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HERRERA ET AL .
(Continued) PICOS question addressed by a SR
in three non-randomized single-group before-and-after studies. Inter- dental papilla height by indirect meta-analysis from two non- randomized single-group before-and-after studies and root resorption by indirect meta-analysis from three non-randomized single-group before-and-after studies. Risk of bias All studies were evaluated as high risk of bias based on the ROBINS-I or RoB 2.0 tools. Effect sizes and their clinical relevance There was no statistically significant difference in the overall PPD change between combined periodontal – orthodontic therapy com- pared with periodontal therapy alone, in a meta-analysis of two non- randomized multi-group comparative cohort studies with 92 patients (MD = 0.31 mm; 95% CI [ 0.83; 0.22]; p = .26; I 2 = 83%). Indirect meta-analyses from single-group before-and-after studies on the effect of OT reported significant CAL gain with a pooled change of 0.24 mm (95% CI [ 0.38; 0.10mm]; p < .001; I 2 = 79% [7 studies]). Similarly, there was PPD reduction with a pooled change of 0.23 mm (95% CI [ 0.49; 0.04]; p = .09; I 2 = 95% [7 studies]); and RBL gain with a pooled change of 0.36 mm (95% CI [ 0.59; 0.13]; p = .002; I 2 = 88% [7 studies]). There was no significant effect in terms of the percentage of RBL changes from the combined periodontal – orthodontic therapy (1 study; 20 patients; MD = 0.60%; 95% CI [ 2.80; 1.60]; p = .59). One study reported reduced gingival inflammation (bleeding index) with combined periodontal – orthodontic therapy compared with only periodontal treatment (1 study; 72 patients; MD = 13.89%; 95% CI [ 16.06; 11.72]; p < .001). Indirect meta-analyses reported no significant effect on average gingival recession either for the combined periodontal – orthodontic therapy with pooled change of 0.53 mm (95% CI [ 2.07; 1.01]; p = .50; I 2 = 98% [3 studies]); or solely for OT subsequent to peri- odontal therapy, with pooled change of 0.09 mm (95% CI [ 0.01; 0.20]; p = .09; I 2 = 0% [2 studies]). Indirect meta-analysis reported increased inter-dental papilla height after OT with pooled change of 1.42 mm (95% CI [ 1.98; 0.86]; p < .001; I 2 = 94% [2 studies]). Indirect meta-analyses reported no significant increase in root resorption either for the combined periodontal – orthodontic therapy with pooled change of 0.42 mm (95% CI [ 0.63; 0.22]; p < .001; I 2 = 56% [3 studies]); or solely for the subsequent OT with pooled change of 0.49 mm (95% CI [ 1.04; 0.06]; p = .08; I 2 = 71% [2 studies]). Consistency The results on the periodontal outcomes and gingival inflammation indicated either minor non-relevant effects or benefits from the com- bined periodontal – orthodontic therapy. Consistency could not be for- mally assessed by direct meta-analysis due to the small number of included studies.
R7.3: Evidence-based recommendation d. seems to improve inter-dental papilla height ; e. does not significantly affect root resorption and seems to reduce tooth mobility . Supporting literature (Papageorgiou et al., 2021) Quality of evidence Moderate Grade of recommendation GradeB — " Strength of consensus Consensus (0% of the group abstained due to potential CoI)
Background
Intervention
Pathological tooth migration is a frequent sequela of periodontal attach- ment loss in stage IV periodontitis patients manifested by tooth drifting, flaring and elongation. Its correction requires OT after completion of periodontal therapy. The treatment of these sequelae usually involves intrusive, retrusive, and alignment tooth movements, which may poten- tially cause adverse effects (further periodontal attachment or bone loss, increased gingival inflammation, or increased root resorption) or second- ary effects (undesired aesthetic outcomes such as gingival recession and loss of inter-dental papilla) to the affected teeth.
Available evidence
Number and design of included studies Thirty-four studies (from 37 publications) were included, reporting data from 1090 participants with mean age of 43.7 years and a female/male ratio of 3/1. Included studies were either comparative (randomized or non-randomized) or single-group cohort studies with at least one group withpre – post data combining periodontal – orthodontic therapy in stage IV periodontitis patients with pathologic tooth migration. Data were analysed either directly from comparative studies (ran- domized/non-randomized) or indirectly, by pooling all study arms from pre – post data studies, calculating the average effects for each out- come and identifying the associated factors through subgroup/meta- regression analyses. In this background text, the latter is referred to as indirect meta-analyses and their results presented as pooled changes ; for direct meta-analysis , mean differences (MD) are presented. Data for periodontal outcomes were retrieved from two comparative studies for PPD and from one study for RBL. Indirect meta-analyses from single-group before-and-after studies assessed CAL (7 studies), PPD (7 studies) and RBL (7 studies). Gingival inflammation was reported in one retrospective non- randomized comparative study, while gingival recession was reported
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