Open versus closed surgical exposure of canine teeth that are displaced in the roof of the mouth

 

Abstract

Background

Palatal canines are upper permanent canine (eye) teeth that have become displaced in the roof of the mouth. They are a frequently occurring anomaly, present in 2% to 3% of the population. Management of this problem is both time consuming and expensive and involves surgical exposure (uncovering) followed by fixed braces for 2 to 3 years to bring the canine into alignment within the dental arch. Two techniques for exposing palatal canines are routinely used in the UK: one method (the closed technique) involves orthodontically moving the canine into its correct position beneath the palatal mucosa and the second method (the open technique) involves orthodontically moving the canine into its correct position above the palatal mucosa.

Objectives

To establish if clinical, patient centred and economic outcomes are different according to whether an 'open' or 'closed' technique is employed for uncovering palatal canines.

Search methods

MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Oral Health Group's Trials Register were searched (to 29th February 2008). There were no restrictions with regard to publication status or language.

Selection criteria

Patients receiving surgical treatment to correct upper palatally impacted canines. There was no restriction for age, presenting malocclusion or the type of active orthodontic treatment undertaken. Unilateral and bilaterally displaced canines were included.

Trials including participants with craniofacial deformity/syndrome were excluded.

Data collection and analysis

Two review authors independently and in duplicate assessed studies for inclusion. The Cochrane Collaboration statistical guidelines were to be followed for data synthesis.

Main results

No studies were found that met the inclusion criteria.

Authors' conclusions

This review has revealed that currently, there is no evidence to support one surgical technique over the other in terms of dental health, aesthetics, economics and patient factors. Until high quality clinical trials with participants randomly allocated into the two treatment groups are conducted, methods of exposing canines will be left to the personal choice of the surgeon and orthodontist.

 

Plain language summary

Open versus closed surgical exposure of canine teeth that are displaced in the roof of the mouth

Canines in the upper jaw usually erupt in the mouth between the age of 11 to 12 years. In 2% to 3% of the population these teeth fail to erupt into the mouth and become lodged in the roof of the mouth (palate), they are then referred to as 'palatally impacted'. Their impaction can cause damage to the roots of neighbouring teeth and the damage may be so severe that these neighbouring teeth are subsequently lost. The tissue around these impacted canine teeth may undergo cystic change. Also, impaction of these teeth can lead to aesthetic problems.
Management of this problem is both time consuming and expensive and involves surgical exposure (uncovering) followed by fixed braces for 2 to 3 years to bring the canine into its correct position. Two techniques for exposing palatal canines are routinely used in the UK: One method (closed technique) involves surgically uncovering the tooth, gluing an attachment on the exposed tooth and repositioning the palatal flap. Shortly after surgery, an orthodontic brace is used to apply gentle forces to bring the canine into its correct position within the dental arch. The canine moves into position beneath the mucosa. An alternative method (open technique) is to surgically uncover the canine tooth as before, but instead of gluing an attachment on the exposed tooth, removing a window of tissue from around the tooth and placing a dressing (pack) to cover the exposed area. Approximately 10 days later, this pack is removed and the canine is allowed to erupt naturally. Once the tooth has erupted sufficiently for an orthodontic attachment to be glued onto its surface, orthodontic brace treatment is commenced to bring the tooth into line. The canine moves into its correct position above the mucosa.
This review has revealed that currently, there is no evidence to support one surgical technique over the other in terms of dental health, aesthetics, economics and patient factors. Until high quality clinical trials with participants randomly allocated into the two treatment groups are conducted, methods of exposing canines will be left to the personal choice of the surgeon and orthodontist.

 

摘要

背景

口頂(顎側)埋伏犬齒之開放性與封閉性手術露出術

顎側阻生犬齒是上顎恆犬齒因不正常發育位置而生長於口頂.這是個常見的發育阻生,盛行率大約為人口數的2%到3%.針對上顎犬齒阻生的處理是很耗費時間與金錢的,同時需要合併手術露出及矯正治療,費時約兩到三年以固定式矯正器將犬齒往下帶到牙弓中和諧的排列位置.在英國,針對顎側阻生犬齒的手術露出術有兩種常被使用的方式:一是封閉性手術露出,以矯正的機械力將覆蓋於顎側黏膜下的犬齒牽引到正常位置;一是開放性手術露出,以矯正的機械力將露出於顎側黏膜之犬齒牽引到正常位置.

目標

試圖建立臨床上以病人為中心,成本效益考量的結果下,對於上顎阻生犬齒的最佳處理方式,其中包含了開放式以及封閉式兩種術式.

搜尋策略

從MEDLINE, EMBASE以及Cochrane Central Register of Controlled Trials (CENTRAL)和Cochrane Oral Heealth Group's Trials Register等資料庫,蒐集了至2008年2月29日的資料.資料的來源沒有國籍與語言的限制.

選擇標準

取樣對象選擇了接受手術露出術的顎側阻生犬齒的病人.在取樣方面沒有年齡,咬合不正分類,及其接受矯正治療的方式等限制.單側及雙側的阻生犬齒都被包括在樣本中.然同時有顎側阻生犬齒且合併其他顱顏發育異常的病人則不被列入統計.

資料收集與分析

兩篇不同之文獻回顧的作者進行獨立且可重複性的實驗.並遵循了考科藍實證醫學資料庫的統計標準去做資料分析.

主要結論

沒有任一個研究符合條件.

作者結論

由此回顧文獻中可以發現近期並沒有證據支持在口腔健康,美觀,經濟,病人個別因素等考量下,哪一種手術露出術是優於另一種的.針對開放性或封閉性手術露出,目前尚待更嚴謹的隨機臨床試驗,在這之前對於阻生犬齒的處理仍是以外科醫師與矯正科醫師達成共識為主.

翻譯人

本摘要由臺灣大學附設醫院楊方瑜翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

上顎犬齒通常於11到12歲間萌發至口內.有2%到3%的人有上顎犬齒無法順利萌發,而形成顎側阻生犬齒,這些情空被形容為部分阻生.這樣的犬齒阻生可能對鄰牙的牙根造成影響,嚴重程度可至使牙根吸收而使鄰牙脫落.而阻生犬齒的周圍軟組織也容易變化形成囊腫.犬齒的阻生也會造成外觀上的不美觀.針對上顎犬齒阻生的處理是很耗費時間與金錢的,同時需要合併手術露出及矯正治療,費時約兩到三年以固定式矯正器將犬齒往下帶到牙弓中和諧的排列位置.在英國,針對顎側阻生犬齒的手術露出術有兩種常被使用的方式:一是封閉性手術露出,在露出之犬齒上黏著矯正裝置,再將顎側翻瓣縫合復位.術後不久即以矯正的機械力將覆蓋於顎側黏膜下的犬齒牽引到正常位置;一是開放性手術露出,與封閉性手術露出一樣切開翻瓣,黏著上矯正裝置,不同的是要做開窗術移除牙齒周圍組織,並以敷料覆蓋露出的區域.約術後十天,可移除敷料且此時犬齒已有條件順利萌發.犬齒露出至一定程度後,再上矯正裝置以矯正的機械力將露出於顎側黏膜之犬齒牽引到正常位置.而由此回顧文獻中可以發現近期並沒有證據支持在口腔健康,美觀,經濟,病人個別因素等考量下,哪一種手術露出術是優於另一種的.針對開放性或封閉性手術露出,目前尚待更嚴謹的隨機臨床試驗,在這之前對於阻生犬齒的處理仍是以外科醫師與矯正科醫師達成共識為主.