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Extraction of primary (baby) teeth for unerupted palatally displaced permanent canine teeth in children

  • Review
  • Intervention

Authors


Abstract

Background

The permanent canine tooth in the maxillary (upper) jaw sometimes does not erupt into the mouth correctly. In about 1% to 3% of the population these teeth will be diverted into the roof of the mouth (palatally). It has been suggested that if the primary canine is removed at the right time this palatal eruption might be avoided. This is an update of a Cochrane review first published in 2009.

Objectives

To evaluate the effect of extracting the primary maxillary canine on the eruption of the palatally ectopic maxillary permanent canine.

Search methods

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 20 April 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE via OVID (1946 to 20 April 2012) and EMBASE via OVID (1980 to 20 April 2012). There were no restrictions regarding language or date of publication.

Selection criteria

Trials were selected if they met the following criteria: a randomised or quasi-randomised controlled trial, involving the extraction of the deciduous maxillary canine and assessing eruption/non-eruption of the palatally displaced maxillary permanent canine.

Data collection and analysis

Data extraction was undertaken independently by two review authors. The primary outcome was the reported prevalence of eruption or non-eruption of the ectopic permanent canine into the mouth following observation or intervention. Results were to be expressed as risk ratios for dichotomous outcomes with 95% confidence intervals and mean differences for continuous outcomes. Heterogeneity was to be investigated, including both clinical and methodological factors. Authors of trials were contacted to request unpublished data.

Main results

Reports of two randomised controlled trials previously excluded from an earlier version of the review due to "deficiencies in reporting, insufficient data" have now been included. These two trials included approximately 128 children, with more than 150 palatally displaced canine teeth, and both were conducted by the same research group. Data presented in the trial reports are either incomplete or inconsistent. Both trials are at high risk of bias. It must be emphasised that both trials have serious deficiencies in the way they were designed, conducted, and reported, and attempts to contact the authors to obtain detailed information and clarify inconsistencies have been unsuccessful. Allocation to treatment appears to be at the level of the individual, but outcomes of successful treatment relate to included teeth and data are not reported for each treatment group. Adverse effects are not reported. Neither trial provides any evidence to guide clinical decision making.

Authors' conclusions

There is currently no evidence of the effects of extraction of primary canine teeth in 10-13 year old children with one or two palatally displaced permanent canine teeth.

摘要

拔除乳尖牙治疗儿童上颌恒尖牙腭侧偏移的效果评价

研究背景

(上)颌恒尖牙有时会发生异位萌出的情况。约1%–3%的人上颌恒尖牙萌出位置偏向腭侧。临床上建议在适当时间提前拔除乳尖牙,可避免恒尖牙异位萌出。这篇是对2009年发表的一篇Cochrane系统综述的更新。

研究目的

评估拔除上颌乳尖牙对上颌恒尖牙向腭侧异位萌出的效果。

检索策略

检索考克兰口腔健康小组试验注册库(Cochrane Oral Health Group's Trials Register)(截至2012年4月)、 考克兰临床试验注册库(Cochrane Central Register of Controlled Trials ,CENTRAL)(The Cochrane Library 2012, Issue 1)、MEDLINE(OVID路径,1946年–2012年4月20日)、EMBASE(OVID路径,1980年–2012年4月20日)等数据库。本文不限制语种及发表日期。

标准/纳入排除标准

纳入研究需符合以下标准: 1.随机或半随机对照试验 2. 对上颌乳尖牙采取拔除措施后,评价上颌恒尖牙的腭侧偏移萌出情况。

数据收集与分析

2位评价员同时独立进行文献筛选。主要结局指标为干预后恒尖牙的异位萌出情况。采用相对危险度(Risk ratio, RR)及其95% 可信区间(Confidence interval, CI)作为二分类变量资料的效应量,均数差(Mean difference, MD)及其95% CI作为连续型变量的效应量。对各研究之间的方法学异质性及临床异质性进行评价。与研究的作者进行联系以取得未发表的数据。

主要结果

前一版系统综述中由于报告不完整及数据不足被剔除的2篇RCT在本次更新中被纳入。这两项试验共涉及128个儿童,超过150例上颌尖牙异位萌出,而且是由同一个研究小组设计实施的。数据报告不完整或研究间不一致。两项研究都为高偏倚风险。我们必须强调这两项试验在设计、实施、报告上都有严重缺陷,并尝试与原作者取得联系以获取细节信息解释不一致性,未果。研究分组是基于个体水平,但结局指标是按牙齿个数进行报告,而且并没有报告每个组的治疗结局。副作用也未报告。这两项试验均不能为指导临床实践提供证据。

作者结论

目前尚无证据支持拔除10-13岁儿童的一两颗上颌乳尖牙可改善上颌恒尖牙向腭侧异位萌出的情况。

翻译注解

更新译者:方赛男,审校:梁宁、李静。北京中医药大学循证医学中心2017年7月28日

Plain language summary

Extraction of baby canine teeth for correcting poorly aligned adult canine teeth in children

Occasionally, permanent canine teeth (sometimes called eye teeth) do not erupt properly in the mouth. In around 3% of children, either one or both canines (left and right) remain buried under the gum in the roof of the mouth, out of alignment from the tooth's correct position (known as palatally displaced teeth).

If these permanent canine teeth remain displaced, they can cause problems such as damage to, or change the position of neighbouring teeth, and very occasionally lead to cyst formation or infection.

One possible treatment for this problem is to extract the primary (baby) canine in 10 to 13 year old children and hope that the buried canine corrects its alignment of its own accord (called spontaneous correction), by moving from a displaced position to the correct placement in the mouth.

This review looks at whether extracting palatally displaced canine teeth in children is successful in preventing further complications for patients. Only two of the studies found were considered suitable for inclusion, with a total of 125 participants. There were concerns about aspects of the design and reporting in both of the studies; therefore we have found no reliable evidence of the effects of extraction of the baby canine tooth or teeth. High quality clinical trials are required to guide decision making.

Laički sažetak

Vađenje mliječnih očnjaka za ispravljanje lošeg položaja neizniknutih trajnih očnjaka u djece

Ponekad trajni zub očnjak ne izraste pravilno u ustima U oko 3% djece bilo jedan ili oba očnjaka (lijevi ili desni) ostanu neizrasli ispod desni u nepcu, izvan pravilne pozicije zubi (poznato kao palatinalni/ektopični zubi).

Ako ti trajni očnjaci ostanu na krivom mjestu, mogu uzrokovati probleme kao što su oštećenje, ili promjena položaja susjednih zuba, a ponekad mogu dovesti do nastanka ciste ili infekcija.

Jedan mogući način liječenja ovoga problema je vađenje primarnog (mliječnog) očnjaka u djece u dobi između 10 i 13 godina i nadati se da će neizrasli očnjak sam ispraviti svoj položaj (spontana korekcija), tako što će se od nepravilnog položaja pomaknuti na ispravno mjesto u ustima.

Ovaj Cochrane sustavni pregled je analizirao da li je vađenje očnjaka krivo smještenih na nepcu u djece učinkovito u sprječavanju budućih komplikacija za pacijenta. Samo dvije studije pokazale su se prikladnima za uključivanje u sustavni pregled, s ukupno 125 sudionika. Studije su imale manjkavosti vezano za ustroj i način prikaza rezultata. Stoga nisu nađeni nikakvi pouzdani dokazi o učincima vađenja mliječnih očnjaka ili zubi. Visoko kvalitetne kliničke studije na ovu temu su nužne da bi se mogle donijeti odgovarajuće odluke u praksi.

Bilješke prijevoda

Hrvatski Cochrane
Prevela: Ivana Propadalo
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr

Ringkasan bahasa mudah

Cabutan gigi kanin susu untuk membetulkan gigi kanin kekal yang tersesar dalam kalangan kanak-kanak.

Ada kalanya gigi kanin kekal (dipanggil gigi mata) tidak erupt dengan betul di dalam mulut. Di dalam lebih kurang 3% kanak-kanak, sama ada satu atau kedua-dua kanin (kiri dan kanan) tinggal terbenam di bawah gusi di bahagian lelangit mulut, tidak sejajar dengan posisi tepat (disebut gigi yang teranjak ke palatal).

Jika gigi kanin kekal ini tersesar, ia boleh menyebabkan masalah misalnya kerosakan atau perubahan posisi gigi bersebelahan, dan kadangkala boleh membentuk sista atau jangkitan.

Satu rawatan yang mungkin untuk masalah ini ialah cabutan gigi kanin susu dalam kalangan kanak-kanak berumur 10 hingga 13 tahun dan mengharapkan kanin yang tertanam akan membetulkan kedudukan dengan sendiri (pembetulan spontan), dengan bergerak daripada posisi tersear kepada posisi yang betul di dalam mulut.

Ulasan ini melihat sama ada cabutan gigi kanin yang tersesar ke palatal dalam kalangan kanak-kanak berjaya mencegah komplikasi lanjutan bagi pesakit. Hanya terdapat dua kajian yang dianggap sesuai untuk dimasukkan, dengan jumlah 125 peserta. Terdapat kebimbangan tentang aspek reka bentuk dan laporan dalam kedua-dua kajian; oleh itu kami tidak mendapati bukti yang boleh diterima tentang kesan cabutan gigi kanin susu. Lebih banyak kajian berkualiti tinggi diperlukan untuk membantu dalam membuat keputusan.

Catatan terjemahan

Diterjemah oleh Noorliza Mastura Ismail (Kolej Perubatan Melaka-Manipal). Disunting oleh Tan May Loong (Penang Medical College). Untuk sebarang pertanyaan berkaitan terjemahan ini, sila hubungi noorliza.mastura@manipal.edu.my

概要

拔除乳尖牙纠正儿童中不整齐的成年犬齿

有时,永久性犬齿(有时称为眼齿)不会在口腔内正常萌出。恒尖牙(又叫做虎牙)在萌发过程中可能会向腭侧异位,甚至被牙龈包裹,其发生率约为3%。

如果这些恒尖牙的异位不矫正,将会引起周围牙齿的偏移,甚至囊肿和感染。

一种推荐的治疗方式是,在儿童10至13岁时,将覆盖于恒牙上方的乳尖牙拔除,让其自然地在正确位置萌出。

本综述研究拔除儿童乳尖牙是否能成功避免并发症的发生。只有两项共计125人的试验提供了可供参考的结论。考虑到这两项试验在设计、报告方面的问题,我们仍未获得可靠的证据证实拔出乳尖牙的疗效。需要高质量的临床试验指导临床实践。

翻译注解

更新译者:方赛男,审校:梁宁、李静。北京中医药大学循证医学中心2017年7月28日