Evaluation of Soft and Hard Tissue Changes Following the Use of Rapid Molar Intruder for the Management of Skeletal Anterior Open Bite in Mixed Dentition: A Randomized Controlled Trial
Abstract:The aim of the study was to evaluate skeletal, dentoalveolar, and soft tissue changes following early anterior open bite (AOB) treatment using a rapid molar intruder (RMI).
Materials and methodsA two-arm, parallel-group, randomized controlled trial was conducted on 40 patients aged 8-12 years with anterior open bites. They were randomly allocated to the RMI group and the untreated control group (UCG) with a 1:1 allocation ratio. At the beginning of the treatment (T1) and after nine months of treatment (T2), la… Show more
“…Subsequently, 18 were assessed for eligibility, of which 10 were excluded (Appendix 2 ). Finally, 8 articles [ 25 – 32 ], 2 of which reported data from the same trial [ 26 , 27 ] were included in this review. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Table 2 summarizes the characteristics of the included randomized controlled trials. All the included trials were 2-arm parallel RCTs [ 25 – 28 , 30 – 32 ], except one study that was three-arm parallel group RCT [ 29 ]. All of the included trials were conducted in a university setting in various countries: Brazil [ 31 ], India [ 28 ], Egypt [ 26 , 27 ], Syria [ 29 , 30 , 32 ] and Spain [ 25 ].…”
Section: Resultsmentioning
confidence: 99%
“…The age range fell between 7 and 40 years. Duration of the active phase of intrusion ranged between 6 months [ 25 ], 8–10 months [ 28 , 29 , 32 ], and 12 months [ 30 , 31 ]. One study only reported a retention phase of 10 months [ 28 ].…”
Section: Resultsmentioning
confidence: 99%
“…Labial bow (0.9 mm) to achieve a competent seal Full time wear for 12 m Retention: night time wear Pre- and post-TT lateral cephalograms 9 angular and 8 linear measurements Duration of intrusion: 12 m Skeletal Angular (°): SNA, SNB, ANB, MM, SN.GoMe, Björk Linear (mm): S-Go, N-Me Dentoalveolar Angular (°): 1U.SN,1L. GoMe,1U.1L Linear (mm): 1U-SPP, 6U-SPP,1L-GoMe, 6L-GoMe, OJ, OB Hasan et al [ 32 ] (2022) University setting—Syria n = 40 (19F, 21M) E (RMI) : n = 20, (10F, 10M), (9.7 ± 0.66y) C (no TT) : n = 20 (9F, 11M), (9.9 ± 0.54 y) Clinical: 8–12 y (mixed dentition stage) Skeletal AOB Class I, II Radiographic inclusion: (SN/GoMe) > 33° MM > 27° facial axis (Y-axis) > 65° RMI: TPA and lingual arch. Nickle-titanium active springs attached to the tubes of upper and lower permanent first molars Intrusion force: 800 g per side Pulpotomy and occlusal reduction on primary molars were undertaken to reestablish occlusal contact Full time wear Pre- and post-TT lateral cephalograms 9 m apart 20 variables Duration of intrusion: 9 m Skeletal SNA, SNB, SN/GoMe, MM, Björk Sum, Y axis, S-Go, N-Men, Dentoalveolar U1-PP, U6-PP, L6-MP, U1/SN, U1/L1, OB, OJ 1M, first molar; 2M, second molar; AOB, anterior open bite; C, control; cN, centinewtons; DB, distobuccal; E, experimental; EMG, electromyography; F, females; FPBB, fixed posterior bite block; g, gram; h, hours; Go, gonion; J, joules; kv, kilovolts; L, lower; LLLT, low-level laser therapy; M, males; m, months; MB, mesiobuccal; Me, menton; MM, maxillary mandibular angle; mm, millimeters; MP, mandibular plane; mW, milliwatts; Mx, maxillary; N, nasion; nm, nanometers; OB, overbite; OBB, open bite Bionator; OJ, overjet; P, palatal, PBM, photobiomodulation; PM, premolar; RMI, rapid molar intruder; RPBB, removable posterior bite block; RPBP, removable posterior bite plane; S, sella; SS, stainless steel; TAD, temporary anchorage device; TPA, transpalatal arch; TT, treatment; U, upper; y, years …”
Section: Resultsmentioning
confidence: 99%
“…The removable posterior bite plane (RPBB) was used with a crib and compared to an open bite Bionator (OBB) functional appliance [ 30 ]. Additionally, the use of the rapid molar intruder (RMI) spring appliance was compared to a no treatment control in one trial [ 32 ]. As for the TAD-based maxillary molar intrusion studies, one trial compared the use of two different force magnitudes (200 g and 400 g) on the efficacy of intrusion with mini-screws [ 26 , 27 ].…”
Aims
To systematically assess the efficacy of the various interventions used to intrude maxillary molars. Furthermore, to evaluate associated root resorption, stability of intrusion, subsequent vertical movement of mandibular molars, cost effectiveness, compliance, patient reported outcomes and adverse events.
Methods
A pre-registered and comprehensive literature search of published and unpublished trials until March 22nd 2023 with no language restriction applied in PubMed/Medline, Embase, Scopus, DOSS, CENTRAL, CINAHL Plus with Full Text, Web of Science, Global Index Medicus, Dissertation and Theses Global, ClinicalTrials.gov, and Trip (PROSPERO: CRD42022310562). Randomized controlled trials involving a comparative assessment of treatment modalities used to intrude maxillary molars were included. Pre-piloted data extraction forms were used. The Cochrane Risk of Bias tool was used for risk of bias assessment, and The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used for certainty of evidence appraisal.
Results
A total of 3986 records were identified through the electronic data search, of which 24 reports were sought for retrieval. Of these, 7 trials were included. One trial was judged at high risk of bias, while the others had some concerns. Based on individual small sample studies, maxillary molar intrusion was achieved using temporary anchorage devices (TADs) and rapid molar intruder appliance (RMI). It was also observed to a lesser extent with the use of open bite bionator (OBB) and posterior bite blocks. The molar intruder appliance and the posterior bite blocks (spring-loaded or magnetic) also intruded the lower molars. Root resorption was reported in two studies involving TADs. None of the identified studies involved a comparison of conventional and TAD-based treatments for intrusion of molars. No studies reported outcomes concerning stability, cost-effectiveness, compliance and patient-reported outcomes. Insufficient homogeneity between the included trials precluded quantitative synthesis. The level of evidence was very low.
Conclusions
Maxillary molar intrusion can be attained with different appliances (removable and fixed) and with the use of temporary anchorage devices. Posterior bite blocks (spring-loaded or magnetic) and the RMI offer the additional advantage of intruding the mandibular molars. However, stability of the achieved maxillary molar intrusion long term is unclear. Further high-quality randomized controlled trials are needed.
“…Subsequently, 18 were assessed for eligibility, of which 10 were excluded (Appendix 2 ). Finally, 8 articles [ 25 – 32 ], 2 of which reported data from the same trial [ 26 , 27 ] were included in this review. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Table 2 summarizes the characteristics of the included randomized controlled trials. All the included trials were 2-arm parallel RCTs [ 25 – 28 , 30 – 32 ], except one study that was three-arm parallel group RCT [ 29 ]. All of the included trials were conducted in a university setting in various countries: Brazil [ 31 ], India [ 28 ], Egypt [ 26 , 27 ], Syria [ 29 , 30 , 32 ] and Spain [ 25 ].…”
Section: Resultsmentioning
confidence: 99%
“…The age range fell between 7 and 40 years. Duration of the active phase of intrusion ranged between 6 months [ 25 ], 8–10 months [ 28 , 29 , 32 ], and 12 months [ 30 , 31 ]. One study only reported a retention phase of 10 months [ 28 ].…”
Section: Resultsmentioning
confidence: 99%
“…Labial bow (0.9 mm) to achieve a competent seal Full time wear for 12 m Retention: night time wear Pre- and post-TT lateral cephalograms 9 angular and 8 linear measurements Duration of intrusion: 12 m Skeletal Angular (°): SNA, SNB, ANB, MM, SN.GoMe, Björk Linear (mm): S-Go, N-Me Dentoalveolar Angular (°): 1U.SN,1L. GoMe,1U.1L Linear (mm): 1U-SPP, 6U-SPP,1L-GoMe, 6L-GoMe, OJ, OB Hasan et al [ 32 ] (2022) University setting—Syria n = 40 (19F, 21M) E (RMI) : n = 20, (10F, 10M), (9.7 ± 0.66y) C (no TT) : n = 20 (9F, 11M), (9.9 ± 0.54 y) Clinical: 8–12 y (mixed dentition stage) Skeletal AOB Class I, II Radiographic inclusion: (SN/GoMe) > 33° MM > 27° facial axis (Y-axis) > 65° RMI: TPA and lingual arch. Nickle-titanium active springs attached to the tubes of upper and lower permanent first molars Intrusion force: 800 g per side Pulpotomy and occlusal reduction on primary molars were undertaken to reestablish occlusal contact Full time wear Pre- and post-TT lateral cephalograms 9 m apart 20 variables Duration of intrusion: 9 m Skeletal SNA, SNB, SN/GoMe, MM, Björk Sum, Y axis, S-Go, N-Men, Dentoalveolar U1-PP, U6-PP, L6-MP, U1/SN, U1/L1, OB, OJ 1M, first molar; 2M, second molar; AOB, anterior open bite; C, control; cN, centinewtons; DB, distobuccal; E, experimental; EMG, electromyography; F, females; FPBB, fixed posterior bite block; g, gram; h, hours; Go, gonion; J, joules; kv, kilovolts; L, lower; LLLT, low-level laser therapy; M, males; m, months; MB, mesiobuccal; Me, menton; MM, maxillary mandibular angle; mm, millimeters; MP, mandibular plane; mW, milliwatts; Mx, maxillary; N, nasion; nm, nanometers; OB, overbite; OBB, open bite Bionator; OJ, overjet; P, palatal, PBM, photobiomodulation; PM, premolar; RMI, rapid molar intruder; RPBB, removable posterior bite block; RPBP, removable posterior bite plane; S, sella; SS, stainless steel; TAD, temporary anchorage device; TPA, transpalatal arch; TT, treatment; U, upper; y, years …”
Section: Resultsmentioning
confidence: 99%
“…The removable posterior bite plane (RPBB) was used with a crib and compared to an open bite Bionator (OBB) functional appliance [ 30 ]. Additionally, the use of the rapid molar intruder (RMI) spring appliance was compared to a no treatment control in one trial [ 32 ]. As for the TAD-based maxillary molar intrusion studies, one trial compared the use of two different force magnitudes (200 g and 400 g) on the efficacy of intrusion with mini-screws [ 26 , 27 ].…”
Aims
To systematically assess the efficacy of the various interventions used to intrude maxillary molars. Furthermore, to evaluate associated root resorption, stability of intrusion, subsequent vertical movement of mandibular molars, cost effectiveness, compliance, patient reported outcomes and adverse events.
Methods
A pre-registered and comprehensive literature search of published and unpublished trials until March 22nd 2023 with no language restriction applied in PubMed/Medline, Embase, Scopus, DOSS, CENTRAL, CINAHL Plus with Full Text, Web of Science, Global Index Medicus, Dissertation and Theses Global, ClinicalTrials.gov, and Trip (PROSPERO: CRD42022310562). Randomized controlled trials involving a comparative assessment of treatment modalities used to intrude maxillary molars were included. Pre-piloted data extraction forms were used. The Cochrane Risk of Bias tool was used for risk of bias assessment, and The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used for certainty of evidence appraisal.
Results
A total of 3986 records were identified through the electronic data search, of which 24 reports were sought for retrieval. Of these, 7 trials were included. One trial was judged at high risk of bias, while the others had some concerns. Based on individual small sample studies, maxillary molar intrusion was achieved using temporary anchorage devices (TADs) and rapid molar intruder appliance (RMI). It was also observed to a lesser extent with the use of open bite bionator (OBB) and posterior bite blocks. The molar intruder appliance and the posterior bite blocks (spring-loaded or magnetic) also intruded the lower molars. Root resorption was reported in two studies involving TADs. None of the identified studies involved a comparison of conventional and TAD-based treatments for intrusion of molars. No studies reported outcomes concerning stability, cost-effectiveness, compliance and patient-reported outcomes. Insufficient homogeneity between the included trials precluded quantitative synthesis. The level of evidence was very low.
Conclusions
Maxillary molar intrusion can be attained with different appliances (removable and fixed) and with the use of temporary anchorage devices. Posterior bite blocks (spring-loaded or magnetic) and the RMI offer the additional advantage of intruding the mandibular molars. However, stability of the achieved maxillary molar intrusion long term is unclear. Further high-quality randomized controlled trials are needed.
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