Cochrane · intervention · CD012851
Interventions for promoting the eruption of palatally displaced permanent canine teeth, without the need for surgical exposure, in children aged 9 to 14 years
Benson, PE, Atwal, A, Bazargani, F, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
27
current version
GRADE rated
4
No studies
13
Included studies
4
as reported
No studies 13 · 48.1%Ungraded 10 · 37%Very low 4 · 14.8%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 diagnosed as having one or both permanent maxillary canines palatally displaced, where the definition of PDC was clear and likely to be valid; studies with at least 80% of participants aged 9 to 14 years. Exclusion: participants with craniofacial anomalies; participants with a history of, or currently in, active orthodontic treatment | 199 randomised participants (164 analysed), 108 girls and 91 boys; 82 diagnosed with unilateral PDC and 117 with bilateral PDC; aged 8 to 13 years at recruitment; all four studies undertaken in Europe (Italy, Sweden, Norway) |
| Intervention | Any interceptive intervention, including: extraction of the primary canine (single extraction) or primary canine and first molar (double extraction); creation of space by widening the upper dental arch (RME, quadhelix or other); creation of space by lengthening the upper dental arch (headgear, mini-implants or other); creation of space within the dental arch (fixed orthodontic appliance or other), to promote eruption of a PDC without surgical exposure | Extraction of the primary canine (n=67); Double primary tooth (canine and first molar) extraction (n=132) |
| Comparison | No treatment; delayed treatment; or another interceptive intervention (non-intervention control group or an alternative intervention group) | No extraction / non-intervention control (n=67); Single primary (canine) tooth extraction (n=132) |
| Outcomes | Primary: incidence of eruption of the PDC into the mouth. Secondary (treatment efficacy): incidence of successfully erupted PDC that were favourably positioned; number of participants referred for surgical exposure; time point of referral; time taken for the canine to erupt; overall treatment time wearing orthodontic appliances; patient-reported outcomes (quality of life or pain). Adverse events: root resorption of the impacted canine or adjacent incisors and first premolars; other adverse effects such as gingival disease and demineralisation. Cost-effectiveness: costs. Also examined: effect of severity of PDC displacement towards the midline on the proportion of successful eruptions | Incidence of eruption of the PDC into the mouth (n=4); Incidence of successfully erupted PDC favourably positioned (n=1); Number of participants referred for surgical exposure (n=4); Root resorption of adjacent permanent teeth (n=1); Patient-reported pain and discomfort (n=1); Effect of severity of PDC displacement on successful eruption (n=4) |
| Study designs | RCTs with a non-intervention control group or an alternative intervention group; minimum follow-up six months after intervention (or recruitment for non-intervention controls); parallel-group design (participants with unilateral or bilateral PDC, or both) | RCT (n=4) |
| Timing | Clinically relevant time points about four to six months, 12 months and 18 months following completion of the intervention | 12 months (n=2); 18 months (n=3); 24 months (n=1); 48 months (n=2) |
Search date: 2021-02. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; MEDLINE Ovid; Embase Ovid
Questions and results
Show all 2 versionsExtraction of the primary (baby) canine (single primary tooth extraction) vs No extraction (non-intervention control)
Population: Young people aged 9 to 14 years diagnosed with one or both palatally displaced permanent maxillary canines (PDC)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Root resorption of adjacent permanent teeth caused by the PDC 12 months | RR 0.60 [0.28, 1.31] | 1 study · 89 participants | Ungraded |
Time taken for the canine to erupt into the mouth | no estimate extracted | 0 studies | No studies |
Reported improvement in the position of the ectopic canine measured from radiographs | Improvement in the position of the ectopic canine was not extracted as a distinct outcome (alpha-angle was the trial's own outcome). | 0 studies | No studies |
Incidence of eruption of the PDC into the mouth 12 months | RR 2.87 [0.90, 9.23] 25.5 [-1.4, 112.2] percentage points (more) | 1 study · 45 participants | Very low Downgraded: imprecision, indirectness |
Patient-reported outcomes (pain, discomfort and analgesic use) Evening after extraction and one week later | Self-reported VAS pain (Naoumova 2012): pain and discomfort from extraction of the primary canine were low both during and after the procedure and mostly absent at one week; 35% of boys and 50% of girls took one dose… | 1 study · 44 participants | Ungraded |
Any other adverse effects, such as gingival disease and demineralisation | Only root resorption was assessed; other adverse effects (gingival disease, demineralisation) were not reported. | 0 studies | No studies |
Effect of severity of PDC displacement towards the midline on the proportion of successful eruptions 12 months · By baseline sector (severity of displacement) | Table 4 (Naoumova 2015): probability of successful eruption depended on displacement severity; sector 2 (mild) 14/19 (74%) erupted vs sector 4 0/10 erupted; data refer to 59 teeth (mITT). | 1 study · 59 participants | Ungraded |
Incidence of successfully erupted PDC that were favourably positioned | Favourable position of the erupted PDC was not reported for this comparison. | 0 studies | No studies |
Overall treatment time wearing orthodontic appliances | no estimate extracted | 0 studies | No studies |
Costs / cost-effectiveness | The study did not report cost-effectiveness. | 0 studies | No studies |
Number of participants referred for surgical exposure of the PDC 12 months | RR 0.61 [0.29, 1.28] -18.0 [-35.5, 20] percentage points (fewer) | 1 study · 45 participants | Very low Downgraded: imprecision, indirectness |
Double primary (canine and first molar) tooth extraction vs Single primary (canine) tooth extraction
Population: Young people aged 9 to 14 years diagnosed with one or both palatally displaced permanent maxillary canines (PDC)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incidence of eruption of the PDC into the mouth 48 months (maximum; mITT) | RR 1.28 [1.06, 1.54] | 2 studies · 96 participants | Ungraded |
Number of participants referred for surgical exposure of the PDC 48 months (maximum; mITT) | RR 0.31 [0.06, 1.45] -6.0 [-8.2, 3.9] percentage points (fewer) | 2 studies · 96 participants | Very low Downgraded: imprecision, indirectness |
Costs / cost-effectiveness | The studies did not report cost-effectiveness. | 0 studies | No studies |
Reported improvement in the position of the ectopic canine measured from radiographs | no estimate extracted | 0 studies | No studies |
Patient-reported outcome measures (PROMs), including quality of life and pain | no estimate extracted | 0 studies | No studies |
Incidence of successfully erupted PDC that were favourably positioned 24 months | RR 1.64 [0.33, 8.03] | 1 study · 23 participants | Ungraded |
Incidence of eruption of the PDC into the mouth 18 months (mean; mITT) | RR 0.68 [0.35, 1.31] -8.8 [-17.9, 8.6] percentage points (fewer) | 3 studies · 119 participants | Very low Downgraded: imprecision, indirectness |
Effect of severity of PDC displacement towards the midline on the proportion of successful eruptions 12 to 48 months · By baseline sector (severity of displacement) | Tables 11-15 (Hadler-Olsen 2020; Bonetti 2010; Bonetti 2011): partial relationship between severity of medial displacement and successful eruption; e.g. at 18 months 17/75 (23%) sector 2 erupted vs 1/17 (6%) sector 3,… | 3 studies | Ungraded |
Any other adverse effects, such as gingival disease and demineralisation | The studies did not report adverse events. | 0 studies | No studies |
Incidence of successfully erupted PDC that were favourably positioned 12 months | RR 1.09 [0.08, 15.42] | 1 study · 23 participants | Ungraded |
Incidence of eruption of the PDC into the mouth 24 months | RR 0.61 [0.29, 1.25] | 1 study · 23 participants | Ungraded |
Root resorption of the impacted canine or adjacent incisors and first premolars | The studies did not report adverse events. | 0 studies | No studies |
Incidence of eruption of the PDC into the mouth 12 months | RR 0.27 [0.04, 2.08] | 1 study · 23 participants | Ungraded |
Time taken for the canine to erupt into the mouth | no estimate extracted | 0 studies | No studies |
Incidence of successfully erupted PDC that were favourably positioned 18 months | RR 1.64 [0.33, 8.03] | 1 study · 23 participants | Ungraded |
Overall treatment time wearing orthodontic appliances | no estimate extracted | 0 studies | No studies |