction,alveolar bone remodeling,mandibular incisor retraction

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