A systematic review of the interceptive treatment of palatally displaced maxillary canines

Department of Orthodontics, Institute of Odontology at the Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
The European Journal of Orthodontics (Impact Factor: 1.48). 04/2011; 33(2):143-9. DOI: 10.1093/ejo/cjq045
Source: PubMed

ABSTRACT

The aim of this study was to assess whether interceptive treatment in the mixed dentition prevents impaction of palatally displaced canines (PDC) by systematically reviewing the literature. A literature search of PubMed, the Cochrane Library electronic databases, and Scopus was performed covering the period from January 1966 to May 2009. The inclusion criteria were mixed dentition with unilateral or bilateral PDC, randomized controlled trials (RCT), prospective and retrospective studies with untreated controls, and clinical trials comparing at least two treatment strategies. Three reviewers selected and extracted the data independently and evaluated the quality of the studies. Inter-examiner reliability was measured using the intraclass correlation coefficient (ICC). The search strategy resulted in 686 articles, of which two met the inclusion criteria. Because of the unequivocal results and heterogeneity in the study methods, the scientific evidence was too weak to fully evaluate the effect that interceptive treatment might have on PDC and which treatment modalities are most effective. The quality of the studies was rated as low because of inadequate sample selection and deficient description of sample size, confounding factors, uncertainty of randominization, and no blinding in measurements. The ICC value for total scores was >0.80, e.g. perfect agreement. To obtain reliable scientific evidence as to whether interceptive treatment prevents impaction of PDC and which treatment modalities are the most effective, better controlled and well-designed RCTs are needed. Future studies should also include assessment of patient satisfaction and pain experience as well as analysis of the costs and side-effects of treatments.

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    ABSTRACT: International Journal of Paediatric Dentistry 2011; 22: 17–26 Background. Pain following the extraction of the primary canine in children with palatally displaced canines (PDC) as an interceptive treatment has not been investigated. Aims. To describe pain, discomfort, dental anxiety, and use of analgesics following the extraction of primary canines in children with PDC. Design. Forty-four children, aged 10–13 with PDC, were included. Pain intensity, discomfort, and analgesic consumption were rated the first evening and 1 week after the extraction of the primary canine. Dental anxiety was assessed pre-extraction, using the dental anxiety scale (DAS). A matched reference group also completed the DAS. Results. No significant differences were found between the study and the reference group regarding the pre-extraction assessments. Post-extraction pain and discomfort was low. The experience of the injection was graded worse than the extraction, and more pain was rated at the evening post-extraction than during the extraction. Analgesics were used only the first evening. High correlation was detected between DAS and pain during injection and extraction. Conclusions. The experience of pain and discomfort during and after extraction of the primary canines is low, despite that 42% of the children used analgesics. Therefore, appropriate analgesics and recommendation doses pre- and post-extraction should be prescribed.
    No preview · Article · Jun 2011 · International Journal of Paediatric Dentistry
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    ABSTRACT: Data sourcesPubMed, the Cochrane Library electronic databases and Scopus were searched.Study selectionRandomised controlled trials (RCT), prospective and retrospective studies with untreated controls and clinical trials comparing at least two treatment strategies conducted in the mixed dentition with unilateral or bilateral PDC were included.Data extraction and synthesisThree reviewers selected and extracted the data independently and evaluated the quality of the studies. Inter-examiner reliability was measured using the intraclass correlation coefficient (ICC).ResultsOwing to heterogeneity in the study methods and unequivocal results, the scientific evidence was too weak to evaluate the effect of interceptive treatment on PDC or which treatment modalities are most effective. The quality of the studies is low due to inadequate sample selection and deficient description of sample size, confounding factors, uncertainty of randomisation and no blinding in measurements.ConclusionsTo obtain reliable scientific evidence as to whether interceptive treatment prevents impaction of PDC and which treatment modalities are the most effective, better controlled and well-designed RCTs are needed. Future studies should also include assessment of patient satisfaction and pain experience as well as analysis of the costs and side-effects of treatments.
    Preview · Article · Mar 2012 · Evidence-based dentistry
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    ABSTRACT: DesignRandomised controlled trial.InterventionPatients between 8-13 years of age with either unilateral or bilateral PDC diagnosed on radiograph with the presence of mild crowding at the maxillary arch and/or molar relation showing Class II tendency were included. The head gear group (HG) used cervical pull headgear alone for one year for 12-14 hours a day, while the rapid maxillary expansion/headgear (RME/HG) group were treated with a banded rapid maxillary expander, (7 mm of active expansion; at the end of expansion all patients retained the expander for six months), followed by use of a cervical pull headgear as in the HG group. A control group received no active treatment.Outcome measureA successful outcome for PDC was defined as the full eruption of the tooth, thus permitting bracket positioning for final arch alignment at 18 months after the initial observation.ResultsSixty of the 64 patients who entered the trial were available for final assessment. Successful eruption was 85.7% in the RME/HG group, 82.3% in the HG group and 36% in the control group. There was no statistically significant difference between the HG and RME/HG groups.Conclusions The use of rapid maxillary expansion and headgear (or headgear alone) in PDC cases increases the success rate of eruption of the canine significantly (almost three times more than in untreated controls).
    No preview · Article · Oct 2012 · Evidence-based dentistry
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