Open versus closed surgical exposure of palatally impacted maxillary canines: comparison of the different treatment outcomes-a systematic review.

OBJECTIVE

This study aims to compare the effectiveness of two different canine exposure techniques (open and closed) regarding periodontal outcomes, duration of surgical treatment and canine's eruption, patient's inconvenience, aesthetics, and orthodontic treatment complications.

SEARCH METHODS

Electronic database searches of published and unpublished literature were performed. The reference lists of eligible studies were hand searched for additional studies.

SELECTION CRITERIA

Randomized clinical trials (RCTs), quasi-randomized clinical trials (Q-RCTs) and non-randomized trials of prospective and retrospective design with patients of any age that compared group with palatally impacted canines treated by open exposure to a similar group treated by closed exposure technique were selected. There was not any restriction in language or year of publication.

DATA COLLECTION AND ANALYSIS

Study selection, data extraction, and risk of bias assessment were performed individually and in duplicate.

RESULTS

Search strategy resulted in 159 articles and nine articles were selected for the final analysis. They were three non-randomized trials, one Q-RCT, and two reports of another Q-RCT and three reports of one RCT. The level of reported evidence was high for the RCT and one Q-RCT but poorer for the other trials. Four articles reported periodontal outcomes, three searched the duration of surgical procedure, two the duration of canine eruption, two investigated patient's inconvenience, two reported on failure rates and two addressed aesthetic outcomes. The results are inconsistent and there is considerable disagreement for the majority of the outcomes among studies.

CONCLUSION

According to existing articles we may conclude that there is no difference between the two techniques regarding the periodontal outcomes and aesthetic appearance. The surgical procedure is shorter in the open exposure group and the amount of postoperative pain during the first day is similar between the open and closed surgical exposure patients. However, these conclusions are based on two single trials with high level of evidence, while the rest of the studies present high risk of bias.