RESIDENTS' JOURNAL REVIEW

ARTICLES SELECTED AND REVIEWED BY: Systematic review of profile change

SENIOR RESIDENTS, DEPARTMENT OF
ORTHODONTICS, SCHOOL OF DENTAL AND after maxillofacial surgery
ORAL SURGERY, COLUMBIA UNIVERSITY, Joss CU, Joss-Vassalli IM, Berge
SJ, Kuijpers-
NEW YORK Jagtman AM. Soft tissue profile changes after
bilateral sagittal split osteotomy for mandibular
Thomas J. Cangialosi, Department Chair, and setback: a systematic review. J Oral Maxillofac Surg
Margherita Santoro, Program Director 2010;68:2792-801; e-pub, August 2010.

T he prediction of facial profile changes after maxillofa-

cial surgery is a significant part of treatment planning
for surgical orthodontic patients. Since most clinicians
Assessing risk of gingival recession in
use a 2-dimensional approach with lateral cephalograms,
adults the availability of precise research data as a basis for pre-
Sarfati A, Bourgeois D, Katsahian S, Mora F, diction software is critical. This article provides a system-
Bouchard P. Risk assessment for buccal gingival atic review of the literature on the soft-tissue changes in
recession defects in an adult population. patients who underwent bilateral sagittal split osteoto-
J Periodontol 2010;81:1419-25. mies for mandibular setback. The authors sought to
determine the ratio between soft-tissue and hard-tissue
movements and illustrate differences in short-term and

G ingival recession is common in adults. However, it is

not clear how periodontal, systemic, and environ-
mental factors are associated with gingival recession.
long-term results. An online search resulted in 766 arti-
cles. After assessment and extraction of the articles by 2
observers, 8 articles met the inclusion criteria and were se-
This cross-sectional study examined some of the risk fac- lected. Studies other than human clinical trials, and those
tors. The data originated in the First National Periodon- with syndromic patients and patients who needed further
tal and Systemic Examination Survey; 1093 men and surgical intervention, or sample sizes less than 10, were
1051 women, aged 35 to 65 years, were selected with excluded. The authors observed that anteroposterior
a multi-stage stratification method by age, sex, socio- changes in lower lip to mandibular incisor and mentola-
economic status, and region to represent the total bial fold to B-point had a 1:1 ratio in both the short
French civilian population. Full-mouth periodontal eval- and long terms. Soft-tissue pogonion to pogonion
uation, biometric data, body mass index, blood serum exhibited a 1:1 ratio in the short term but was lower in
glucose concentration, frequency of dental visits, smok- the long term. The response of the upper lip was highly
ing status, and alcohol consumption were all recorded. variable when compared with the mandibular incisor,
The extent and the severity of midbuccal recession B-point, and pogonion, primarily exhibiting protrusion.
were the focus of the study and were measured as the Evidence-based conclusions on soft-tissue changes are
number of affected sites and quantified in millimeters. difficult to draw, and there is a need for well-designed
Mesial and distal buccal sites were used for the Miller prospective studies with adequate sample sizes and exclu-
classifications. Age, sex, alcohol consumption, and sion of additional surgical procedures. Moreover, variabil-
diabetic status were set as the categorical variables for ity in postsurgical relapse and the presence of bonded
the multivariate linear regression models with backward brackets are variables that might affect the accuracy of
selection. The results demonstrated that 84.6% of the measurements and should be considered in the future.
sample had at least 1 recession site. Only 1.8% of the Reviewed by Christine Kownatzki
sample had severe recession ($6 mm). The Miller classes
I and II included most of the sample; gingival recession
could affect any tooth. Age, sex, plaque index, and to- One-year comparison of 3 retention
bacco consumption are independent risk factors for methods
the extent and severity of gingival recessions. Further-
Edman Tynelius G, Bondemark L, Lilja-Karlander E.
more, the number of missing teeth and the gingival
Evaluation of orthodontic treatment after 1 year of
bleeding index are related to the severity of gingival retention—a randomized controlled trial. Eur J
defects. Diabetes, increase of body mass index, alcohol Orthod 2010;32:542-7; e-pub, January 2010.
intake, and dental visits showed no correlation with
gingival recession.
Reviewed by YunYan Tracy Shen T he aims of this randomized controlled trial were to
evaluate and compare 3 retention methods after
431
432 Residents' journal review

1 year of orthodontic retention. Seventy-five patients group. The results showed that GCs act directly on OCs
were recruited and randomly assigned to 3 groups of and change the morphology of resorption lacunae. No
25: a vacuum-formed retainer in the maxilla and bonded difference was found in the total resorbed bone surface,
canine-to-canine retainer in the mandible, a vacuum- and metabolic activity was either unaffected or nega-
formed retainer in the maxilla combined with stripping tively affected in the experimental group. With GCs,
of the 10 proximal surfaces of the mandibular anterior there was a 30% increase in the number of deeper and
teeth, and a prefabricated positioner covering the teeth elongated trenches, an increase in TRACP (OCs activity
in the maxilla and the mandible. The inclusion criteria marker), a 3-times increase in CTX levels (OC collagenol-
were treatment plan involving extraction of 4 premolars, ysis activity marker), and less collagen left over at the
space deficiencies in both jaws, Class I molar relationship bottom of the excavations. Exposure to GCs changes
or 3-mm anterior-posterior deviation, permanent denti- the resorption pattern of OCs from alternating between
tion, and no prior orthodontic treatment. All subjects resorption and migration to continuous erosion of the
underwent fixed straight-wire appliance treatment by bone surface. This behavioral change is thought to occur
1 orthodontist. Dental casts were obtained at 3 times: through enhanced collagenolysis, ensuring prolonged
before treatment, immediately after treatment, and after contact between OCs and mineral components. The au-
12 months of retention. Six measurements—Little’s thors concluded that the change in osteoclastic resorp-
irregularity index, intercanine width, intermolar width, tion mode from intermittent to continuous might
arch length, overjet, and overbite—were obtained. The contribute to the early bone fragilization of patients
groups were compared by 1-way analysis of variance treated with GCs.
(ANOVA). The results showed that, on a short-term basis Reviewed by Ga Lee
(1 year), all 3 retention strategies had an equal capacity
to retain the orthodontic treatment results. Small but
significant differences were seen in mandibular interca-
nine width, mandibular arch length, and overbite groups Upper airway length and sleep apnea
1 and 2. The authors asserted that this study was the first Susarla SM, Abramson ZR, Dodson TB, Kaban LB.
randomized controlled trial study to demonstrate that Cephalometric measurement of upper airway length
mandibular anterior stripping without additional reten- correlates with the presence and severity of
tion methods was sufficient for successful retention, and obstructive sleep apnea. J Oral Maxillofac Surg
that a positioner can be used in the permanent dentition 2010;68:2846-55.
as a successful short-term retention device.
Reviewed by Vanessa Ku
O bstructive sleep apnea (OSA) is a breathing disorder
characterized by recurrent episodic collapses of the
upper airway and is associated with increases in resis-
Effect of glucocorticoids on osteoclasts tance to airflow in the pharyngeal airway. Previous stud-
ies have established a correlation between upper airway
and bone resorption length (UAL), measured on computed tomograms, with

JM. Glucocorticoids maintain
Søe K, Delaisse the presence and severity of OSA. However, using com-
human osteoclasts in the active mode of their puted tomography scans to evaluate OSA can be costly,
resorption cycle. J Bone Miner Res 2010;25: inconvenient, and excessive in radiation exposure. The
2184-92. aims of this study were to measure UAL on lateral ceph-
alograms and to assess its relationship with the presence

G lucocorticoids (GCs) are widely used immune sup-

pressants that can lead to bone loss. Previous stud-
ies have shown that high doses of GCs impair the
and severity of OSA. The authors hypothesized that UAL,
measured along the long axis of the airway from the
posterior palate to the superior hyoid would be longer
function of osteoblasts, therefore having a negative im- in patients with OSA. With a case-control study design,
pact on bone formation. However, the impairment of 96 adults with OSA and 56 controls with skeletal Class
osteoblasts alone does not explain a rapid increase in II malocclusion without OSA were enrolled. The respira-
fracture risk in the first 3 to 6 months of treatment. tory disturbance index (RDI) was used to measure disease
This study examined the effect of GCs on osteoclasts severity. Bivariate analysis indicated that OSA subjects
(OCs) and bone resorption. Mature human OCs were were predominately older and male, and had a higher
generated from CD141 cells in the presence of M-CSF body mass index, longer and narrower airway, longer
and RANKL and then seeded on bone slices with the ad- hyoid-mandible distance, and longer soft palates. UAL
dition of 1.6 mM of prednisolone in the experimental was significantly longer in patients with OSA and is

April 2011  Vol 139  Issue 4 American Journal of Orthodontics and Dentofacial Orthopedics
Residents' journal review 433

a predictor of OSA in both men and women, with UAL of endocortical and periosteal activity under oscillating
$72 mm in men and $62 mm in women. UAL strongly loads. However, this study suggests that, for sutural
correlated with RDI in men and moderately correlated bone growth, continuous forces are more effective.
with RDI in women. The results demonstrated high Reviewed by Jared T. Lee
sensitivity and high specificity of UAL for the diagnosis
of OSA. The authors recommended that UAL should be
included in the routine cephalometric measurements
for evaluating and following patients with OSA. Pulpal vitality of traumatized maxillary
Reviewed by Betty Chen
incisors
Bauss O, Scha€fer W, Sadat-Khonsari R, Kno € sel M.
Expanding sutures with continuous Influence of orthodontic extrusion on pulpal vitality
of traumatized maxillary incisors. J Endod
forces 2010;36:203-7; e-pub, December 2009.
Liu SS, Kyung HM, Buschang PH. Continuous
forces are more effective than intermittent forces in
expanding sutures. Eur J Orthod 2010;32:371-80;
e-pub, January 2010.
T his retrospective study aimed to investigate the ef-
fects of orthodontic extrusion on the pulpal vitality
of previously traumatized maxillary incisors. Patients
were selected at 3 private orthodontic practices. Three
groups were compared. Group 1 (n 5 77 teeth) under-
T he authors reported greater sutural separation and
bone formation with continuous forces vs intermit-
tent forces in a suture-expansion study involving
went orthodontic treatment to extrude a previously
traumatized and vital maxillary incisor. Group 2 included
juvenile male New Zealand white rabbits. A 50-g expan- orthodontic patients with no trauma history (n 5 400),
sion force was generated by a nickel-titanium open-coil and group 3 had traumatized teeth with no orthodontic
spring placed between 2 titanium miniscrew implants. treatment (n 5 193). Groups 1 and 3 were further sub-
These implants were located 4 to 5 mm from the midsag- divided into subgroups: periodontal injuries (subluxa-
ittal suture on the dorsum of the cranium. One group tion, extrusion, lateral luxation, and intrusive luxation)
(n 5 7) had the force applied continuously for 29 con- and hard-tissue lesions (fracture of enamel or enamel
secutive days. The second group (n 5 7) had the force and dentin). Pulpal vitality was diagnosed by using
applied intermittently (5 days on, 1 day off) for 29 crown color, cryogenic spray, and periapical and pano-
days. Two fluorescent bone labels, oxytetracycline and ramic radiographs. Differences between the groups
calcein, were administered to all animals at various times were tested with the chi-square test and a 5 0.05.
during the study to quantify new bone formation. The Greater losses of vitality were found in the orthodontics
continuous group averaged 1.3 mm of sutural separa- and trauma group with periodontal injuries compared
tion, and the intermittent group showed 0.8 mm of sep- with the orthodontic group (P \0.001) and the trauma
aration. The 4 one-day breaks in the intermittent group group (P \0.004). No differences were found between
resulted in a 61% sutural opening compared with the the central and lateral incisors or in hard-tissue lesions
continuous group. Since forces were applied for 86% with or without orthodontic treatment. The authors
of the time in the intermittent group, the authors calcu- concluded that maxillary incisors were in more danger
lated a relapse of 25% and cited the recoil of stretched of pulpal necrosis if they had a history of periodontal
collagen fibers as reasons for relapse. Between days 7 trauma. They also recommended the use lighter extru-
and 17, the intermittent group showed 59% as much sive forces during treatment. The frequency of devital-
mineral apposition and 61% as much bone formation; ization was small (9.1%, 0.5%, and 1.6%, respectively,
sutural bone formation was proportional to sutural sep- in the 3 groups). Further research with larger groups of
aration. The authors mentioned other mineralized tissue patients is needed to increase the statistical power.
adaptation studies with long bones that showed greater Reviewed by Brendan Smith

American Journal of Orthodontics and Dentofacial Orthopedics April 2011  Vol 139  Issue 4