Cassina Chiara, Papageorgiou Spyridon N, Eliades Theodore
Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
Eur J Orthod. 2018 Jan 23;40(1):1-10. doi: 10.1093/ejo/cjx047.
Permanent canines are amongst the teeth most affected by impaction and ectopic eruption. Although impacted canines are often subjected to surgical exposure and alignment with either the open or the closed technique for many decades, their treatment effects have not yet been systematically asssessed.
The aim of this systematic review was to critically assess whether significant differences exist in the outcomes of the open or closed surgical exposure of impacted canines.
An unrestricted electronic search of nine databases from inception to December 2016 was performed.
Included were randomized or prospective non-randomized studies comparing open versus closed exposure of impacted canines in human patients.
After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of mean differences (MDs) and odds ratios (ORs), including their 95 per cent confidence intervals (CIs) were performed, followed by subgroup and sensitivity analyses.
A total of eight unique studies and a total of 433 (30.1% male/59.9% female) patients were included, with an average age of 15.2 years and a total of 453 impacted canines (48.6% and 51.4% in the open and closed exposure, respectively). Open exposure of impacted canines was associated with reduced duration of canine alignment (two studies; MD = -2.14 months; 95% CI = -4.23 to -0.05 months; P < 0.05; moderate heterogeneity and moderate quality) and lower odds of tooth ankylosis (one study; OR = 0.15; 95% CI = 0.03-0.83; P < 0.05; low quality) compared to closed exposure; both findings being independent of canine localization. However, initial alignment of palatally impacted canines took overall significantly longer than labially impacted canines (8.87 versus 4.17 months).
Based on existing evidence, open surgical exposure seems to be superior in treatment duration and ankylosis risk over the closed technique. Due to the limited number of small included trials, further research is needed for robust clinical recommendations.
PROSPERO (CRD42016051916).
恒牙列中，尖牙最易受到阻生和异位萌出的影响。尽管几十年来，阻生尖牙常常采用开放或闭合技术进行手术暴露和排齐，但对其治疗效果尚未进行系统评估。
本系统评价旨在严格评估阻生尖牙开放或闭合手术暴露的疗效是否存在显著差异。
对9个数据库进行了从建库至2016年12月的无限制电子检索。
纳入比较人类患者阻生尖牙开放与闭合暴露的随机或前瞻性非随机研究。
根据Cochrane指南进行重复研究选择、数据提取和偏倚风险评估后，对平均差（MDs）和比值比（ORs）进行随机效应荟萃分析，包括其95%置信区间（CIs），随后进行亚组分析和敏感性分析。
共纳入8项独立研究，总计433例患者（男性占30.1%/女性占59.9%），平均年龄15.2岁，共有453颗阻生尖牙（开放暴露组和闭合暴露组分别占48.6%和51.4%）。与闭合暴露相比，阻生尖牙的开放暴露与尖牙排齐时间缩短相关（两项研究；MD = -2.14个月；95%CI = -4.23至-0.05个月；P < 0.05；中度异质性和中度质量），且牙齿粘连的几率较低（一项研究；OR = 0.15；95%CI = 0.03 - 0.83；P < 0.05；低质量）；这两个结果均与尖牙位置无关。然而，腭侧阻生尖牙的初始排齐总体上比唇侧阻生尖牙明显更长（8.87个月对4.17个月）。
基于现有证据，开放手术暴露在治疗时间和粘连风险方面似乎优于闭合技术。由于纳入的小型试验数量有限，需要进一步研究以得出可靠的临床建议。
PROSPERO（CRD42016051916）。
