A retrospective evaluation of iatrogenic dental root damage with predrilled vs drill‐free bone anchor screws for intermaxillary fixation

Widar, Fredrik; Kashani, Hossein; Kanagaraja, Sanjiv; Dahlin, Christer; Rasmusson, Lars

doi:10.1111/j.1600-9657.2011.01051.x

Cited by 16 publications

(25 citation statements)

References 28 publications

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“…The quality of healing of root damage after implant removal varies, and a damaged dental pulp is less likely to repair completely [ 8 , 21 , 25 ]. These issues have also been reported for inter-maxillary fixation screws used in maxillofacial surgery [ 26 – 28 ]. Various studies have also associated close implant-root contact with increased failure rates [ 4 , 10 , 29 – 31 ].…”

Section: Introductionmentioning

confidence: 77%

Insertion torque recordings for the diagnosis of contact between orthodontic mini-implants and dental roots: a systematic review

Reynders

Ladu²,

Ronchi³

et al. 2016

Syst Rev

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BackgroundMost orthodontic mini-implants (OMIs) are inserted between dental roots. The prevalence of contacting these structures is high. Such contacts can cause permanent root damage and implant instability. Increased torque levels during implant insertion (the index test) could be a more accurate and immediate measure for diagnosing implant-root contact (the target condition) than radiographs (the reference standard) and could ultimately lead to a reduction or elimination of X-ray exposure. To address this issue, we asked three questions: (1) whether OMIs with root contact had higher insertion torque values than those without, (2) what is the accuracy of the index test compared with the reference standard to diagnose the target condition and what are the adverse effects of the index test, and (3) whether intermediate torque values have clinical diagnostic utility.MethodsMethods were conducted according to our published protocol, which was based on the PRISMA-P 2015 statement. We applied broad spectrum eligibility criteria that included randomized and non-randomized studies on clinical, animal, and cadaver models. Not including such models would be unethical because it could slow down knowledge creation on the adverse effects of implant insertion. We conducted searches in more than 40 electronic databases including MEDLINE and 10 journals were hand-searched. Grey literature and reference lists were also searched. All research procedures were conducted independently by three reviewers. Authors of selected studies were contacted to obtain additional information. Outcomes on the three different research models were analysed separately. Systematic error was assessed with the Cochrane ‘Risk of bias tool’ for non-randomized studies.ResultsOne clinical, two animal, and two cadaver studies fulfilled the eligibility criteria of the first research question. All studies and subgroups demonstrated higher insertion torque values for OMIs with the target condition than those without. Mean differences (MD) between these effect estimates were statistically significant in one beagle model (MD, 4.64; 95 % CI, 3.50 to 5.79) and three subgroups of cadaver studies (MD, 2.70; 95 % CI, 1.42 to 3.98) (MD, 3.97; 95 % CI, 2.17 to 5.78) (MD, 0.93; 95 % CI, 0.67 to 1.20). Highest mean differences were identified in most self-drilling compared with pre-drilling groups. Clinical heterogeneity between studies was high, and many items were underreported. All studies except one cadaver study scored at least one domain as ‘serious risk’ of bias. No studies addressed the second research question. One cadaver study addressed the third question which showed the importance of recording torque levels during the entire implant insertion process. Responses of contacted authors were helpful, but often difficult to obtain. Implants fractured in one animal and in one cadaver model.ConclusionsAll eligible studies scored higher insertion torque values for implants with root contact than those without, but none of these studies assessed the diagnostic accura...

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Section: Introductionmentioning

confidence: 77%

Insertion torque recordings for the diagnosis of contact between orthodontic mini-implants and dental roots: a systematic review

Reynders

Ladu²,

Ronchi³

et al. 2016

Syst Rev

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show abstract

“…As outlined above, it could also be viewed as unethical not to include these research models. This issue was further strengthened in the context of the 1) high prevalence of the target disorder and the associated biologic damage and implant instability [ 7 - 9 , 20 ]; 2) ethical limitations of designing clinical studies on this research topic; 3) overwhelming evidence that data on adverse effects of interventions are poorly reported in the literature [ 51 , 52 ]; 4) the wide application of this interventional procedure in both orthodontics and maxillofacial surgery [ 10 , 13 - 15 ]; and 5) the usefulness of the research information for a wide group of stakeholders, that is, clinicians, researchers, patients in need of orthodontic implants or intermaxillary fixation screws, guideline developers, policymakers, and companies that produce implants and surgical instruments.…”

Section: Discussionmentioning

confidence: 99%

“…This condition can cause extensive damage to the roots [ 7 , 12 ]. Studies in maxillofacial surgery have reported similar problems with intermaxillary fixation screws [ 13 - 15 ]. The quality of the healing of the root injury as a result of the target condition varies and damage involving the dental pulp is less likely to repair completely [ 7 , 12 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Insertion torque recordings for the diagnosis of contact between orthodontic mini-implants and dental roots: protocol for a systematic review

Reynders

Ladu²,

Ronchi³

et al. 2015

Syst Rev

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BackgroundHitting a dental root during the insertion of orthodontic mini-implants (OMIs) is a common adverse effect of this intervention. This condition can permanently damage these structures and can cause implant instability. Increased torque levels (index test) recorded during the insertion of OMIs may provide a more accurate and immediate diagnosis of implant-root contact (target condition) than radiographic imaging (reference standard). An accurate index test could reduce or eliminate X-ray exposure. These issues, the common use of OMIs, the high prevalence of the target condition, and because most OMIs are placed between roots warrant a systematic review. We will assess 1) the diagnostic accuracy and the adverse effects of the index test, 2) whether OMIs with root contact have higher insertion torque values than those without, and 3) whether intermediate torque values have clinical diagnostic utility.MethodsThe Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015 statement was used as a the guideline for reporting this protocol. Inserting implants deliberately into dental roots of human participants would not be approved by ethical review boards and adverse effects of interventions are generally underreported. We will therefore apply broad spectrum eligibility criteria, which will include clinical, animal and cadaver models. Not including these models could slow down knowledge translation.Both randomized and non-randomized research studies will be included. Comparisons of interest and subgroups are pre-specified. We will conduct searches in MEDLINE and more than 40 other electronic databases. We will search the grey literature and reference lists and hand-search ten journals. All methodological procedures will be conducted by three reviewers. Study selection, data extraction and analyses, and protocols for contacting authors and resolving conflicts between reviewers are described. Designed specific risk of bias tools will be tailored to the research question. Different research models will be analysed separately. Parameters for exploring statistical heterogeneity and conducting meta-analyses are pre-specified. The quality of evidence for outcomes will be assessed through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.DiscussionThe findings of this systematic review will be useful for patients, clinicians, researchers, guideline developers, policymakers, and surgical companies.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0014-6) contains supplementary material, which is available to authorized users.

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“…Eleven studies concerning self-tapping screws adequately described the number of patients, the number and type of screws, root damage, and treatment. 13,15,17,18,[20][21][22]24,[26][27][28] Five studies described the same data for self-drilling screws. 5,8,10,14,28 Table 3 presents these cumulative data, suggesting self-drilling screws have a better safety profile.…”

Section: Root Traumamentioning

confidence: 93%

Is There Enough Evidence to Regularly Apply Bone Screws for Intermaxillary Fixation in Mandibular Fractures?

Bins

Oomens

Boffano

et al. 2015

Journal of Oral and Maxillofacial Surgery

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A retrospective evaluation of iatrogenic dental root damage with predrilled vs drill‐free bone anchor screws for intermaxillary fixation

Abstract: There is an increased potential risk of iatrogenic injury and permanent damage to the dental roots when a technique that involves predrilled holes for bone anchor screws is used.

Cited by 16 publications

References 28 publications

Insertion torque recordings for the diagnosis of contact between orthodontic mini-implants and dental roots: a systematic review

Insertion torque recordings for the diagnosis of contact between orthodontic mini-implants and dental roots: a systematic review

Insertion torque recordings for the diagnosis of contact between orthodontic mini-implants and dental roots: protocol for a systematic review

Is There Enough Evidence to Regularly Apply Bone Screws for Intermaxillary Fixation in Mandibular Fractures?

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