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Cochrane Database of Systematic Reviews

Exposición quirúrgica abierta versus cerrada de dientes caninos desplazados hacia el techo de la boca

Information

DOI:
https://doi.org/10.1002/14651858.CD006966.pub3Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 21 August 2017see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Oral Health Group

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Nicola Parkin

    Correspondence to: Academic Unit of Oral Health and Development, School of Clinical Dentistry, University of Sheffield, Sheffield, UK

    [email protected]

  • Philip E Benson

    Academic Unit of Oral Health and Development, School of Clinical Dentistry, University of Sheffield, Sheffield, UK

  • Bikram Thind

    Department of Orthodontics and Maxillofacial Surgery, Solihull Hospital, Solihull, UK

  • Anwar Shah

    The Windmill Orthodontics, Bedale, UK

  • Ismail Khalil

    Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK

  • Saiba Ghafoor

    Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK

Contributions of authors

Conceiving, designing and co‐ordinating the review (Nicola Parkin (NP)).
Developing search strategy and undertaking searches (NP, Philip Benson (PB)).
Screening search results and retrieved papers against inclusion criteria (NP, PB, Anwar Shah (AS), Bikram Thind (BT), Ismail Khalil (IK), Saiba Ghafoor (SG)).
Appraising risk of bias and quality of evidence (NP, PB).
Extracting data from papers (NP, PB, IK, SG).
Writing to authors for additional information (NP, IK, SG).
Data management for the review and entering data into RevMan 5 (NP).
Analysis and interpretation of data (NP, PB).
Writing the review (NP, PB).
Providing general advice on the review (PB).

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • National Institute for Health Research (NIHR), UK.

    This project was supported by the NIHR, via Cochrane Infrastructure funding to Cochrane Oral Health. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

  • Cochrane Oral Health Global Alliance, Other.

    The production of Cochrane Oral Health reviews has been supported financially by our Global Alliance since 2011 (http://oralhealth.cochrane.org/partnerships‐alliances). Contributors over the past year have been the American Association of Public Health Dentistry, USA; British Association for the Study of Community Dentistry, UK; the British Society of Paediatric Dentistry, UK; the Canadian Dental Hygienists Association, Canada; the Centre for Dental Education and Research at All India Institute of Medical Sciences, India; the National Center for Dental Hygiene Research & Practice, USA; New York University College of Dentistry, USA; NHS Education for Scotland, UK; and Swiss Society for Endodontology.

Declarations of interest

Nicola Parkin: none known. NP is an author on one of the included trials.
Philip E Benson: none known. PB is an author on one of the included trials.
Bikram Thind: none known.
Anwar Shah: none known.
Ismail Khalil: none known.
Saiba Ghafoor: none known.

Acknowledgements

We would like to thank Helen Worthington at Cochrane Oral Health in Manchester, UK, for her support and supervision of undergraduate students Ismail Khalil and Saiba Ghafoor. We also acknowledge Laura MacDonald, Anne Littlewood and Helen Wakeford from the Cochrane Oral Health editorial base; Jayne Harrison (editor with Cochrane Oral Health), Helen J Grady, Oswaldo Jesus Mejias Rotundo and Aman Ulhaq for comments on drafts of the review; and Jason Elliot‐Smith for final copy editing.

Version history

Published

Title

Stage

Authors

Version

2017 Aug 21

Open versus closed surgical exposure of canine teeth that are displaced in the roof of the mouth

Review

Nicola Parkin, Philip E Benson, Bikram Thind, Anwar Shah, Ismail Khalil, Saiba Ghafoor

https://doi.org/10.1002/14651858.CD006966.pub3

2008 Oct 08

Open versus closed surgical exposure of canine teeth that are displaced in the roof of the mouth

Review

Nicola Parkin, Philip E Benson, Bikram Thind, Anwar Shah

https://doi.org/10.1002/14651858.CD006966.pub2

2008 Jan 23

Open versus closed surgical exposure of eye (canine) teeth that are displaced in the roof of the mouth

Protocol

Nicola Parkin, Philip E Benson, Bikram S Thind, Anwar Shah

https://doi.org/10.1002/14651858.CD006966

Differences between protocol and review

The primary outcomes are now success of surgery, complications and aesthetics at the end of treatment. Periodontal (gum) health, duration of treatment and patient‐reported outcomes are secondary outcomes.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Open technique
Figures and Tables -
Figure 1

Open technique

Closed technique
Figures and Tables -
Figure 2

Closed technique

Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
Figures and Tables -
Figure 4

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

Study flow diagram of searches conducted for this update (2008 to 2017)
Figures and Tables -
Figure 5

Study flow diagram of searches conducted for this update (2008 to 2017)

Comparison 1 Open surgical technique versus closed surgical technique, Outcome 1 Success of surgery.
Figures and Tables -
Analysis 1.1

Comparison 1 Open surgical technique versus closed surgical technique, Outcome 1 Success of surgery.

Comparison 1 Open surgical technique versus closed surgical technique, Outcome 2 Aesthetics.
Figures and Tables -
Analysis 1.2

Comparison 1 Open surgical technique versus closed surgical technique, Outcome 2 Aesthetics.

Comparison 1 Open surgical technique versus closed surgical technique, Outcome 3 Posttreatment aesthetics and morphology.
Figures and Tables -
Analysis 1.3

Comparison 1 Open surgical technique versus closed surgical technique, Outcome 3 Posttreatment aesthetics and morphology.

Comparison 1 Open surgical technique versus closed surgical technique, Outcome 4 Patient response.
Figures and Tables -
Analysis 1.4

Comparison 1 Open surgical technique versus closed surgical technique, Outcome 4 Patient response.

Comparison 1 Open surgical technique versus closed surgical technique, Outcome 5 Pain (dichotomous).
Figures and Tables -
Analysis 1.5

Comparison 1 Open surgical technique versus closed surgical technique, Outcome 5 Pain (dichotomous).

Comparison 1 Open surgical technique versus closed surgical technique, Outcome 6 Gum health.
Figures and Tables -
Analysis 1.6

Comparison 1 Open surgical technique versus closed surgical technique, Outcome 6 Gum health.

Comparison 1 Open surgical technique versus closed surgical technique, Outcome 7 Gingival recession (dichotomous).
Figures and Tables -
Analysis 1.7

Comparison 1 Open surgical technique versus closed surgical technique, Outcome 7 Gingival recession (dichotomous).

Comparison 1 Open surgical technique versus closed surgical technique, Outcome 8 Treatment time.
Figures and Tables -
Analysis 1.8

Comparison 1 Open surgical technique versus closed surgical technique, Outcome 8 Treatment time.

Comparison 1 Open surgical technique versus closed surgical technique, Outcome 9 Patient response (satisfaction).
Figures and Tables -
Analysis 1.9

Comparison 1 Open surgical technique versus closed surgical technique, Outcome 9 Patient response (satisfaction).

Open surgical technique compared with closed surgical technique for palatally impacted canines

Patient or population: people with maxillary palatally impacted canines

Settings: oral surgery departments

Intervention: open surgical technique

Comparison: closed surgical technique

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Closed surgery

Open surgery

Success of surgery

943 per 1000

934 per 1000
(877 to 1000)

RR

0.99 (0.93 to 1.06)

141
(3 studies)

⊕⊕⊝⊝
low1

The available evidence suggests that there is no difference in the success of surgery between the techniques and that both techniques have a high success rate.

Complications

One surgical failure was due to detachment of the gold chain (closed group).

One study reported two complications following surgery, both in the closed group: a post‐operative infection requiring antibiotics and pain during alignment of the canine as the gold chain penetrated through the gum tissue of the palate.

Aesthetics

(reported in various manners at different time points)

This outcome was measured in a variety of ways in the studies that cannot be pooled.

⊕⊝⊝⊝
very low2

This outcome is subjective and can be measured and reported in many different ways. The current evidence suggests that there is no difference in aesthetic outcomes between the groups.

Patient response

(pain and discomfort reported in different ways between 1 to 10 days postoperatively)

This outcome was measured in a variety of ways in the studies that cannot be pooled.

⊕⊝⊝⊝
very low3

This outcome is subjective and was measured and reported in different ways. The current evidence suggests that there is no difference in patient response outcomes between the groups.

Gum health

(clinical attachment level (CAL); 3 months post‐debond)

Mean CAL in the closed group
1.6 mm

Mean CAL in the intervention groups was 0.1 mm lower
(0.45 mm lower to 0.25 mm higher)

62
(1 study)

⊕⊕⊝⊝
low4

This outcome was measured and reported in different ways in different studies. The current evidence suggests that there is no difference in periodontal outcomes between the groups.

Treatment time

(length of time in operating theatre from first incision to final suture)

Mean of the closed group was

34.3 minutes in Parkin 2012;

and

37.7 minutes in Gharaibeh 2008.

Mean of the open group was 3.18 minutes less (7.59 minutes less to 1.22 minutes more)

89 (2 studies)

⊕⊝⊝⊝
very low5

The current evidence suggests that there is no difference in length of time in surgery between the groups.

*The basis for the assumed risk is the Parkin 2012 closed group. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

1 Downgraded one level due to high risk of bias in two studies. Downgraded one level as two studies had no failures.

2 Downgraded one level due to high risk of bias in one study. Downgraded one level as each outcome only reported by single studies. Downgraded one level as studies with few participants and large confidence intervals for some outcomes.

3 Downgraded two levels due to high risk of bias in two studies and subjective participant‐reported outcome with no blinding. Downgraded one level as each outcome only reported by single studies.

4 Downgraded two levels as single small study at high risk of bias.

5 Downgraded one level due to high risk of bias in one study. Downgraded one level as substantial heterogeneity between results. Downgraded one level as studies with few participants and large confidence intervals for some outcomes.

Figures and Tables -
Comparison 1. Open surgical technique versus closed surgical technique

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Success of surgery Show forest plot

3

141

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.93, 1.06]

2 Aesthetics Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Correctly identified treated tooth ‐ orthodontists

1

67

Mean Difference (IV, Random, 95% CI)

2.70 [‐11.22, 16.62]

2.2 Correctly identified treated tooth ‐ laypeople

1

67

Mean Difference (IV, Random, 95% CI)

0.10 [‐8.42, 8.62]

2.3 Unoperated canine looks best ‐ orthodontists

1

67

Mean Difference (IV, Random, 95% CI)

‐0.30 [‐14.88, 14.28]

2.4 Unoperated canine looks best ‐ lay people

1

67

Mean Difference (IV, Random, 95% CI)

‐1.70 [‐15.69, 12.29]

3 Posttreatment aesthetics and morphology Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 Number of canines with different colour

1

43

Risk Ratio (M‐H, Random, 95% CI)

1.91 [0.19, 19.52]

3.2 Number of canines not in ideal position in dental arch

1

43

Risk Ratio (M‐H, Random, 95% CI)

2.39 [0.52, 10.99]

3.3 Number of canines not ideally inclined

1

43

Risk Ratio (M‐H, Random, 95% CI)

1.91 [0.78, 4.66]

4 Patient response Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 Pain on VAS

1

60

Mean Difference (IV, Random, 95% CI)

0.0 [‐1.09, 1.09]

4.2 Total discomfort score

1

60

Mean Difference (IV, Random, 95% CI)

0.10 [‐4.17, 4.37]

5 Pain (dichotomous) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

5.1 Pain day 1

1

32

Risk Ratio (M‐H, Random, 95% CI)

0.86 [0.61, 1.20]

5.2 Pain day 7

1

32

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Gum health Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

6.1 Probing depths (mm)

1

43

Mean Difference (IV, Fixed, 95% CI)

‐0.14 [‐0.48, 0.20]

6.2 Bleeding on probing (PBI index)

1

43

Mean Difference (IV, Fixed, 95% CI)

0.21 [‐0.14, 0.56]

6.3 Clinical attachment loss (mm)

1

62

Mean Difference (IV, Fixed, 95% CI)

‐0.10 [‐0.45, 0.25]

6.4 Crestal bone levels mesial (%)

1

43

Mean Difference (IV, Fixed, 95% CI)

3.21 [‐0.33, 6.75]

6.5 Crestal bone levels distal (%)

1

43

Mean Difference (IV, Fixed, 95% CI)

‐0.18 [‐3.09, 2.73]

6.6 Gingival recession ‐ midbuccal

2

105

Mean Difference (IV, Fixed, 95% CI)

‐0.02 [‐0.21, 0.16]

6.7 Gingival recession ‐ midpalatal

1

43

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Gingival recession (dichotomous) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

7.1 Midpalatal recession

1

62

Risk Ratio (M‐H, Random, 95% CI)

1.32 [0.63, 2.77]

8 Treatment time Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

8.1 Length of time in surgery

2

89

Mean Difference (IV, Random, 95% CI)

‐3.30 [‐9.97, 3.36]

8.2 Time taken for eruption

1

43

Mean Difference (IV, Random, 95% CI)

‐3.81 [‐5.80, ‐1.82]

8.3 Length of fixed appliance phase

1

43

Mean Difference (IV, Random, 95% CI)

‐3.77 [‐9.20, 1.66]

9 Patient response (satisfaction) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Figures and Tables -
Comparison 1. Open surgical technique versus closed surgical technique