To intrude or not to intrude? A systematic review of the controversy surrounding orthodontic intrusion on reduced periodontium

OBJECTIVE

The main objective of this review was to evaluate the effects of orthodontic intrusion on patients with reduced periodontium. Additionally, this review aims to explore the potential for attachment gain and tissue regeneration in these patients and identify optimal therapeutic conditions to mitigate any negative effects of intrusion.

METHODS

A systematic review was conducted according to the PRISMA 2020 statement. Duplicate electronic searches of the PubMed, Cochrane, EMC Premium, and Science Direct databases were performed by two independent reviewers. Data extraction and quality assessments, including risk of bias evaluation using the Cochrane and ROBINS-I tools were conducted.

RESULTS

From an initial pool of 418 articles, 29 were selected after title and abstract screening for full-text review. Following thorough full-text reading, 15 studies were ultimately included in the analysis. The total number of patients included in the studies is 528, who underwent orthodontic intrusion on reduced periodontium. Studies indicated a decrease in periodontal pocket depth and an increase in clinical attachment with ortho-periodontal treatment. Alveolar bone level outcomes varied, showing both increases and losses. Authors generally observed improved papillary regeneration and reduced gingival recessions.

CONCLUSION

Clinical studies involving combined ortho-periodontal treatment showed that orthodontic intrusion on a reduced but healthy periodontium can be considered a beneficial treatment for the periodontium, provided that potential adverse effects are carefully monitored.

Comparative evaluation of treatment of angular bone defect related to over-erupted tooth using guided tissue regeneration (GTR) followed by orthodontic intrusion (OI) versus OI followed by GTR: a controlled clinical trial

BACKGROUND

Prematurity resulted from pathological migration of periodontally involved teeth with the loss of vertical stopping points between teeth, which can lead to teeth over eruption with dimensional changes favoring occlusal discrepancies. Therefore, evaluating and comparing the effect of guided tissue regeneration followed by orthodontic intrusion as opposed to orthodontic intrusion tracked by guided tissue regeneration in the treatment of an over-erupted tooth with angular bone loss.

METHODS

Twenty teeth in ten cases were selected with at least two teeth with vertical over-eruption and angular bone loss with the presence of their opposing. In group one, ten teeth over-erupted were treated by guided tissue regeneration followed by orthodontic intrusion, whereas, in group two, ten teeth over-erupted were treated by orthodontic intrusion followed by guided tissue regeneration. They were evaluated clinically for pocket depth, bleeding on probing, and tooth mobility. Radiographical evaluation assessed by cone beam computed tomography.

RESULTS

Clinically, there existed a statistically significant difference (P value ≤ 0.05) in favor of group one at six months post and in favor of group two at one year from re-evaluation regarding pocket depth and tooth mobility. Radiographically, in group one, there was a statistically significant improvement (P value ≤ 0.05) at six months post-guided tissue regeneration or orthodontic intrusion regarding defect depth and dimensional changes of the defect area, with a statistically significant difference (P value ≤ 0.05) in favor of group two at one year from re-evaluation phase regarding defect depth and defect area dimensional changes.

CONCLUSION

There was a short-term improvement in group one, which deteriorated over a long period compared with group two, so it is preferable to start orthodontic intrusion before guided tissue regeneration.

Treatment of Extrusive Luxation in Permanent Teeth: Literature Review with Systematic Criteria

INTRODUCTION

Extrusive luxation is a traumatic dental injury caused by the action of oblique forces, characterized by partial displacement of the tooth out of its socket. The ideal treatment for this type of trauma involves repositioning the tooth in its socket. However, in cases where the tooth cannot be repositioned, different options may be considered, such as intentional reattachment and orthodontic intrusion. The aim is to review the literature on the extrusive luxation of permanent teeth while assessing the risks of complications for two methods of delayed treatment for extrusive luxation.

MATERIALS AND METHODS

An electronic search from August 2005 to August 2014 was performed by two reviewers independently, and conflicts were resolved by a third reviewer. The databases used were PubMed and Scopus; the reviewers performed a manual search of the following journals: Dental Traumatology, American Journal of Orthodontics, and Clinical Oral Investigation.

RESULTS

After removing the duplicate studies, 328 articles were found. Out of these, 321 were rejected as not addressing the proposed research topic. In addition, five articles were excluded because apical repositioning was used for treatment. Therefore, four articles formed the basis of the study.

CONCLUSION

Factors, such as root formation, the degree of tooth mobility, and the presence of tooth vitality were decisive for the choice of treatment. However, both treatments were effective and showed favorable results, i.e., without periodontal and root damage.

CLINICAL SIGNIFICANCE

Knowledge of the risks of complications among two methods of delayed treatment for extrusive luxation, as well as other important factors to take into consideration when choosing a treatment assists dentists in improving the prognostic.