Surgical-Periodontal aspects in orthodontic traction of palatally displaced canines: a meta-analysis

Periodontal outcomes of surgically exposed and orthodontically aligned buccally impacted maxillary canines: A systematic review and meta-analysis

OBJECTIVE

To compare the periodontal outcomes of surgically exposed and orthodontically aligned buccally impacted maxillary canines to spontaneously erupted maxillary canines.

DATA SOURCES

An unrestricted search was carried out of indexed databases (Medline, EMBASE, Web of Science and Scopus), reference lists of included studies, and grey literature published until December 2023.

DATA SELECTION

Observational and experimental studies that addressed the focused question 'Do periodontal outcomes of buccally impacted maxillary canines that were surgically exposed and subsequently extruded and aligned using orthodontic alignment, differ from those of spontaneously erupted maxillary canines?' were included.

DATA EXTRACTION

Study screening, selection and data extraction were performed independently by two authors, with disagreement resolved by a third reviewer. The risk of bias was assessed using the JBI Critical Appraisal Checklist and GRADE approach.

RESULTS

A total of 857 citations were found and five studies were eligible for inclusion. Supragingival plaque accumulation and gingival inflammation were similar between impacted canines and their contralaterals in most studies. Meta-analyses revealed no significant differences in keratinised tissue width (prospective studies: MD = -0.28, 95% confidence interval [CI] = -1.13-0.56, I² = 78%; retrospective studies: MD = 0.61, 95% CI = -1.51-2.72, I² = 94%). However, a meta-analysis of prospective studies showed slightly greater mean probing depth for impacted canines compared to their contralateral canines (prospective studies: MD = 0.16, 95% CI = 0.04-0.28, I² = 0%). The evidence certainty for keratinised tissue width and probing depth outcomes was low.

CONCLUSION

Surgically exposed and orthodontically aligned buccally impacted canines have slightly greater probing depths, potential bone loss and increased clinical crown length, compared to their counterparts. However, these small differences (<1 mm) are unlikely to be clinically significant.

The Analysis of Intermolar Width and Skeletal Base Class as a Predictor of Potential Maxillary Canine Impaction in Permanent Dentition: A Cross-Sectional Study

Objectives. This study aimed to analyze the inter-molar width and skeletal base class to predict maxillary canine impaction in permanent dentition. Methods. This cross-sectional study was carried out between September 2021 to March 2022. Patients aged between 13 and 20 years were recruited. These patients' cone-beam computer tomography(CBCT), lateral cephalogram, and dental casts were collected and analyzed. For statistical analysis, T-test and Chi-square tests were applied. Results. A total of 92 patients were enrolled in this study. Inter-molar width was significantly decreased in patients with impacted canine(P < .001). The skeletal base classification was statistically significant when compare with intermolar width(P < .05). The location of impaction (P = .060), type of impaction(P = .435), and side of impaction(P = .239) were determined to be statistically insignificant. Conclusion. The Inter-molar width was decreased in patients with impacted canine; therefore, it may be a potential risk factor. The skeletal classification was found to affect inter-molar width in impacted canine patients.

The Effectiveness of Conventional and Accelerated Methods of Orthodontic Traction and Alignment of Palatally Impacted Canines in Terms of Treatment Time, Velocity of Tooth Movement, Periodontal, and Patient-Reported Outcomes: A Systematic Review

The objective of the current review was to evaluate the effectiveness of traditional and accelerated methods of palatally impacted canine's (PIC) traction in terms of treatment duration, velocity, periodontal, and patient-reported variables.

An electronic search for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) published between January 1990 and October 2021 was conducted in nine databases. Five major orthodontic journals were hand searched for additional studies. The participants were patients with unilateral or bilateral PICs who received conventional or accelerated orthodontic treatment with fixed appliances. Cochrane’s risk of bias tool (RoB 2 tool) for RCTs and ROBINS-I tool for CCTs were used to assess the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines were used to assess the overall quality of the evidence.

Nine articles (eight RCTs and one CCT) were included in this review (371 patients). There was no clarity in most studies about the possible effect of the mechanical traction method on treatment outcomes. The treatment duration decreased (about three to six months) when the open surgical method was used with traditional techniques and the traction velocity increased significantly (about 1-1.5 mm/month) when acceleration methods were used. No significant differences were found between the conventional intervention groups, as well as between the traditional and accelerated groups, in terms of most periodontal variables (p > 0.005).

No significant differences were found in the pain levels associated with traditional PICs' traction when comparing different exposure methods in the short-term follow-up (1-10 days), while contradictory results were found in the pain incidence between these methods. The relationship between the pain/discomfort levels and the type of mechanical traction method was not evaluated. According to the GRADE, the quality of evidence supporting these findings ranged from low to very low.

The combination of the open surgical technique with various designs of either superelastic wires or elastic traction means can lead to a reduction in the orthodontic treatment duration of PICs. The use of direct anchorage by miniscrews to move the PICs away from the adjacent teeth roots can lead to a reduction in root resorption and shorten the treatment duration. The evidence supporting these findings ranged from low to very low. The use of different types of mechanical means for conventional PICs' traction, with the use of open or closed traction techniques, does not lead to significant differences in periodontal outcomes between intervention groups. Contradictory results exist regarding the severity of the perceived pain in relation to the surgical exposure type, and the relationship between this variable and the mechanical traction method is still unclear. The use of accelerated methods for PICs' traction can lead to an increase in the velocity of traction movement with no significant differences in periodontal outcomes between accelerated and conventional methods. The evidence supporting these findings ranged from low to very low. More high-quality randomized CCTs are needed to establish good evidence in this field.

The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42021274476) during the first stages of this review.