Cochrane · intervention · CD006966
Open versus closed surgical exposure of canine teeth that are displaced in the roof of the mouth
Parkin, N, Benson, PE, Thind, B, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
21
current version
GRADE rated
5
No studies
0
Included studies
3
as reported
No studies 0 · 0%Ungraded 16 · 76.2%Very low 3 · 14.3%Low 2 · 9.5%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 | People receiving surgical treatment to correct maxillary palatally impacted canines. There is no restriction for age, presenting malocclusion or the type of active orthodontic treatment undertaken. We included unilaterally and bilaterally displaced canines. We excluded trials including participants with craniofacial deformity/syndrome. | 146 participants across three studies (32, 71 and 43), all with unilateral or bilateral palatally displaced canines; all children/adolescents with mean ages 17.5, 14.2 and 15.8 years; majority female |
| Intervention | Surgical exposure of palatally impacted canines with an open surgical technique; Surgical exposure of palatally impacted canines with a closed surgical technique | Open surgical exposure (n=69) |
| Comparison | Closed surgical technique (in some outcomes, the untreated contralateral canine served as a within-patient control) | Closed surgical exposure (n=71 to 72) |
| Outcomes | Primary outcomes: Success of surgery (eruption of the canine crown sufficient for orthodontic alignment without repeated surgery); Complications or adverse effects; Aesthetics of the treated canine compared to the untreated contra-lateral canine. Secondary outcomes: Patient-reported outcomes (pain/discomfort soon after surgery and satisfaction after orthodontic treatment); Gum health at a minimum of three months after fixed appliance removal (loss of attachment, bleeding on probing, recession of the gum margin, crestal bone height); Treatment time (length of time in theatre, duration of orthodontic treatment, number of appointments, with cost implications) | Success of surgery (n=141, 3 studies); Complications (1 study); Aesthetics (2 studies); Patient response/pain-discomfort (2 studies); Gum health incl. CAL (n=62, 1 study) and other periodontal measures (up to 2 studies); Treatment time incl. length of time in surgery (n=89, 2 studies), time to eruption and orthodontic duration (1 study) |
| Study designs | Randomised or quasi-randomised controlled clinical trials in which palatally impacted canines are surgically exposed and subsequently aligned using orthodontic treatment | Randomised (1) and quasi-randomised (2) two-arm parallel-group trials |
| Timing | Gum health recorded at a minimum of three months after fixed appliance removal | Follow-up spanned surgery (10 days for success) to 3 months post-debond (gum health) |
Search date: 2017-02. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid
Questions and results
Show all 3 versionsOpen surgical exposure vs Closed surgical exposure
Population: People with maxillary palatally displaced (impacted) canines, unilateral or bilateral (children/adolescents; mean ages 14.2 to 17.5 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment time: time from surgical exposure to eruption/bonding a bracket Exposure to bonding | MD -3.81 [-5.80, -1.82] | 1 study · 43 participants | Ungraded |
Aesthetics: canine rated as abnormal position in the dental arch End of treatment | RR 2.39 [0.52, 10.99] | 1 study · 43 participants | Ungraded |
Gum health: gingival recession (six-point probing) 3 months post-debond | RR 0.19 [0.01, 3.76] | 1 study · 43 participants | Ungraded |
Patient response: total discomfort score (pain, difficulty eating, brushing, speaking, bad taste) Postoperative | MD 0.10 [-4.17, 4.37] | 1 study · 60 participants | Ungraded |
Aesthetics: canine rated as abnormal tooth inclination End of treatment | RR 1.91 [0.78, 4.66] | 1 study · 43 participants | Ungraded |
Gum health: midpalatal gingival recession 3 months post-debond | RR 1.32 [0.63, 2.77] | 1 study · 62 participants | Ungraded |
Patient response: satisfaction with treatment (satisfactory vs unsatisfactory) After orthodontic treatment | RR 1.00 [0.92, 1.09] | 1 study · 43 participants | Ungraded |
Gum health: periodontal probing depth 3 months post-debond | MD -0.14 [-0.48, 0.20] | 1 study · 43 participants | Ungraded |
Patient response (pain/discomfort reported soon after surgery) 1 to 10 days postoperative | SoF (Patient response, pain and discomfort reported in different ways between 1 to 10 days postoperatively): 'This outcome was measured in a variety of ways in the studies that cannot be pooled'; quality very low… | 2 studies | Very low Downgraded: risk of bias, imprecision |
Gum health: bleeding on probing (Papilla Bleeding Index) 3 months post-debond | MD 0.21 [-0.14, 0.56] | 1 study · 43 participants | Ungraded |
Treatment time: duration of orthodontic treatment (placement to removal of fixed appliances) Fixed-appliance phase | MD -3.77 [-9.20, 1.66] | 1 study · 43 participants | Ungraded |
Patient response: pain/soreness score (visual analogue scale 1 to 10) Postoperative | MD 0.00 [-1.09, 1.09] | 1 study · 60 participants | Ungraded |
Patient response: moderate or severe pain at 1 day postoperative 1 day postoperative | RR 0.86 [0.61, 1.20] | 1 study · 32 participants | Ungraded |
Complications or adverse effects Perioperative to alignment | SoF (Complications, no GRADE rating given): 'One surgical failure was due to detachment of the gold chain (closed group). One study reported two complications following surgery, both in the closed group: a… | 1 study | Ungraded |
Gum health: midbuccal gingival recession (mm) 3 months post-debond | MD -0.02 [-0.21, 0.16] | 2 studies · 105 participants | Ungraded |
Aesthetics: canine rated as abnormal tooth colour End of treatment | RR 1.91 [0.19, 19.52] | 1 study · 43 participants | Ungraded |
Success of surgery (eruption of the canine crown sufficient for orthodontic alignment, without repeated surgery) 10 days postoperative | RR 0.99 [0.93, 1.06] 943 per 1000 (closed group) vs 934 per 1000 | 3 studies · 141 participants | Low Downgraded: risk of bias, imprecision |
Treatment time: length of time in the operating theatre (first incision to final suture) Intraoperative | MD -3.18 [-7.59, 1.22] -3.18 [-7.59, 1.22] minutes | 2 studies · 89 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Gum health: radiographic crestal bone level 3 months post-debond | MD 3.21 [-0.33, 6.75] | 1 study · 43 participants | Ungraded |
Aesthetics of the treated canine compared with the untreated contralateral canine End of treatment | SoF (Aesthetics, reported in various manners at different time points): 'This outcome was measured in a variety of ways in the studies that cannot be pooled'; quality very low (⊕⊝⊝⊝). Results: Parkin 2012 -… | 2 studies | Very low Downgraded: risk of bias, imprecision |
Gum health: clinical attachment level (CAL) 3 months post-debond | MD -0.10 [-0.45, 0.25] -0.10 [-0.45, 0.25] mm | 1 study · 62 participants | Low Downgraded: risk of bias, imprecision |