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Temas

Open technique
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Figure 1

Open technique

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Closed technique
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Figure 2

Closed technique

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

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

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

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

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

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

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Comparison 1 Open surgical technique versus closed surgical technique, Outcome 1 Success of surgery.
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Analysis 1.1

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

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Comparison 1 Open surgical technique versus closed surgical technique, Outcome 2 Aesthetics.
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Analysis 1.2

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

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

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

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Comparison 1 Open surgical technique versus closed surgical technique, Outcome 4 Patient response.
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Analysis 1.4

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

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

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

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Comparison 1 Open surgical technique versus closed surgical technique, Outcome 6 Gum health.
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Analysis 1.6

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

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

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

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Comparison 1 Open surgical technique versus closed surgical technique, Outcome 8 Treatment time.
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Analysis 1.8

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

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

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

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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.

Figuras y tablas -
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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
Figuras y tablas -
Comparison 1. Open surgical technique versus closed surgical technique
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