Extraction of primary canines for interceptive orthodontic treatment of palatally displaced permanent canines: A systematic review


Almasoud, N.N.

Angle Orthodontist 87(6): 878-885

2017


To determine whether the successful management of palatally displaced permanent canines (PDCs) can be achieved by the interceptive extraction of primary maxillary canines. Digital databases (Medline, Scopus, Web of Science, and Cochrane) were searched to retrieve articles published from 1952 to April 2016. The university librarian developed search strategies for each database. Two calibrated reviewers independently reviewed potentially related titles and abstracts. Papers meeting the inclusion and exclusion criteria were read in full. The selected articles were evaluated and scored according to methodological quality criteria. Four randomized clinical trials (RCTs) were included in the systematic review. Compared with two older studies, two more recent RCTs were found to have better study designs, were better conducted, and involved better reporting of the results. The included studies compared intervention groups (children with PDCs undergoing extraction of primary canines) with controls (subjects with PDCs but no primary canine extractions). In three of the four studies, the interceptive extraction of primary canines facilitated eruption of PDCs in more than 65% of cases. Overall, the intervention groups had a markedly higher incidence of successful eruption of PDCs (50%-69%) compared with the control groups (36%-42%). Based on the available evidence, it is reasonable to conclude that eruption of PDCs can be facilitated by extraction of primary canines. However, further high-quality, randomized clinical trials are warranted in other population groups. It is hoped that this study will help orthodontists make evidence-based decisions about clinically managing PDCs.

Original
Article
Extraction
of
primary
canines
for
interceptive
orthodontic
treatment
of
palatally
displaced
permanent
canines:
A
systematic
review
Naif
N.
Almasouda
ABSTRACT
Objective:
To
determine
whether
the
successful
management
of
palatally
displaced
permanent
canines
(PDCs)
can
be
achieved
by
the
interceptive
extraction
of
primary
maxillary
canines.
Materials
and
Methods:
Digital
databases
(Medline,
Scopus,
Web
of
Science,
and
Cochrane)
were
searched
to
retrieve
articles
published
from
1952
to
April
2016.
The
university
librarian
developed
search
strategies
for
each
database.
Two
calibrated
reviewers
independently
reviewed
potentially
related
titles
and
abstracts.
Papers
meeting
the
inclusion
and
exclusion
criteria
were
read
in
full.
The
selected
articles
were
evaluated
and
scored
according
to
methodological
quality
criteria.
Results:
Four
randomized
clinical
trials
(RCTs)
were
included
in
the
systematic
review.
Compared
with
two
older
studies,
two
more
recent
RCTs
were
found
to
have
better
study
designs,
were
better
conducted,
and
involved
better
reporting
of
the
results.
The
included
studies
compared
intervention
groups
(children
with
PDCs
undergoing
extraction
of
primary
canines)
with
controls
(subjects
with
PDCs
but
no
primary
canine
extractions).
In
three
of
the
four
studies,
the
interceptive
extraction
of
primary
canines
facilitated
eruption
of
PDCs
in
more
than
65%
of
cases.
Overall,
the
intervention
groups
had
a
markedly
higher
incidence
of
successful
eruption
of
PDCs
(50%-69%)
compared
with
the
control
groups
(36%-42%).
Conclusions:
Based
on
the
available
evidence,
it
is
reasonable
to
conclude
that
eruption
of
PDCs
can
be
facilitated
by
extraction
of
primary
canines.
However,
further
high-quality,
randomized
clinical
trials
are
warranted
in
other
population
groups.
It
is
hoped
that
this
study
will
help
orthodontists
make
evidence-based
decisions
about
clinically
managing
PDCs.
(Angle
Orthod.
0000;
00:000-000.)
KEY
WORDS:
Palatally
displaced
canine;
Interceptive
orthodontics;
Systematic
review
INTRODUCTION
Permanent
canines
are
the
secondmost
commonly
impacted
teeth
after
third
molars,
and
almost
1%-3%
of
the
population
has
been
found
to
have
impacted
maxillary
canines."
In
about
85%
of
cases
with
impaction,
maxillary
canines
are
palatally
displaced.
3
Genetic
predisposition
and
several
other
factors
are
a
Assistant
Professor,
Preventive
Dental
Sciences
Depart-
ment,
College
of
Dentistry,
University
of
Dammam,
Kingdom
of
Saudi
Arabia.
Corresponding
author:
Dr
Naif
N.
Almasoud,
Preventive
Dental
Sciences
Department,
College
of
Dentistry,
University
of
Dammam,
P.O.Box
1982,
Dammam
31441,
Kingdom
of
Saudi
Arabia
(e-mail:
Accepted:
June
2017.
Submitted:
February
2017.
Published
Online:
August
11,
2017
©
0000
by
The
EH
Angle
Education
and
Research
Foundation,
Inc.
implicated
in
the
etiology
of
palatally
displaced
maxillary
canines
(PDCs)."
The
management
of
these
clinical
problems
may
require
interdisciplinary
ap-
proaches
in
addition
to
substantial
participation
by
orthodontists.
6
Complications
resulting
from
PDCs
include
loss
of
space
in
the
dental
arch,
displacement
and
resorption
of
adjacent
roots,
and
formation
of
cysts
in
rare
cases.
6
Moreover,
patients
may
undergo
traumatic
surgical
exposure
of
PDCs,
followed
by
prolonged
and
costly
fixed
orthodontic
treatment.
74
The
management
of
PDCs
may
require
surgically
exposing
the
canine
and
applying
a
fixed
orthodontic
appliance
to
guide
it
into
appropriate
occlusion
or
extracting
the
primary
canine
to
provide
space
for
its
successor
to
eliminate
or
minimize
developing
maloc-
clusion,
an
approach
called
"interceptive
orthodon-
tics."
Early
interceptive
treatment
can
lessen
the
degree
of
developing
malocclusion
and
thus
decrease
the
need
for
future
orthodontic
treatment
of
permanent
DOI:
10.2319/021417-105.1
1
Angle
Orthodontist,
Vol
00,
No
00,
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2
ALMASOUD
Table
1.
Search
Strategy
in
Different
Databases
Number
of
Key
Words
Databases
Articles
(canine
or
cuspid)
and
(maxillary
or
palatal)
and
(impacted
or
unerupted
or
retained
or
ectopic
or
displaced)
and
(interceptive
or
extraction
or
removal)
teeth.'°
It
can
also
minimize
the
time
and
cost
of
treatment
in
addition
to
improving
self-esteem
and
patient
satisfaction."
Previously,
Ericson
and
Kurol
12
reported
that
extrac-
tion
of
primary
canines
is
the
treatment
of
choice
for
impacted
maxillary
canines,
as
78%
of
such
cases
resulted
in
normal
occlusion.
Several
prospective
studies
12-14
and
a
retrospective
cohort
study'°
have
also
shown
that
primary
canine
extraction
facilitated
the
eruption
of
PDCs.
Other
studies
have
reported
interceptive
extraction
of
PDCs
combined
with
ortho-
dontic
treatment
(rapid
maxillary
expansion)
or
extrac-
tion
of
primary
molars.
15-18
However,
these
studies
varied
considerably
in
their
design,
sample-size
calcu-
lation,
criteria
for
clinical
examination,
and
outcomes.
Parkin
et
al.
19
conducted
a
systematic
review
in
2009
in
which
they
were
unable
to
provide
reliable
evidence
to
support
the
effectiveness
of
interceptive
extraction
of
deciduous
canines
to
manage
PDCs.
Later,
Naoumo-
va
et
al.
3
(2011)
included
two
studies
in
their
systematic
review
to
determine
whether
extraction
of
primary
canines
helps
prevent
the
impaction
of
permanent
maxillary
canines.
However,
robust
evidence
in
favor
of
their
hypothesis
was
limited.
In
2012,
Parkin
et
al.
2
°
considered
two
studies
for
their
systematic
review
to
determine
whether
complications
of
PDCs
can
be
prevented
via
the
extraction
of
primary
canines.
Due
to
the
lack
of
reliable
studies,
the
authors
of
these
systematic
reviews
stressed
the
need
for
more
clinical
trials
with
high-quality
methodology.
3,19,20
As
a
result,
two
recent
randomized
clinical
trials
reported
the
spontaneous
correction
of
PDCs
after
the
extraction
of
primary
canines.
21
'
22
The
present
systematic
review
summarized
the
relevant
randomized
clinical
trials
to
provide
reliable
estimates
of
the
efficacy
of
interceptive
orthodontic
intervention,
specifically,
to
find
out
whether
successful
management
of
PDCs
can
be
achieved
by
interceptive
extraction
of
deciduous
maxillary
canines.
MATERIALS
AND
METHODS
The
preferred
reporting
items
for
systematic
re-
views
and
meta-analysis
(PRISMA)
guidelines
were
followed
for
the
present
systematic
review
(www.
prisma-statement.org
).
23
Information
Sources
Search
strategies
were
developed
and
electronic
databases
including
Medline
(PubMed),
Scopus,
Web
of
Science,
and
the
Cochrane
Collaboration
Oral
Health
Group's
Trials
were
searched
with
the
help
of
an
experienced
librarian
through
the
University
of
Dammam
library
resources.
Clinical
trials
listed
in
clinicaltrials.gov
and
wvvw.who.int/trialsearch/
were
also
searched.
Studies
published
between
1952
and
April
2016
were
eligible
for
inclusion
in
the
present
systematic
review.
The
electronic
search
was
coupled
with
manual
searching.
The
reference
lists
of
retrieved
studies,
both
original
and
review,
were
carefully
reviewed.
In
addition,
citation
searching
was
carried
out
by
searching
the
citations
of
relevant
studies
in
Google
Scholar
to
find
more
studies
on
similar
topics.
Search
Strategy
The
search
strategy
made
use
of
Boolean
operators
with
different
key
words.
The
key
words
included
"canine,"
"cuspid,"
"maxillary,"
"palatal,"
"impacted,"
"unerupted,"
"retained,"
"ectopic,"
"displaced,"
"inter-
ceptive,"
"orthodontics,"
"primary,"
"deciduous,"
"treat-
ment,"
"management,"
"extraction,"
and
"removal"
(Table
1).
Eligibility
Criteria
The
inclusion
and
exclusion
criteria
were
established
based
on
populations,
interventions,
comparisons,
outcomes,
and
study
designs
(PICOS).
Details
of
inclusion
and
exclusion
criteria
are
given
in
Table
2.
Study
Selection
and
Methodological
Quality
Criteria
Calibration
for
interexaminer
reproducibility
was
carried
out
for
two
reviewers
(N.N.A.
and
M.A.N.).
Both
reviewers
independently
reviewed
the
titles
and
abstracts
of
the
articles
for
inclusion
in
the
present
systematic
review.
Disagreements
about
the
inclusion
of
certain
articles
were
resolved
by
discussion
and
mutual
consensus.
The
articles
that
met
the
inclusion
and
exclusion
criteria
were
read
fully
and
evaluated
for
their
quality
based
on
methodological
quality
criteria
(Table
3)
adapted
from
the
CONSORT
statement,
24
Jadad
quality
assessment
scale,
2
°
and
previous
similar
studies.
3
'
2
°
Each
reviewer
independently
scored
the
selected
studies
and
discrepancies
in
the
scoring
of
studies
were
resolved
through
discussion.
Each
study
re-
ceived
a
score
out
of
11
points
(Table
4).
The
studies
Medline
(Pubmed)
331
Scopus
345
Web
of
Science
190
Angle
Orthodontist,
Vol
00,
No
00,
0000
INTERCEPTIVE
TREATMENT
OF
PALATALLY
DISPLACED
CANINES
3
Table
2.
Inclusion
and
Exclusion
Criteria
No.
of
Articles
Inclusion
Criteria
Exclusion
Criteria
Excluded
(n
=
860)
Randomized
clinical
trials
or
cohort
studies
that
evaluated
eruption
of
PDCs
after
interceptive
extraction
of
primary
canines
Interceptive
orthodontic
treatment
provided
to
unilaterally
or
bilaterally
displaced
palatal
canines
during
late
mixed
dentition
stage
Clinical
examinations
were
performed
using
radiographs
and
or
cast
models
Studies
not
related
to
the
objective
of
the
present
systematic
review:
cross-sectional
prevalence
studies.
Studies
of
interceptive
treatment
without
a
control
group.
Stuies
of
adults
or
participants
with
previous
orthodontic
treatment.
Studies
evaluating
surgical
exposure
of
PDCs.
Studies
involving
children
with
primary
dentition.
Review
articles,
discussions,
and
critical
summaries.
Case
reports,
research
reports,
and
case
series.
Animal
studies.
532
49
240
39
were
classified
as
good
(>9
points),
moderate
(7-9
points),
or
poor
(<7
points)
in
quality
based
on
the
scoring
of
the
methodological
criteria.
RESULTS
Study
Selection
The
flow
diagram
in
Figure
1
illustrates
the
PRISMA
process
that
was
used
to
identify,
screen,
and
select
studies
for
inclusion
in
the
present
review.
Searching
through
Medline,
Scopus,
and
Web
of
Science
retrieved
about
866
articles.
Duplicate
articles
(repeti-
tions)
were
removed.
Titles
of
the
articles
were
read
and
those
found
unrelated
to
the
topic
of
research
were
excluded,
which
led
to
the
exclusion
of
791
articles.
The
remaining
75
articles
were
selected
and
their
abstracts
were
thoroughly
read.
This
resulted
in
selecting
33
articles
for
complete
reading,
and
the
inclusion
and
exclusion
criteria
were
applied
to
these
papers.
Finally,
four
articles
met
the
inclusion
and
exclusion
criteria,
to
which
were
applied
the
method-
ological
quality
criteria.
Table
3.
Methodological
Quality
Criteriaa
Sr
No.
Items
Scoring
Design
of
randomized
clinical
trial
Eligibility
criteria
for
study
participants
Sample
size
determination
Details
about
clinical
diagnostic
criteria
Ethical
considerations
Method
of
blinding
Methods
and
type
of
randomization
Description
of
recruitment
period
and
follow-up
Withdrawals
and
dropouts
Clearly
defined
outcomes
Appropriate
statistical
analyses
Total
score
11
a
Methodological
quality
criteria
adapted
from
the
CONSORT
statement
(24),
Jadad
quality
assessment
scale
(25),
and
previous
similar
studies
(3,20).
Characteristics
of
the
Included
Studies
Table
4
summarizes
the
characteristics
of
the
four
selected
studies.
The
recent
study
by
Naoumova
et
al.
21
found
the
highest
prevalence
(69%)
of
successful
eruption
of
PDCs.
In
three
of
the
four
studies,
interceptive
extraction
of
primary
canines
facilitated
the
eruption
of
PDCs
in
more
than
65%
of
cases.
Overall,
the
intervention
groups
in
the
selected
studies
had
a
significantly
higher
incidence
of
successful
eruption
of
PDCs
(ranging
from
50%
to
69%)
com-
pared
with
the
control
groups
(36%-42%).
Quality
Assessment
of
Selected
Studies
Table
5
presents
the
evaluation
of
the
methodolog-
ical
quality
of
the
four
studies
included
in
the
present
systematic
review.
The
two
recent
studies
21,22
scored
higher
than
did
the
two
older
studies.
28,27
Risk
of
Bias
The
risk
of
bias
was
assessed
in
the
four
selected
studies
using
PRISMA
guidelines.
28
Most
studies
were
found
to
have
a
high
risk
of
bias
(Table
6).
The
measures
of
effect
size
of
published
studies
such
as
odds
ratio,
relative
risk,
and
standardized
mean
differences
are
calculated
in
meta-analysis
to
report
the
strength
of
the
relationship
between
inter-
vention
and
control
groups
(two
variables)
and
thus
the
effect
of
intervention.
29
Hence,
due
to
the
nature
and
inconsistencies
of
the
data
reported
in
the
selected
studies,
it
was
not
possible
to
perform
a
meta-analysis.
DISCUSSION
It
was
encouraging
to
find
two
recent
studies
21,22
with
better
methodological
rigor
than
previous
studies
28,27
that
were
also
included
in
similar
systematic
re-
views.
3,20
Although
a
large
body
of
high
quality
A
B
C
D
E
F
G
H
J
K
Angle
Orthodontist,
Vol
00,
No
0,
0000
Full-text
articles
assessed
for
eligibility
(n
=
33)
Full-text
articles
excluded,
with
reasons
(n
=
29)
Records
identified
through
database
searching
(n
=
866)
Additional
records
identified
through
other
sources
(n=0)
Studies
included
in
quantitative
synthesis
(meta-analysis),
(n
=
0)
Studies
included
in
qualitative
synthesis
(n=4)
Records
after
duplicates
removed
(n
=
864)
Records
screened
(n
=
864)
Records
excluded
(n
=831)
Ide
n
t
ific
a
t
io
n
4
ALMASOUD
Table
4.
Summary
of
the
Characteristics
of
Included
Studies
Study
Definition
Participants'
Authors
Design
of
PDCs
Intervention
Gender
&
Age
(y)
Naoumova
et
al.,
Randomized
Not
Children
with
PDCs
Boys
=
8;
2015
(21)
clinical
trial
mentioned
assigned
to
extraction
&
girls
=
16.
nonextraction
groups
67
children
aged
10-13
y.
Bazargani
et
al.,
Randomized
Not
One
side
of
maxilla
with
Boys
=
27;
girls
=
40.
2014
(22)
clinical
trial
mentioned
PDCs
served
as
24
children,
aged
extraction
site,
while
10-14
y
contralateral
side
was
control
site
Baccetti
et
al.,
Randomized
Not
Children
with
PDCs
Boys
=
27;
girls
=
42.
2008
(26)
clinical
trial
mentioned
assigned
to
3
groups:
69
children,
(1)
mean
age,
extraction
group,
11.7
y
(2)
extraction
with
headgear,
&
(3)
control
Leonardi
et
al.,
Randomized
Not
Children
with
PDCs
Boys
=
16;
2004
(27)
clinical
trial
mentioned
assigned
to
3
groups:
girls
=
30.
(1)
extraction
group,
(2)
46
children
extraction
with
mean
age,
11.6-12.2
y
headgear,
&
(3)
control
PRISMA
flow
diagram
of
the
search
process
Figure
1.
PRISMA
flow
diagram
of
the
search
process.
Angle
Orthodontist,
Vol
00,
No
00,
0000
INTERCEPTIVE
TREATMENT
OF
PALATALLY
DISPLACED
CANINES
5
Table
4.
Extended
Duration
of
Follow-up
Methods/Measurement
&
Dropouts
Outcome
Eruption
of
PDCs
in
69%
of
cases
in
extraction
group.
Eruption
of
PDCs
in
39%
of
cases
in
control
group
PDC
was
diagnosed
as
a
Follow-up:
12
mo.
canine
without
labial
Total
observation
period:
bulge
on
palpation
but
24
mo.
diagnosed
Dropouts:
none
radiographically
when
crown
was
palatally
placed
PDC
was
diagnosed
as
a
Follow
up:
nonpalpable
canine
18
mo.
bulge
&
by
using
Dropouts:
none
panoramic
radiograph
Eruption
of
PDCs
at
extraction
sites
was
67%.
Eruption
of
PDCs
at
control
sites
was
42%
PDC
was
diagnosed
through
panoramic
&
periapical
radiographs
as
palatally
placed
permanent
canine
in
maxilla
Intraosseous
palatal
position
of
permanent
canines
was
diagnosed
as
PDCs
using
panoramic
&
periapical
radiographs
Follow-up:
18
mo.
Dropouts:
5
Follow-up:
18
mo.
Total
observation
period:
48
mo.
Dropouts:
7
Successful
eruption
of
PDCs
in
65.2%
of
cases
in
extraction
group.
Successful
eruption
of
PDCs
in
36%
of
cases
in
control
group.
Successful
eruption
of
PDCs
in
87.5%
of
cases
in
extraction
group
with
headgear.
Eruption
of
PDCs
in
50%
of
cases
in
extraction
group;
not
significantly
different
than
controls.
Successful
eruption
of
PDCs
in
80%
of
cases
in
extraction
group
with
headgear
research
is
still
lacking
in
the
literature,
it
was
reasonable
to
conclude,
based
on
the
available
evidence,
that
the
interceptive
extraction
of
primary
maxillary
canines
can
be
employed
as
an
acceptable
approach
to
facilitate
the
eruption
of
PDCs.
All
studies
included
in
the
present
systematic
review
compared
the
percentage
of
success
or
improvement
between
the
intervention
and
control
groups.
Naoumo-
va
et
al.
21
found
that
69%
of
cases
in
the
extraction
group
had
spontaneous
eruption
of
the
permanent
maxillary
canines
compared
with
39%
of
the
control
group.
Bazargani
et
al.
18
reported
a
success
rate
of
67%
at
the
extraction
sites
and
42%
at
the
control
sites.
Similarly,
Baccetti
et
al.
26
found
a
significantly
higher
success
rate
of
65.2%
in
the
treatment
group,
compared
with
36%
in
untreated
controls.
Leonardi
et
al.
27
demonstrated
that
the
50%
success
rate
in
the
extraction
group
was
not
significantly
different
from
that
in
the
control
group.
Three
studies
21
'
22
'
26
received
ethical
approval
from
the
respective
institutional
review
boards/committees,
and
these
studies
also
specified
that
verbal
or
written
consent
was
obtained
from
the
subjects
or
their
parents/guardians.
Leonardi
et
al.
27
did
not
obtain
ethical
approval
from
an
institutional
review
board;
however,
the
authors
received
informed
consent
from
the
study
participants
or
parents.
Sample
size
calculations
were
performed
appropri-
ately
in
two
of
the
four
studies.
21
'
22
The
clinical
diagnostic
procedures
used
in
the
selected
studies
involved
clinical
and
radiographic
examinations
at
baseline
and
during
and
after
the
follow-up
period.
Bazargani
et
al.
22
also
took impressions
for
study
casts
and
included
a
single
examiner
who
assessed
the
reproducibility
of
measurements
performed
every
3
months
during
the
observation
period.
Similarly,
Baccetti
et
al.
26
and
Leonardi
et
al.
27
reported
a
high
rate
of
reproducibility
of
measurements
in
their
studies.
Two
calibrated
examiners
independently
performed
all
Table
5.
Methodological
Quality
of
Selected
Studies
Items
for
Methodological
Quality
Criteria
Total
Methodological
Authors
ABC
D
E
F
G
H
I
J
K
Score
Quality
of
the Study
Naoumova
et
al.,
2015
(21)
1
1 1
1
1
0.5
1 1
1
1
0.5
10
Good
Bazargani
et
al.,
2014
(22)
1
1 1
1
1
0
0.5
1
1
1
1
9.50
Good
Baccetti
et
al.,
2008
(26)
1
1
0
1
1
0
0
0.5
0
1
1
6.5
Poor
Leonardi
et
al.,
2004
(27)
1
1
0
0.5
0 0
0
0.5
0
1
1
5
Poor
Angle
Orthodontist,
Vol
00,
No
0,
0000
6
Table
6.
Assessment
of
Bias
Risk
ALMASOUD
Randomized
Clinical
Trial'
Concealment
of
Randomization
RCT
Stopped
Early
Blinding
of
Patients
Blinding
of
Caregivers
Blinding
of
Data
Collectors
Blinding of
Outcome
Assessors
Naoumova
et
al.,
2015
(21)
Bazargani
et
al.,
2014
(22)
Baccetti
et
al.,
2008
(26)
Leonardi
et
al.,
2004
(27)
Yes
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Yes
No
No
No
the
measurements
in
the
study
performed
by
Naou-
mova
et
al.
21
The
inclusion
of
a
control
group
was
adequately
reported
in
three
studies.
21,26,27
Bazargani
et
al.
22
recruited
a
sample
of
24
consecutive
patients
with
bilateral
PDCs;
one
side
of
the
maxilla
served
as
the
extraction
site
(treatment
group),
while
the
contralateral
side
as
the
nonextraction
site
(control
group).
Details
of
the
randomization
process
were
discussed
in
all
four
selected
studies.
Naoumova
et
al.
21
employed
a
block
randomization
method
and
concealment
of
allocation.
Bazargani
et
al."
generated
a
computerized
random-
ization
list
and
briefly
described
the
process
of
randomization.
On
the
other
hand,
in
the
two
older
studies,
16
'
17
the
methods
of
randomization
were
not
adequately
discussed
and
an
unequal
number
of
cases
were
allocated
to
the
intervention
and
control
groups.
Discrepancies
in
the
reporting
of
information
were
found
in
the
study
by
Leonardi
et
al.
27
The
authors
mentioned
that
there
were
50
participants
at
the
start
of
study
and
that
7
of
them
dropped
out.
However,
they
also
stated
that
46
participants
were
divided
into
three
groups.
Similarly,
Baccetti
et
al.
26
reported
that
75
participants
were
enrolled
and
70
individuals
complet-
ed
the
trial,
as
5
subjects
left
the
study.
Later,
they
described
the
allocation
of
69
participants
into
three
groups.
No
such
data
inaccuracies
were
found
in
the
two
recent
trials.
21
'
22
The
follow-up
period
varied
among
the
four
studies.
Naoumova
et
al.
21
reported
a
follow-up
period
of
12
months,
after
which
surgical
exposure
of
the
canine
and
orthodontic
treatment
were
performed
on
those
subjects
who
did
not
exhibit
spontaneous
canine
eruption;
thus,
the
total
observation
period
was
24
months.
The
remaining
three
studies
had
an
average
follow-up
period
of
18
months,
but
the
total
observation
period
in
the
study
by
Leonardi
et
al.
27
was
48
months.
Regarding
dropouts,
Baccetti
et
al.
26
and
Leonardi
et
al.
27
mentioned
five
and
seven
dropouts,
respectively,
in
their
studies.
However,
neither
the
reasons
for
dropout
nor
their
effects
on
the
overall
results
were
discussed.
Naoumova
et
al.
(2015)
21
investigated
the
effect
on
the
resorption
of
adjacent
teeth,
but
found
no
differences
in
control
or
intervention
groups.
Similarly,
Bazargani
et
al.,
(2014)
22
observed
no
midline
shift
after
unilateral
extraction
of
the
primary
maxillary
canine.
Two
previous
studies
did
not
report
any
side
effects
of
intervention.
26,27
All
the
studies
in
the
present
systematic
review
had
more
than
single
outcomes.
Naoumova
et
al.
(2015)
investigated
whether
extraction
of
the
primary
canine
facilitated
the
eruption
of
the
palatally
displaced
canine
and
also
evaluated
the
root
resorption
of
teeth
adjacent
to
PDCs.
21
Two
outcomes
were
evaluated
in
two
studies
conducted
by
Baccetti
et
al.
(2008)
and
Leonardi
et
al.
(2004).
26,27
Authors
of
both
these
studies
observed
two
interceptive
methods
for
managing
PDCs,
that
is,
extraction
of
the
deciduous
canine
alone
and
extraction
of
the
deciduous
canine
along
with
using
cervical
pull
headgear.
Bazargani
et
al.,
(2014)
analyzed
three
main
outcomes
in
their
random-
ized
clinical
trial.
22
They
evaluated
the
(1)
effect
of
extraction
of
the
primary
canine
on
the
successful
eruption
of
PDCs,
(2)
age
of
patients
appropriate
for
interceptive
treatment,
and
(3)
impact
of
unilateral
extraction
of
the
primary
canine
on
midline
shift.
In
addition,
included
studies
did
not
report
confounding
factors
that could
affect
the
results.
Some
studies
were
not
included
in
the
present
systematic
review
because
they
did
not
fulfil
the
inclusion
and
exclusion
criteria.
However,
those
studies
reported
that
most
cases
of
PDCs
achieved
a
normal
eruptive
position
after
extraction
of
deciduous
maxillary
canines.
12,13,3
°
,31
It
is
hoped
that
the
present
systematic
review
will
help
clinicians
and
orthodontists
make
informed
decisions
about
the
management
of
PDCs
by
interceptively
extracting
primary
canines,
preferably
in
children
aged
10-11
years,
as
reported
by
Bazargani
et
al.
22
Limitations
The
main
limitation
of
this
review
was
the
inclusion
of
two
older
studies
26,27
that
were
of
insufficient
quality
due
to
a
lack
of
methodological
rigor,
including
inadequate
information
about
the
selection
of
partici-
pants
and
sample
size
calculation,
heterogeneity
in
study
designs,
and
inconsistency
in
outcome
defini-
tions.
These
two
studies
26
'
27
were
performed
in
Italy
whereas
the
two
more
recent
trials
21,22
were
conducted
in
Sweden,
and
all
four
studies
recruited
subjects
of
Caucasian
ancestry.
This
might
limit
the
generalizabil-
Angle
Orthodontist,
Vol
00,
No
00,
0000
INTERCEPTIVE
TREATMENT
OF
PALATALLY
DISPLACED
CANINES
7
ity
of
our
findings
to
individuals
from
different
regions
of
the
world.
Therefore,
high-quality
randomized
clinical
trials
to
investigate
the
efficacy
of
interceptive
extrac-
tion
of
the
deciduous
canine
for
PDCs
involving
different
population
groups
are
necessary.
Moreover,
an
evaluation
of
the
complications
of
the
interceptive
method,
patient
satisfaction
about
this
treatment
modality,
and
its
associated
financial
expenses
should
also
be
carried
out.
CONCLUSIONS
Based
on
the
currently
available
body
of
research,
it
is
reasonable
to
conclude
that
the
eruption
of
PDCs
can
be
facilitated
by
the
extraction
of
primary
canines.
Although
evidence
about
the
efficacy
of
extracting
deciduous
canines
for
the
successful
management
of
PDCs
is
mounting,
there
is
still
a
need
to
conduct
further
high-quality,
randomized,
clinical
trials
re-
cruiting
different
population
groups.
It
is
also
important
to
evaluate
the
side
effects
and
a
cost
analysis
of
this
procedure.
REFERENCES
1.
Richardson
G.
A
review
of
impacted
permanent
maxillary
cuspids-diagnosis
and
prevention.
J
Can
Dent
Assoc.
2000;66:497-501.
2.
Ericson
S,
Kurol
J.
Radiographic
examination
of
ectopically
erupting
maxillary
canines.
Am
J
Orthod
Dentofacial
Orthop.
1987;91:483-492.
3.
Naoumova
J,
Kurol
J,
Kjellberg
H.
A
systematic
review
of
the
interceptive
treatment
of
palatally
displaced
maxillary
ca-
nines.
Eur
J
Orthod.
2011;33:143-149.
4.
Husain
J,
Burden
D,
McSherry
P.
The
management
of
the
palatally
ectopic
maxillary
canine.
The
Royal
College
of
Surgeons
of
England,
Faculty
of
Dental
Surgery,
Clinical
Guidelines
2010.
Available
at:
www.rcseng.ac.uk/fds/
publications-clinical-guidelines/clinical_guidelines/.
Ac-
cessed
October
13,2015.
5.
Litsas
G.
A
review
of
early
displaced
maxillary
canines:
etiology,
diagnosis
and
interceptive
treatment.
Open
Dent
J.
2011;5:39-47.
6.
Falahat
B,
Ericson
S,
Mak
D'Amico
R,
Bjerklin
K.
Incisor
root
resorption
due
to
ectopic
maxillary
canines:
a
long-term
radiographic
follow-up.
Angle
Orthod.
2008;78:778-785.
7.
Manne
R,
Gandikota
C,
Juwadi
SR,
Rama
HRM,
Anche
S.
Impacted
canines:
etiology,
diagnosis,
and
orthodontic
management.
J
Pharm
Bioall
Sci.
2012;4:S234-S238.
8.
Bazargani
F,
Magnuson
A,
Dolati
A,
Lennartsson
B.
Palatally
displaced
maxillary
canines:
factors
influencing
duration
and
cost
of
treatment.
Eur
J
Orthod.
2013;35:310-316.
9.
Naoumova
J.
Interceptive
treatment
of
palatally
displaced
canines.
Swed
Dent
J.
2014;234(suppl):7-118.
10.
King
GJ,
Brudvik
P.
Effectiveness
of
interceptive
orthodontic
treatment
in
reducing
malocclusions.
Am
J
Orthod
Dentofa-
cial
Orthop.
2010;137:18-25.
11.
Wong
ML,
Che
Fatimah
Awang,
Ng
LK,
Norlian
D,
Rashidah
Dato
Burhanudin,
Gere
MJ.
Role
of
interceptive
orthodontics
in
early
mixed
dentition.
Singapore
Dent
J.
2004;26:10-14.
12.
Ericson
S,
Kurol
J.
Early
treatment
of
palatally
erupting
maxillary
canines
by
extraction
of
the
primary
canines.
Eur
J
Orthod.
1988;10:283-295.
13.
Power
SM,
Short
MB.
An
investigation
into
the
response
of
palatally
displaced
canines
to
the
removal
of
deciduous
canines
and
an
assessment
of
factors
contributing
to
favourable
eruption.
Br
J
Orthod.
1993;20:215-223.
14.
Olive
RJ.
Orthodontic
treatment
of
palatally
impacted
maxillary
canines.
Aust
Orthod
J.
2002;18:64-70.
15.
Alessandri
Bonet
G,
Incerti
Parenti
S,
Zanarini
M,
Marini
I.
Double
vs
single
primary
teeth
extraction
approach
as
prevention
of
permanent
maxillary
canines
ectopic
eruption.
Pediatr
Dent
2010;32:407-412.
16.
Armi
P,
Cozza
P,
Baccetti
T.
Effect
of
RME
and
headgear
treatment
on
the
eruption
of
palatally
displaced
canines:
a
randomized
clinical
study.
Angle
Orthod.
2011;81:370-374.
17.
Baccetti
T,
Mucedero
M,
Leonardi
M,
Cozza
P.
Interceptive
treatment
of
palatal
impaction
of
maxillary
canines
with
rapid
maxillary
expansion:
a
randomized
clinical
trial.
Am
J
Orthod
Dentofacial
Orthop.
2009;136:657-661.
18.
Baccetti
T,
Sigler
LM,
McNamara
JA
Jr.
An
RCT
on
treatment
of
palatally
displaced
canines
with
RME
and/or
a
transpalatal
arch.
Eur
J
Orthod.
2011;33:601-607.
19.
Parkin
N,
Benson
PE,
Shah
A,
Thind
B,
Marshman
Z,
Glenroy
G,
et
al.
Extraction
of
primary
(baby)
teeth
for
unerupted
palatally
displaced
permanent
canine
teeth
in
children.
Cochrane
Database
Syst
Rev.
2009;2.
doi:10.
1002/14651858.CD004621.pub2
20.
Parkin
N,
Furness
S,
Shah
A,
Thind
B,
Marshman
Z,
Glenroy
G,
et
al.
Extraction
of
primary
(baby)
teeth
for
unerupted
palatally
displaced
permanent
canine
teeth
in
children.
Cochrane
Database
Syst
Rev.
2012;12:CD004621.
21.
Naoumova
J,
Kurol
J,
Kjellberg
H.
Extraction
of
the
deciduous
canine
as
an
interceptive
treatment
in
children
with
palatal
displaced
canines:
shall
we
extract
the
deciduous
canine
or
not?
Eur
J
Orthod.
2015;37(pt
1):209-218.
22.
Bazargani
F,
Magnuson
A,
Lennartsson
B.
Effect
of
interceptive
extraction
of
deciduous
canine
on
palatally
displaced
maxillary
canine:
a
prospective
randomized
clinical
study.
Angle
Orthod.
2014;84:3-10.
23.
Moher
D,
Liberati
A,
Tetzlaff
J,
Altman
DG.
The
PRISMA
Group.
Preferred
reporting
items
for
systematic
reviews
and
meta-analyses:
the
PRISMA
statement.
Int
J
Surg.
2010;8:336-341.
24.
CONSORT.
Available
at:
http://www.consort-statementorg/
about-consort.
Accessed
December
6,2015.
25.
Jadad
AR,
Moore
IRA,
Carroll
D,
Jenkinson
C,
Reynolds
DJ,
Gavaghan
DJ,
et
al.
Assessing
the
quality
of
reports
of
randomized
clinical
trials:
is
blinding
necessary?
Controlled
Clin
Trials.
1996;17:1-12.
26.
Baccetti
T,
Leonardi
M,
Armi
P.
A
randomized
clinical
study
of
two
interceptive
approaches
to
palatally
displaced
canines.
Eur
J
Orthod.
2008;30:381-385.
27.
Leonardi
M,
Armi
P,
Franchi
L,
Baccetti
T.
Two
interceptive
approaches
to
palatally
displaced
canines:
a
prospective
longitudinal
study.
Angle
Orthod.
2004;74:581-586.
28.
Liberati
A,
Altman
DG,
Tetzlaff
J,
Mulrow
C,
Gotzsche
PC,
loannidis
JPA,
et
al.
The
PRISMA
statement
for
reporting
Angle
Orthodontist,
Vol
00,
No
0,
0000
8
ALMASOUD
systematic
reviews
and
meta-analyses
of
studies
that
evaluate
health
care
interventions:
explanation
and
elabo-
ration.
PLoS
Med.
2009;6:e1000100.
29.
Uman
LS.
Systematic
reviews
and
meta-analyses.
J
Can
Acad
Child
Adolesc
Psychiatry.
2011;
20(1):
57-59.
30.
Alessandri
Bonet
G,
Zanarini
M,
Parenti
SI,
Marini
I,
Gatto
MR.
Preventive
treatment
of
ectopically
erupting
maxillary
permanent
canines
by
extraction
of
deciduous
canines
and
first
molars:
a
randomized
clinical
trial.
Am
J
Orthod
Dentofacial
Orthop.
2011;139:316-323.
31.
Bruks
A,
Lennartsson
B.
The
palatally
displaced
maxillary
canine.
A
retrospective
comparison
between
an
interceptive
and
a
corrective
treatment
group.
Swed
Dent
J.
1999;23:149-161.
Angle
Orthodontist,
Vol
00,
No
00,
0000