Cochrane · intervention · CD004621

Extraction of primary (baby) teeth for unerupted palatally displaced permanent canine teeth in children

Cochrane Database of Systematic Reviews · 2012 · Cochrane Library

Oral Health Oral and maxillofacial surgery Orthodontics3 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

current version

GRADE rated

No studies

Included studies

as reported

No studies 2 · 25%Ungraded 6 · 75%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Review question

Element	Planned (methods)	Found (results)
Population	Children with palatally displaced maxillary canines (at least 80% aged 10 to 13 years); trials with craniofacial syndromes or anomalies excluded	70 children completing treatment across 2 included trials (Baccetti 2008: 69 of 75 enrolled; Leonardi 2004: 46 of 50 enrolled), around 8 to 13 years of age; participants had unilateral or bilateral palatally displaced canines (148 PDCs total)
Intervention	Extraction of the primary maxillary canine	Extraction of the primary maxillary canine (n=34 children); Extraction of the primary maxillary canine plus cervical pull headgear (n=45 children)
Comparison	No treatment, delayed treatment, or an alternative treatment such as extraction plus the use of headgear	Untreated control group - no extraction and no headgear (n=36 children)
Outcomes	Primary: reported prevalence of eruption or non-eruption of the permanent canine into the mouth. Secondary: (1) improvement in the vertical position or angulation of the ectopic canine, measured from radiographs; (2) incidence or prevalence of root resorption of the impacted canine and/or incisors and cyst formation; (3) patient satisfaction and pain experience during extraction of the primary canine	Successful eruption of the palatally displaced permanent canine (n=2); Time to eruption of the permanent canine (n=2); Change in the sagittal position of the upper first molars (n=1); Changes in the inclination of the canine to the midline (n=2); Distance of the permanent canine cusp tip to the occlusal line (n=2); Medial position of the canine tooth crown (n=2)
Study designs	Randomised controlled trials (RCTs) or quasi-RCTs with at least a 6-month follow-up, restricted to parallel group studies (cross-over and split-mouth designs excluded)	2 RCTs (3 trial reports); both at high overall risk of bias (no reported random sequence generation or allocation concealment; no outcome assessor blinding; high risk of selective reporting; baseline imbalance)
Timing	At least a 6-month follow-up after the intervention	Follow-up around 18 to 48 months (reporting inconsistent); Baccetti 2008 reported eruption success at 4 years

Search date: 2012-04. Databases: The Cochrane Oral Health Group's Trials Register; The Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE via OVID; EMBASE via OVID

Questions and results

Current version only

Extraction of the primary maxillary canine vs Untreated control (no treatment)

Population: Children with palatally displaced maxillary canines (at least 80% aged 10 to 13 years); trials with craniofacial syndromes or anomalies excluded

CD004621.PUB3 (current) · 6 questions

Outcome	Effect	Evidence	Status / GRADE
Time to eruption of the permanent canine At least 6 months follow-up after the intervention same question in other reviews	Time to eruption of the permanent canine was reported by both trials. The paper reports there was 'no significant difference between the two interceptive approaches in the time required for canine eruption' (extraction…	2 studies	Ungraded
Patient satisfaction and pain experience during extraction of the primary canine At least 6 months follow-up after the intervention same question in other reviews	Neither trial reported the outcome of pain, or patient satisfaction.	0 studies	No studies
Improvement in the vertical position or angulation of the ectopic canine, measured from radiographs (inclination to midline, cusp-tip to occlusal line, medial crown position) At least 6 months follow-up after the intervention same question in other reviews	Changes in the position of the displaced canine measured from radiographs, reported by both trials as medians (non-normal distribution): changes in the inclination of the canine to the midline, the distance of the…	2 studies	Ungraded
Incidence or prevalence of root resorption of the impacted canine and/or incisors and cyst formation At least 6 months follow-up after the intervention same question in other reviews	Root resorption of the impacted canine and/or incisors and cyst formation was not reported by either included trial.	0 studies	No studies
Change in the sagittal position of the upper first molars At least 6 months follow-up after the intervention same question in other reviews	Change in the sagittal position of the upper first molars (Baccetti 2008 only): average sagittal displacement was 2.65 mm in the extraction-only group and 2.32 mm in the untreated control group (0.24 mm in the…	1 study	Ungraded
Prevalence of eruption/non-eruption of the palatally displaced permanent canine (successful eruption) At least 6 months follow-up after the intervention same question in other reviews	Narrative summary (data not poolable, not GRADE-rated). Leonardi 2004: successful eruption of the permanent canine 50% in the extraction-only group, which was not significantly greater than the success rate in…	2 studies · 70 participants	Ungraded

Extraction of the primary maxillary canine plus cervical pull headgear vs Untreated control (no treatment)

Population: Children with palatally displaced maxillary canines (at least 80% aged 10 to 13 years); trials with craniofacial syndromes or anomalies excluded

CD004621.PUB3 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Prevalence of eruption/non-eruption of the palatally displaced permanent canine (successful eruption) At least 6 months follow-up after the intervention same question in other reviews	Narrative (not pooled, not GRADE-rated). Leonardi 2004: successful eruption 80% with extraction plus cervical pull headgear, significantly higher than the untreated control group (Chi2 14.9; P<0.01). Baccetti 2008: the…	2 studies · 81 participants	Ungraded

Extraction of the primary maxillary canine plus cervical pull headgear vs Extraction of the primary maxillary canine alone

Population: Children with palatally displaced maxillary canines (at least 80% aged 10 to 13 years); trials with craniofacial syndromes or anomalies excluded

CD004621.PUB3 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Prevalence of eruption/non-eruption of the palatally displaced permanent canine (successful eruption) At least 6 months follow-up after the intervention same question in other reviews	Narrative (not pooled, not GRADE-rated). Leonardi 2004: extraction plus headgear (80%) gave significantly higher eruption than extraction alone (50%) (Chi2 4.69; P<0.05). Baccetti 2008: extraction plus headgear was…	2 studies · 79 participants	Ungraded

Extraction of the primary maxillary canine vs Retained primary canine (no extraction)

Population: Children with palatally displaced maxillary canines (at least 80% of participants aged 10 to 13 years)

CD004621.PUB2 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Incidence or prevalence of root resorption of the impacted canine and/or incisors and cyst formation At least 6 months follow-up after the intervention	no estimate extracted	0 studies	No studies
Improvement in the vertical position or angulation of the ectopic canine, measured from radiographs At least 6 months follow-up after the intervention	Other outcomes reported in the two excluded publications were changes in the position of the displaced canine measured from radiographs: changes in the inclination of the canine to the midline, the distance of the…	0 studies	No studies
Prevalence of eruption/non-eruption of the palatally displaced permanent canine (successful eruption) At least 6 months follow-up after the intervention	None of the studies fulfilled the criteria to be included in the review. Reported from the two identified-but-excluded trials (data not in a usable form): Leonardi 2004 reported a 50% prevalence of successful eruption…	0 studies	No studies
Patient satisfaction and pain experience during extraction of the primary canine At least 6 months follow-up after the intervention	no estimate extracted	0 studies	No studies

Extraction of the primary maxillary canine vs Retained primary canine (no extraction)

Population: Children with palatally displaced maxillary canines (at least 80% of participants aged 10 to 13 years)

CD004621 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Prevalence of eruption/non-eruption of the palatally displaced permanent canine (successful eruption) At least 6 months follow-up after the intervention	no estimate extracted	NR	No studies
Improvement in the vertical position or angulation of the ectopic canine, measured from radiographs At least 6 months follow-up after the intervention	no estimate extracted	NR	No studies
Patient satisfaction and pain experience during extraction of the primary canine At least 6 months follow-up after the intervention	no estimate extracted	NR	No studies
Incidence or prevalence of root resorption of the impacted canine and/or incisors and cyst formation At least 6 months follow-up after the intervention	no estimate extracted	NR	No studies