Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
School of Dentistry, European University Cyprus, Nicosia, Cyprus.
Eur J Orthod. 2023 Jul 31;45(4):370-381. doi: 10.1093/ejo/cjac076.
Removal of maxillary primary canines and other interceptive treatment modalities in the mixed dentition have been suggested as methods used to increase the rate of normal eruption of palatally displaced permanent canines (PDCs). However, the information on the overall effect on PDCs' position has been inconclusive.
To assess whether this practice improves the position of PDCs and to investigate the quality of the evidence.
Unrestricted searches in 7 databases and manual searching of the reference lists in relevant studies were performed up to June 2022 (Medline via PubMed, CENTRAL, Cochrane Database of Systematic Reviews, Scopus, Web of Science, ClinicalTrials.gov, ProQuest Dissertations, and Theses Global).
We looked for data on the positional changes of PDCs (mesial inclination, vertical position, canine crown cusp tip to midline) from randomized controlled trials assessing the various interceptive treatment modalities.
Following study retrieval and selection, relevant data were extracted, and the risk of bias was assessed using the Cochrane Risk of Bias 2 Tool. Exploratory synthesis and meta-regression were conducted using the random effects model and the overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation approach.
Five studies (3 at low risk of bias) were identified, involving 238 individuals, followed for up to 18 months post-intervention with OPG (orthopantomogram) or CBCT (cone-beam computed tomography). Exploratory data synthesis showed that PDCs' position improved more in the extraction sites compared to non-extraction. Analysis of the studies at low risk confirmed the above observations (6- and 12-month). Improvements were observed in patients using headgear after extraction of primary canines compared to extraction alone, but not in patients with double extraction of primary canines and first molars. The quality of available evidence was rated at best as moderate.
Interceptive treatment modalities in the mixed dentition may improve the position of PDCs. However, more studies are necessary in order to determine the clinical significance of the changes.
PROSPERO (CRD42015029130).
在混合牙列中拔除上颌乳尖牙和其他阻断性治疗方法已被建议用于增加腭侧错位的恒尖牙（PDC）正常萌出的比率。然而，关于这些方法对 PDC 位置整体影响的信息尚无定论。
评估这种做法是否能改善 PDC 的位置，并研究证据的质量。
截至 2022 年 6 月，在 7 个数据库中进行了无限制搜索，并对相关研究的参考文献进行了手动搜索（PubMed 中的 Medline、CENTRAL、Cochrane 系统评价数据库、Scopus、Web of Science、ClinicalTrials.gov、ProQuest 学位论文和全球论文）。
我们寻找了评估各种阻断性治疗方法的随机对照试验中关于 PDC 位置变化（近中倾斜、垂直位置、尖牙牙冠牙尖到中线）的数据。
在检索和选择研究后，提取相关数据，并使用 Cochrane 偏倚风险 2 工具评估偏倚风险。使用随机效应模型进行探索性综合分析和荟萃回归，并使用推荐、评估、开发和评价方法评估现有证据的总体质量。
确定了 5 项研究（3 项低偏倚风险），涉及 238 人，干预后最长随访 18 个月，使用 OPG（全景片）或 CBCT（锥形束 CT）。探索性数据综合表明，与非拔牙相比，拔牙部位的 PDC 位置改善更多。对低偏倚风险的研究进行分析证实了上述观察结果（6 个月和 12 个月）。与单纯拔牙相比，拔牙后使用头帽的患者位置改善，但双拔牙的患者（乳尖牙和第一磨牙）则没有。现有证据的质量被评为最佳中等。
混合牙列中的阻断性治疗方法可能改善 PDC 的位置。然而，需要更多的研究来确定这些变化的临床意义。
PROSPERO（CRD42015029130）。
