The effect of combined surgical-orthodontic treatment on the periodontal health of labially maxillary impacted canines: a systematic review of split-mouth studies.

PURPOSE

The present study aims to systematically review the literature on the effect of combined surgical-orthodontic treatment on the periodontal health of labially maxillary impacted canines, comparing the results between the three available surgical approaches, open and closed eruption technique and apically positioned flap.

METHODS

Seven electronic databases and three registers were searched until September 2024 and lists of references from relevant publications were screened to identify studies (randomised (RCTs) / controlled clinical trials (CCTs) and observational) assessing the periodontal status of labially maxillary impacted canines after combined surgical-orthodontic treatment. Participants consisted of medically and periodontally healthy individuals with labially impacted canines and their untreated contralaterals as comparison. The outcomes assessed were plaque accumulation, gingival inflammation, gingival recession, probing pocket depth, keratinised gingiva width, attached gingiva width, and crestal bone loss. The risk of bias was evaluated using the ROBINS-I tool for the CCTs and Newcastle-Otawa tool for the observational studies.

RESULTS

A total of 1829 studies were identified, and seven were included in the review (one CCT and six observational studies). All evaluated soft tissue periodontal parameters had the most negative outcomes after excisional uncovering, however these findings did not reach clinical significance. When closed eruption technique or an apically positioned flap was performed, the periodontal outcomes were similar to those of untreated teeth.

CONCLUSIONS

This review found no clinically significant adverse effects on the periodontium after combined surgical-orthodontic treatment of labially impacted maxillary canines. Further high-quality, low-bias clinical trials are needed to assess post-treatment periodontal status.