ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Prophylactic Extraction of Deciduous Maxillary Canines May Be an Effective Interceptive Treatment Option for Successful Eruption of Palatally Displaced Maxillary Permanent Canines
Clinical Question In the management of unerupted, palatally displaced maxillary permanent canines, is prophylactic extraction of deciduous maxillary canines a better option for successful eruption of maxillary permanent canines, compared to no extraction?
Clinical Bottom Line For patients with palatally displaced permanent canines, prophylactic extraction of deciduous canines is more effective than no interceptive extraction. This is supported by a two-part randomized controlled trial (RCT). It was determined that the extraction of deciduous canines was the variable that most effected the spontaneous eruption of maxillary permanent canines. A greater percentage of palatally displaced permanent canines erupted when the deciduous canine was extracted as compared to the non-extraction, control group. Additionally, it was found that the eruption time of the permanent maxillary canines was shorter in the extraction group compared to the non-extraction group.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 23235613Parkin/2012Children with palatally displaced maxillary canines. At least 80% of the participants were 10 – 13 years old. Systematic review of randomized trials
Key results“There is no evidence that the prophylactic extraction of primary canine teeth in children aged 10-13 years old with palatally displaced canine teeth results in the successful eruption of permanent canine.”
#2) 25246604Naoumova/201467 children aged 10-13 years with either maxillary unilateral or bilateral palatally displaced canine, persisting deciduous canine and no previous experience of orthodontic treatmentRandomized Controlled Trial
Key resultsThe primary outcome of this RCT determined that significantly more palatally displaced maxillary canines erupted at the extraction site compared to the untreated (no extraction) control site (P = 0.001). “Extraction of deciduous canines in patients with palatally displaced maxillary permanent canines is an effective interceptive approach: 69% of the permanent canines erupted when the deciduous canine was extracted, while 39% erupted in the non-extraction group. The mean eruption time was 15.6 months in the extraction group and 18.3 months in the control group.”
#3) 25700993Naoumova/201567 children aged 10-13 years with either maxillary unilateral or bilateral palatally displaced canine, persisting deciduous canine and no previous experience of orthodontic treatmentRandomized Controlled Trial
Key results“Extraction of the deciduous canine is the variable that affects the spontaneous eruption of the canine most.”
Evidence Search (("Cuspid"[Mesh] AND "Tooth Eruption, Ectopic"[Mesh]) AND "Maxilla"[Mesh]) AND "Tooth Extraction"[Mesh]
Comments on
The Evidence
Validity: The 2012 Cochrane systematic review looked at two randomized controlled trials (RCTs) from 2004 and 2008. After full evaluation of the validity of both trials, it was determined that there were deficits in both trials, mainly in regards to discrepancy in figures involving number of participants and incomplete outcome data with no variance estimates. Further studies that displayed better design and adequately conducted research would be required to determine the full effect of the interceptive treatment in question - extraction of primary canines for the successful eruption of palatally displaced maxillary canines. The systematic review based conclusions on incomplete evidence and asked for further research to be done on the topic in question. The 2014-2015 two-part RCT sought to do a better job of answering the clinical question through research methods such as concealed random allocation, sample size, and correct statistical analysis. Perspective: A Cochrane Review (Parkin/2012) found no reliable evidence of the effects of extraction of deciduous canines due to lack of high-quality studies; however, two later RCTs show that this an effective approach. Although there are other factors involved in the selection of this treatment option, for example resorption of adjacent teeth, it appears that the extraction of deciduous canines provides for an effective treatment option in patients with palatally displaced maxillary canines, and an overall shorter mean eruption time is seen in those individuals who select this treatment intervention.
Applicability Because this intervention is applied to children (aged 10 – 13) and requires the use of local anesthetic, it is often the child’s first experience having a procedure done by the dentist besides normal prophylactic cleanings. It is important that this treatment intervention is justified and fully backed by evidence-based practice because of the invasiveness of the intervention. Additionally, early recognition and timely intervention are critical to these particular patients in order to avoid costly orthodontic, prosthodontic, and oral surgery treatment.
Specialty/Discipline (General Dentistry) (Orthodontics) (Pediatric Dentistry)
Keywords Impacted Maxillary Canine, Impacted Maxillary Cuspids, Ectopic Eruption, Extraction, Deciduous Canine, Orthodontics
ID# 3191
Date of submission: 03/31/2017spacer
E-mail sackos@livemail.uthscsa.edu
Author Samantha Sackos
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Peter Gakunga, DDS, MS, PhD
Faculty mentor/Co-author e-mail gakunga@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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