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The Cochrane Database of Systematic... Aug 2017Palatally displaced canines or PDCs are upper permanent canines, commonly known as 'eye' teeth, that are displaced in the roof of the mouth. This can leave unsightly... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Palatally displaced canines or PDCs are upper permanent canines, commonly known as 'eye' teeth, that are displaced in the roof of the mouth. This can leave unsightly gaps, cause damage to the surrounding roots (which can be so severe that neighbouring teeth are lost or have to be removed) and, occasionally, result in the development of cysts. PDCs are a frequent dental anomaly, present in 2% to 3% of young people.Management of this problem is both time consuming and expensive. It involves surgical exposure (uncovering) followed by fixed braces for two to three years to bring the canine into alignment within the dental arch. Two techniques for exposing palatal canines are routinely used in the UK: the closed technique and the open technique. The closed technique involves uncovering the canine, attaching an eyelet and gold chain and then suturing the palatal mucosa back over the tooth. The tooth is then moved into position covered by the palatal mucosa. The open technique involves uncovering the canine tooth and removing the overlying palatal tissue to leave it uncovered. The orthodontist can then see the crown of the canine to align it.
OBJECTIVES
To assess the effects of using either an open or closed surgical method to expose canines that have become displaced in the roof of the mouth, in terms of success and other clinical and patient-reported outcomes.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 24 February 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (in the Cochrane Library, 2017, Issue 1), MEDLINE Ovid (1946 to 24 February 2017), and Embase Ovid (1980 to 24 February 2017). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
We included randomised and quasi-randomised controlled trials assessing young people receiving surgical treatment to correct upper PDCs. There was no restriction on age, presenting malocclusion or type of active orthodontic treatment undertaken. We included unilaterally and bilaterally displaced canines.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened the results of the electronic searches, extracted data and assessed the risk of bias in the included studies. We attempted to contact study authors for missing data or clarification where feasible. We followed statistical guidelines from the Cochrane Handbook for Systematic Reviews of Interventions for data synthesis.
MAIN RESULTS
We included three studies, involving 146 participants. Two studies were assessed as being at high risk of bias.The main finding of the review was that the two techniques may be equally successful at exposing PDCs (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.93 to 1.06; three studies, 141 participants analysed, low-quality evidence).One surgical failure was due to detachment of the gold chain (closed group). One study reported on complications following surgery and found two in the closed group: a post-operative infection requiring antibiotics and pain during alignment of the canine as the gold chain penetrated through the gum tissue of the palate.We were unable to pool data for dental aesthetics, patient-reported pain and discomfort, periodontal health and treatment time; however, individual studies did not find any differences between the surgical techniques (low- to very low-quality evidence).
AUTHORS' CONCLUSIONS
Currently, the evidence suggests that neither the open or closed surgical technique for exposing palatally displaced maxillary canine teeth is superior for any of the outcomes included in this review; however, we considered the evidence to be low quality, with two of the three included studies being at high risk of bias. This suggests the need for more high-quality studies. Three ongoing clinical trials have been identified and it is hoped that these will produce data that can be pooled to increase the degree of certainty in these findings.
Topics: Cuspid; Esthetics, Dental; Humans; Orthodontics, Corrective; Palate; Randomized Controlled Trials as Topic; Tooth Eruption, Ectopic; Treatment Outcome
PubMed: 28828758
DOI: 10.1002/14651858.CD006966.pub3 -
The Cochrane Database of Systematic... Dec 2021A permanent upper (maxillary) canine tooth that grows into the roof of the mouth and frequently does not appear (erupt) is called a palatally displaced... (Review)
Review
BACKGROUND
A permanent upper (maxillary) canine tooth that grows into the roof of the mouth and frequently does not appear (erupt) is called a palatally displaced canine (PDC). The reported prevalence of PDC in the population varies between 1% and 3%. Management of the unerupted PDC can be lengthy, involving surgery to uncover the tooth and prolonged orthodontic (brace) treatment to straighten it; therefore, various procedures have been suggested to encourage a PDC to erupt without the need for surgical intervention.
OBJECTIVES
To assess the efficacy, safety and cost-effectiveness of any interceptive procedure to promote the eruption of a PDC compared to no treatment or other interceptive procedures in young people aged 9 to 14 years old.
SEARCH METHODS
An information specialist searched four bibliographic databases up to 3 February 2021 and used additional search methods to identify published, unpublished and ongoing studies.
SELECTION CRITERIA
We included randomised controlled trials (RCT) involving at least 80% of children aged between 9 and 14 years, who were diagnosed with an upper PDC and undergoing an intervention to enable the successful eruption of the unerupted PDC, which was compared with an untreated control group or another intervention.
DATA COLLECTION AND ANALYSIS
Two review authors, independently and in duplicate, examined titles, keywords, abstracts, full articles, extracted data and assessed risk of bias using the Cochrane Risk of Bias 1 tool (RoB1). The primary outcome was summarised with risk ratios (RR) and 95% confidence intervals (CI). We reported an intention-to-treat (ITT) analysis when data were available and a modified intention-to-treat (mITT) analysis if not. We also undertook several sensitivity analyses. We used summary of findings tables to present the main findings and our assessment of the certainty of the evidence.
MAIN RESULTS
We included four studies, involving 199 randomised participants (164 analysed), 108 girls and 91 boys, 82 of whom were diagnosed with unilateral PDC and 117 with bilateral PDC. The participants were aged between 8 and 13 years at recruitment. The certainty of the evidence was very low and future research may change our conclusions. One study (randomised 67 participants, 89 teeth) found that extracting the primary canine may increase the proportion of PDCs that successfully erupt into the mouth at 12 months compared with no extraction (RR 2.87, 95% CI 0.90 to 9.23; 45 participants, 45 PDCs analysed; very low-certainty evidence), but the CI included the possibility of no difference; therefore the evidence was uncertain. There was no evidence that extraction of the primary canine reduced the number of young people with a PDC referred for surgery at 12 months (RR 0.61 (95% CI 0.29 to 1.28). Three studies (randomised 132 participants, 227 teeth) found no difference in the proportion of successfully erupted PDCs at 18 months with a double primary tooth extraction compared with extraction of a single primary canine (RR 0.68, 95% CI 0.35 to 1.31; 119 participants analysed, 203 PDCs; mITT; very low-certainty evidence). Two of these studies found no difference in the proportions referred for surgical exposure between the single and the double primary extraction groups data at 48 months (RR 0.31, 95% CI 0.06 to 1.45). There are some descriptive data suggesting that the more severe the displacement of the PDC towards the midline, the lower the proportion of successfully erupted PDCs with or without intervention.
AUTHORS' CONCLUSIONS
The evidence that extraction of the primary canine in a young person aged between 9 and 14 years diagnosed with a PDC may increase the proportion of erupted PDCs, without surgical intervention, is very uncertain. There is no evidence that double extraction of primary teeth increases the proportion of erupted PDC compared with a single primary tooth extraction at 18 months or the proportion referred for surgery by 48 months. Because we have only low to very low certainty in these findings, future research is necessary to help us know for sure the best way to deal with upper permanent teeth that are not erupting as expected.
Topics: Adolescent; Child; Cuspid; Humans; Tooth Extraction; Tooth, Deciduous
PubMed: 34967448
DOI: 10.1002/14651858.CD012851.pub2 -
BMC Oral Health Aug 2021Arch length preservation strategies utilize leeway space or E-space in the mixed dentition to resolve mild to moderate mandibular incisor crowding. The purpose of this... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Arch length preservation strategies utilize leeway space or E-space in the mixed dentition to resolve mild to moderate mandibular incisor crowding. The purpose of this systematic review of the literature was to analyze the effects of arch length preservation strategies in on mandibular second permanent molar eruption.
METHODS
A search for relevant articles published from inception until May 2020 was performed using PubMed/Medline, Cochrane databases, Clinicaltrials.gov, Google scholar and journal databases. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adopted for the conduct of the systematic review. Using RevMan 5.3 software, the most pertinent data were extracted and pooled for quantitative analysis with 95% confidence intervals. Heterogeneity was analyzed by using Cochran Q test and I squared statistics.
RESULTS
A total of 5 studies involving 855 mixed dentition patients with arch length preservation therapy were included in the qualitative analysis. Pooled estimate of the data from two studies revealed 3.14 times higher odds of developing mandibular second molar eruption difficulty due to arch length preservation strategies using lingual holding arch (95% CI; OR 1.10-8.92). There was no heterogeneity found in the analysis. The certainty levels were graded as very low.
CONCLUSIONS
This systematic review demonstrates that arch length preservation strategies pose a risk for development of mandibular second molar eruption disturbances, but the evidence was of very low quality. Registration number: CRD42019116643.
Topics: Child; Dental Arch; Dentition, Mixed; Humans; Mandible; Molar; Tooth Eruption
PubMed: 34380483
DOI: 10.1186/s12903-021-01755-1 -
Clinical Implications of Growth Hormone Deficiency for Oral Health in Children: A Systematic Review.Journal of Clinical Medicine Aug 2021Growth hormone (GH) is involved in the regulation of the postnatal dental and skeletal growth, but its effects on oral health have not been clearly defined. This paper... (Review)
Review
Growth hormone (GH) is involved in the regulation of the postnatal dental and skeletal growth, but its effects on oral health have not been clearly defined. This paper aims to provide a review of current clinical knowledge of dental caries, tooth wear, developmental enamel defects, craniofacial growth and morphology, dental maturation, and tooth eruption in growth hormone deficient (GHD) children. A systematic review was carried out using Scopus, MEDLINE-EbscoHost and Web of Science from 2000 to May 2021. PRISMA guidelines for reporting systematic reviews were followed. All the selected studies involved groups under eighteen years of age, covering a total of 465 GHD patients. The studies that were selected provide reliable evidence for delayed dental maturity and orthodontic disturbances in GHD patients. Data on dental hard tissues pathology are scarce and are limited to occurrences of dental caries. GHD children showed abnormal craniofacial morphology with reduced mandibular dimensions, with a resulting tendency towards Angle's Class II occlusion, which affected up to 31% of patients. Dental age has been shown to be delayed in GHD patients by about 1 to 2 years. Moreover, the risk of dental caries in children with GHD decreases with increasing levels of vitamin D. Hence, further studies would be valuable for evaluating the risk of various oral health problems and to organize targeted dental care for this vulnerable group.
PubMed: 34442031
DOI: 10.3390/jcm10163733 -
Acta Odontologica Scandinavica Aug 2020Dental anomalies occurring in deciduous teeth can affect the eruption of the permanent dentition and the occlusion stability. The occurrence of dental anomalies such as...
Dental anomalies occurring in deciduous teeth can affect the eruption of the permanent dentition and the occlusion stability. The occurrence of dental anomalies such as double teeth during the primary dentition in the daily practice might be frequent. The study aimed to qualitatively summarize the therapeutic management of double teeth in primary incisors. A systematic review regarding the therapy of primary fused incisors in the mandible was performed and the obtained data were assessed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The following electronic databases were screened from 1st January, 1996 until 30th July, 2019: PubMed, Scopus, EBSCO and the archives of paediatric dental journals. The search terms were grouped in anatomic entity: ( OR OR ), pathological condition: ( OR OR OR ), intervention: ( OR OR OR OR OR OR ), observed parameters: ( OR OR ). Ten articles met all inclusion criteria. The data disclosed the occurrence of double teeth in mandibular incisors. The main management of this clinical condition is either preventive or surgical involving the extraction of fused teeth, based on the deciduous nature of the teeth, the degree of caries and malocclusion development risk. An early diagnosis of dental anomalies is fundamental for the application of proper preventive strategies to avoid a potential malocclusion in permanent dentition and to maintain these teeth sound and caries-free until the eruption of the permanent dentition.
Topics: Anodontia; Child; Fused Teeth; Humans; Incisor; Mandible; Tooth, Deciduous
PubMed: 32125202
DOI: 10.1080/00016357.2020.1734233 -
Brazilian Oral Research 2022The purpose of this review was to systematically evaluate all the existing literature on the efficacy of treatments used to relieve the signs and symptoms associated...
The purpose of this review was to systematically evaluate all the existing literature on the efficacy of treatments used to relieve the signs and symptoms associated with teething. A systematic search up to February 2021, without restrictions on language or date of publication, was carried out in MEDLINE/PubMed, SCOPUS, Web of Science, The Cochrane Library, EMBASE, LILACS, BBO, OpenGrey, Google Scholar, Portal de Periódicos da CAPES, clinicaltrials.gov, and the references of the included studies. Clinical studies that evaluated the effect of any intervention to alleviate the signs and symptoms associated with teething in babies and children were included. The risk of bias was assessed using the ROB-2 and ROBINS-I tools. The characteristics and results of the individual studies were extracted and synthesized narratively. The GRADE approach was followed to rate the certainty of the evidence. Three randomized and two non-randomized clinical trials were included. The outcomes of these five articles were classified as high or serious risk of bias. Three studies using homeopathy reported improvement in appetite disorders, gum discomfort, and excess salivation. One study showed a new gel with hyaluronic acid was more effective than an anesthetic gel in improving signs and symptoms such as pain, gingival redness, and poor sleep quality. Another study applied non-pharmacological treatments, which were more effective, especially against excess salivation. Although the present systematic review suggests some therapies could have a favorable effect on signs and symptoms related to teething, definitive conclusions on their efficacy cannot be drawn because of the very low certainty of the evidence. The existing literature on the subject is scarce and heterogeneous and has methodological flaws; therefore, further high-quality investigations are necessary.
Topics: Child; Humans; Infant; Tooth Eruption; Child, Preschool
PubMed: 36507753
DOI: 10.1590/1807-3107bor-2022.vol36.0066 -
Korean Journal of Orthodontics Nov 2022This systematic review aimed to evaluate periodontal parameters in orthodontically tractioned teeth compared with the respective non-tractioned contralateral teeth.
OBJECTIVE
This systematic review aimed to evaluate periodontal parameters in orthodontically tractioned teeth compared with the respective non-tractioned contralateral teeth.
METHODS
Search strategies were developed for six electronic databases and gray literature. Random-effects meta-analyses were performed for the outcomes of interest. Furthermore, the certainty of the evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) tool.
RESULTS
Overall, 2,082 articles were identified, of which 24 were selected for the qualitative synthesis. A significant difference was observed between the impacted and contralateral teeth (mean difference [MD] = 0.25; 95% confidence interval [CI] = 0.10-0.40; I = 0%) when the gingival index was evaluated. Additionally, impacted teeth showed a greater probing depth, with a significant mean difference between the groups (MD = 0.14; 95% CI = 0.07-0.20; I = 6%). Most studies had a low risk of bias; however, the certainty of the evidence was very low owing to the design of existing studies.
CONCLUSIONS
The evidence in the literature indicated that tractioned teeth might show worsening of periodontal parameters related to the gingival index and probing depth; however, the evidence remains uncertain about this outcome. Furthermore, probing depth should be considered regarding its clinical significance because of the small effect size observed.
PubMed: 36424810
DOI: 10.4041/kjod22.123 -
The Angle Orthodontist Nov 2017To determine whether the successful management of palatally displaced permanent canines (PDCs) can be achieved by the interceptive extraction of primary maxillary... (Review)
Review
OBJECTIVE
To determine whether the successful management of palatally displaced permanent canines (PDCs) can be achieved by the interceptive extraction of primary maxillary canines.
MATERIALS AND METHODS
Digital databases (Medline, Scopus, Web of Science, and Cochrane) were searched to retrieve articles published from 1952 to April 2016. The university librarian developed search strategies for each database. Two calibrated reviewers independently reviewed potentially related titles and abstracts. Papers meeting the inclusion and exclusion criteria were read in full. The selected articles were evaluated and scored according to methodological quality criteria.
RESULTS
Four randomized clinical trials (RCTs) were included in the systematic review. Compared with two older studies, two more recent RCTs were found to have better study designs, were better conducted, and involved better reporting of the results. The included studies compared intervention groups (children with PDCs undergoing extraction of primary canines) with controls (subjects with PDCs but no primary canine extractions). In three of the four studies, the interceptive extraction of primary canines facilitated eruption of PDCs in more than 65% of cases. Overall, the intervention groups had a markedly higher incidence of successful eruption of PDCs (50%-69%) compared with the control groups (36%-42%).
CONCLUSIONS
Based on the available evidence, it is reasonable to conclude that eruption of PDCs can be facilitated by extraction of primary canines. However, further high-quality, randomized clinical trials are warranted in other population groups. It is hoped that this study will help orthodontists make evidence-based decisions about clinically managing PDCs.
Topics: Cuspid; Humans; Orthodontics, Interceptive; Palate; Randomized Controlled Trials as Topic; Tooth Extraction; Tooth, Deciduous
PubMed: 28800259
DOI: 10.2319/021417-105.1 -
Public Health Nutrition Oct 2014To examine the quantitative relationship between sugar intake and the progressive development of dental caries. (Review)
Review
OBJECTIVE
To examine the quantitative relationship between sugar intake and the progressive development of dental caries.
DESIGN
A critical in-depth review of international studies was conducted. Methods included reassessing relevant studies from the most recent systematic review on the relationship between levels of sugars and dental caries. Reanalysis of dose-response relationships between dietary sugars and caries incidence in teeth with different levels of caries susceptibility in children was done using data from Japanese studies conducted by Takeuchi and co-workers.
SETTING
Global, with emphasis on marked differences in both national sugar intake and fluoride use and preferably where one factor such as sugar intake changed progressively without changes in other factors over a decade or more.
SUBJECTS
Children aged 6 years or more and adults.
RESULTS
Caries occurred in both resistant and susceptible teeth of children when sugar intakes were only 2-3 % of energy intake, provided that the teeth had been exposed to sugars for >3 years. Despite increased enamel resistance after tooth eruption, there was a progressive linear increase in caries throughout life, explaining the higher rates of caries in adults than in children. Fluoride affects progression of caries development but there still is a pandemic prevalence of caries in populations worldwide.
CONCLUSIONS
Previous analyses based on children have misled public health analyses on sugars. The recommendation that sugar intakes should be ≤10 % of energy intake is no longer acceptable. The much greater adult burden of dental caries highlights the need for very low sugar intakes throughout life, e.g. 2-3 % of energy intake, whether or not fluoride intake is optimum.
Topics: Adolescent; Adolescent Nutritional Physiological Phenomena; Adult; Age Factors; Aged; Aged, 80 and over; Cariostatic Agents; Child; Child Nutritional Physiological Phenomena; Dental Care; Dental Caries; Dietary Sucrose; Fluorides; Health Care Costs; Humans; Incidence; Middle Aged; Nutrition Policy; Patient Compliance; Practice Guidelines as Topic; Quality of Life; Young Adult
PubMed: 24892213
DOI: 10.1017/S136898001400113X