Effectiveness of various interceptive treatments of palatally displaced canines in children between 8 and 14 years old

• Autor(a) principal: Elovikova, Iryna
• Data de Publicação: 2023
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/20.500.11816/4503
• topic: Palatally displaced canines; Palatally impacted canines; Interceptive; Preventive; Spontaneous eruption; Extraction; RME; Headgear

Introduction: Maxillary canines play a very important esthetic and functional role in permanent dentition. This set of teeth is the second most frequently impacted after the third molar and most commonly ectopically erupting amongst the others. Untreated displaced canines often result in impaction. Consequently, causing various complications such as follicular cyst, ankylosis, impacted cuspid root resorption as well as resorption of the roots of neighboring teeth (67% chance of resorption for lateral incisors root and 11.1 % for central incisors roots). Orthodontic treatment of impacted canine intraosseous malposition is very challenging, which requires surgical exposure followed by a long duration orthodontics traction, with possible complications or failure to erupt. Early diagnostic could enable interceptive treatment option to facilitate successful eruption of palatally displaced canines and avoid long and traumatic treatment time and pathological complications. Objective: Systematic review on effectiveness of various interceptive treatments of palatally displaced canines, such as: extraction of deciduous canine, extraction of deciduous canine and first deciduous molar, Rapid Maxillary Expansion (RME), Transpalatal Arch (TPA) and cervical pull headgear as well as combination of these approaches in children between 8 - 14 years of age. Furthermore, to determine whether mentioned interceptive treatments will increase chance of successful eruption of palatally displaced permanent canines. Methodology: Digital repository: PubMed, Web of Science, Cochrane Library, Clinical Trials. Selected articles were in English and French published between January 2000 – June 2023. Which included randomized controlled trials, non-randomized control trials (RCT) and longitudinal studies on palatally displaced canines in children between 8 and 14 years of age, that did not previously have orthodontics treatment nor envisaged surgically assisted one. Result: Eight articles were selected amongst which; seven were Randomized Controlled Trials (RCT) and one – a Prospective Longitudinal Study. Qualitative assessment was done for all the eight studies. The following interceptive treatment protocols were experimented: single deciduous canine extraction, double extraction of deciduous canine and primary first molar, additional orthodontic appliances treatment (RME, TPA, Cervical Pull Headgear) in combination with or without deciduous canine extraction. The successful eruption result rages between 50% to 97.3%, depending on the method, in comparison to 25 % - 48% in control groups. Conclusion. Even though various interceptive treatments of palatally displaced cuspids demonstrate diverse results of effectiveness, due to important difference in sample sizes and, in two RCT, lack of control group or non-randomized allocation of subjects to the control group, makes it difficult to draw a meaningful evidence-based conclusions in two of reviewed studies. Based on the published data, the most notable result with strong evidence was reported in the subjects treated with deciduous canine extraction in combination with Cervical Pull Headgear usage. It would appear that, additional application of orthodontic forces restricts physiological mesial movement of the first maxillary permanent molars. Consequently, ensuring the space maintenance and/or improvement of the upper arch permitter by preventing maxillary distal segment from anterior sagittal displacement. Therefore, preserving necessary space for palatally displaced canine to erupt. Despite demonstration of significant success rate of palatally displaced canine eruption, additional well designed RCT with proper randomization and larger sample sizes would provide more evidence-based data.