Eugenia Lee DMD; Greg Huang DMD, MSD, MPH
Although there is no current reliable evidence to determine the efficacy of implant site development by orthodontic extrusion, it appears to be a viable option.
Of the 18 articles that met the selection criteria, most were case reports and the remaining few were review articles.
Is orthodontic extrusion an effective nonsurgical method of developing implant recipient sites?
The authors searched 6 databases for literature published from 1966 to July 14, 2007. The search was not limited by language, type of study, or any other available limits or restrictions. The authors also hand-searched the reference lists. The criteria for inclusion were: 1) contained one or more of the search terms (orthodontic extrusion, tooth extrusion, forced eruption, alveolar ridge, alveolar bone, and implant), 2) focused on orthodontic extrusion for the specific purpose of implant site development, 3) described by hard and/or soft tissue changes of implant site, and 4) retrievable full-text article available in English. Studies were excluded if they: 1) were letters, editorials, theses, or abstracts, 2) described only techniques, and 3) identified clear sources of bias. Each author independently reviewed studies and resolved discrepancies through discussion and consensus.
The authors identified 79 abstracts from the initial search. They selected 18 for review, of which 15 were case reports and 3 were review papers, respectively. A majority of the reports described orthodontic extrusion of periodontally hopeless maxillary anterior teeth by fixed orthodontic appliances. Treatment times and retention times varied considerably (4-28 weeks and 0 days-6 months respectively). In most cases, implants were placed immediately after extraction, but in some cases a healing period of 2 to 8 weeks was allowed. All cases reported gains in alveolar bone and gingival tissue, resulting in improvements of periodontal health at the implant sites.
Based on the available literature, the orthodontic extrusion of hopeless teeth prior to implant placement appears to be a viable alternative to conventional surgical augmentative procedures in implant site development. Because the authors could not find another method to make direct comparisons, they could not make a conclusion about the relative efficacy of the procedure. Further research is needed to establish what, if any, benefit orthodontic extrusion provides in the development of implant recipient sites.
Source of Funding:
Importance and Context:
The quality and quantity of alveolar bone and gingival tissues in potential implant sites are important factors for determining the prognosis of implant stability, anchorage and coverage. This review examined the available literature to determine the effectiveness of orthodontic extrusion as a nonsurgical method to develop and improve the implant site.
Strengths and Weaknesses of the Systematic Review:
The authors conducted a thorough review. Although they stated the inclusion criteria and the exclusion criteria, the authors failed to provide a list of qualifying but excluded literature sources. Another weakness was that the authors included clinical guidelines that were based on anecdotal information. Two independent reviewers selected studies and performed data abstraction.
Strengths and Weaknesses of the Evidence:
The authors acknowledge that the present systematic review provides poor evidence to answer the question. Limitations of case series include selection bias and a lack of comparison to other methods. Therefore, the strength of conclusions is limited.
Implications for Dental Practice:
No conclusions can be made about the efficacy of orthodontic extrusion for implant site development alone or as it compares to other conventional therapies. The current evidence does not provide clear criteria for case selection or treatment planning decisions when extruding orthodontically for implant site development. Future research should target indications, effectiveness, reliability, and costs (time and expense) of this technique compared to surgical alternatives.