Centre for Craniofacial Development & Regeneration, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guy's Hospital, Floor 27, London SE1 9RT, United Kingdom.
Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Floor 21, Guy's Hospital, Guy's and St Thomas NHS Foundation Trust, London SE1 9RT, United Kingdom.
Eur J Orthod. 2023 Sep 18;45(5):584-598. doi: 10.1093/ejo/cjad039.
Maxillary incisor and canine teeth are commonly impacted and require multidisciplinary treatment to accommodate them in the dental arch.
To assess the periodontal outcomes of impacted maxillary central incisor and canine teeth, which have been successfully aligned in the arch following surgical exposure and orthodontic traction with fixed appliance therapy.
Systematic literature searches without restrictions were undertaken in eight databases.
Studies reporting surgical interventions in combination with orthodontic traction with fixed appliance therapy to align impacted maxillary incisors or canines published up to January 2023.
Duplicate independent study selection, data extraction, and risk of bias assessment.
Random-effects meta-analyses of aggregate data.
Twenty-three studies (21 retrospective and 2 prospective) were included in the final analysis. Three studies reported outcomes for maxillary central incisors and 20 reported outcomes for maxillary canines. For maxillary central incisors, all three studies were rated as being at moderate risk of bias. For maxillary canines, 17 studies and 1 study were rated at moderate and high risk of bias, respectively. Both prospective studies were rated at a low risk of bias. Meta-analyses comparing aligned impacted maxillary canines to their non-impacted contralateral counterparts found the former had increased Plaque Index scores (mean difference [MD] 0.19; 95% confidence interval [CI] 0.03, 0.35; P = 0.03), increased clinical attachment loss (MD 0.40 mm; 95% CI 0.17, 0.63; P = 0.01), increased pocket probing depth (MD 0.18 mm; 95% CI 0.07, 0.28; P = 0.001), increased bone loss (MD 0.51 mm; 95% CI 0.31, 0.72; P < 0.001), and reduced keratinized gingival width (MD -0.31 mm; 95% CI -0.61, -0.01; P = 0.04).
Limited evidence suggests that surgical exposure and orthodontic alignment of impacted maxillary central incisor or canine teeth, results in modest adverse effects in the periodontium. These findings should be viewed with caution as our certainty for these outcomes is very low to low due to the bias and heterogeneity. Further well-conducted studies reporting patient centred outcomes are required.
PROSPERO (CRD42020225639).
上颌切牙和尖牙常发生阻生，需要多学科治疗，以将其纳入牙弓。
评估上颌中切牙和尖牙在接受外科暴露和固定矫治器正畸牵引治疗后成功排列在牙弓内的牙周结局。
系统检索了八个数据库，未设置任何限制条件。
报告了手术干预联合固定矫治器正畸牵引以对齐上颌阻生切牙或尖牙的研究，研究发表时间截至 2023 年 1 月。
重复进行独立的研究选择、数据提取和偏倚风险评估。
汇总数据的随机效应荟萃分析。
最终分析纳入了 23 项研究（21 项回顾性研究和 2 项前瞻性研究）。其中 3 项研究报告了上颌中切牙的结果，20 项研究报告了上颌尖牙的结果。对于上颌中切牙，所有 3 项研究的偏倚风险均被评为中度。对于上颌尖牙，17 项研究和 1 项研究的偏倚风险分别被评为中度和高度。两项前瞻性研究的偏倚风险均较低。比较排列后的上颌阻生尖牙与其非阻生对侧尖牙的荟萃分析发现，前者菌斑指数评分增加（平均差值 [MD] 0.19；95%置信区间 [CI] 0.03，0.35；P = 0.03），临床附着丧失增加（MD 0.40mm；95%CI 0.17，0.63；P = 0.01），探诊深度增加（MD 0.18mm；95%CI 0.07，0.28；P = 0.001），骨丧失增加（MD 0.51mm；95%CI 0.31，0.72；P < 0.001），角化龈宽度减少（MD -0.31mm；95%CI -0.61，-0.01；P = 0.04）。
有限的证据表明，上颌中切牙或尖牙的外科暴露和正畸排列会导致牙周组织产生适度的不良影响。由于存在偏倚和异质性，我们对这些结果的确定性非常低至低，因此应谨慎看待这些发现。需要进一步开展报告以患者为中心的结局的高质量研究。
PROSPERO（CRD42020225639）。
