Vađenje mliječnih zubi zbog neiznikutoga trajnog očnjaka smještenoga na nepcu u djece
Abstract
Background
The permanent canine tooth in the maxillary (upper) jaw sometimes does not erupt into the mouth correctly. In about 1% to 3% of the population these teeth will be diverted into the roof of the mouth (palatally). It has been suggested that if the primary canine is removed at the right time this palatal eruption might be avoided. This is an update of a Cochrane review first published in 2009.
Objectives
To evaluate the effect of extracting the primary maxillary canine on the eruption of the palatally ectopic maxillary permanent canine.
Search methods
We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 20 April 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE via OVID (1946 to 20 April 2012) and EMBASE via OVID (1980 to 20 April 2012). There were no restrictions regarding language or date of publication.
Selection criteria
Trials were selected if they met the following criteria: a randomised or quasi‐randomised controlled trial, involving the extraction of the deciduous maxillary canine and assessing eruption/non‐eruption of the palatally displaced maxillary permanent canine.
Data collection and analysis
Data extraction was undertaken independently by two review authors. The primary outcome was the reported prevalence of eruption or non‐eruption of the ectopic permanent canine into the mouth following observation or intervention. Results were to be expressed as risk ratios for dichotomous outcomes with 95% confidence intervals and mean differences for continuous outcomes. Heterogeneity was to be investigated, including both clinical and methodological factors. Authors of trials were contacted to request unpublished data.
Main results
Reports of two randomised controlled trials previously excluded from an earlier version of the review due to "deficiencies in reporting, insufficient data" have now been included. These two trials included approximately 128 children, with more than 150 palatally displaced canine teeth, and both were conducted by the same research group. Data presented in the trial reports are either incomplete or inconsistent. Both trials are at high risk of bias. It must be emphasised that both trials have serious deficiencies in the way they were designed, conducted, and reported, and attempts to contact the authors to obtain detailed information and clarify inconsistencies have been unsuccessful. Allocation to treatment appears to be at the level of the individual, but outcomes of successful treatment relate to included teeth and data are not reported for each treatment group. Adverse effects are not reported. Neither trial provides any evidence to guide clinical decision making.
Authors' conclusions
There is currently no evidence of the effects of extraction of primary canine teeth in 10‐13 year old children with one or two palatally displaced permanent canine teeth.
PICO
Plain language summary
Vađenje mliječnih očnjaka za ispravljanje lošeg položaja neizniknutih trajnih očnjaka u djece
Ponekad trajni zub očnjak ne izraste pravilno u ustima U oko 3% djece bilo jedan ili oba očnjaka (lijevi ili desni) ostanu neizrasli ispod desni u nepcu, izvan pravilne pozicije zubi (poznato kao palatinalni/ektopični zubi).
Ako ti trajni očnjaci ostanu na krivom mjestu, mogu uzrokovati probleme kao što su oštećenje, ili promjena položaja susjednih zuba, a ponekad mogu dovesti do nastanka ciste ili infekcija.
Jedan mogući način liječenja ovoga problema je vađenje primarnog (mliječnog) očnjaka u djece u dobi između 10 i 13 godina i nadati se da će neizrasli očnjak sam ispraviti svoj položaj (spontana korekcija), tako što će se od nepravilnog položaja pomaknuti na ispravno mjesto u ustima.
Ovaj Cochrane sustavni pregled je analizirao da li je vađenje očnjaka krivo smještenih na nepcu u djece učinkovito u sprječavanju budućih komplikacija za pacijenta. Samo dvije studije pokazale su se prikladnima za uključivanje u sustavni pregled, s ukupno 125 sudionika. Studije su imale manjkavosti vezano za ustroj i način prikaza rezultata. Stoga nisu nađeni nikakvi pouzdani dokazi o učincima vađenja mliječnih očnjaka ili zubi. Visoko kvalitetne kliničke studije na ovu temu su nužne da bi se mogle donijeti odgovarajuće odluke u praksi.
