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

Abstract

Background: Palatal canines are upper permanent canine (eye) teeth that have become displaced in the roof of the mouth. They are a frequently occurring anomaly, present in 2% to 3% of the population. Management of this problem is both time consuming and expensive and involves surgical exposure (uncovering) followed by fixed braces for 2 to 3 years to bring the canine into alignment within the dental arch. Two techniques for exposing palatal canines are routinely used in the UK: one method (the closed technique) involves orthodontically moving the canine into its correct position beneath the palatal mucosa and the second method (the open technique) involves orthodontically moving the canine into its correct position above the palatal mucosa.

Objectives: To establish if clinical, patient centred and economic outcomes are different according to whether an 'open' or 'closed' technique is employed for uncovering palatal canines.

Search strategy: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Oral Health Group's Trials Register were searched (to 29th February 2008). There were no restrictions with regard to publication status or language.

Selection criteria: Patients receiving surgical treatment to correct upper palatally impacted canines. There was no restriction for age, presenting malocclusion or the type of active orthodontic treatment undertaken. Unilateral and bilaterally displaced canines were included.Trials including participants with craniofacial deformity/syndrome were excluded.

Data collection and analysis: Two review authors independently and in duplicate assessed studies for inclusion. The Cochrane Collaboration statistical guidelines were to be followed for data synthesis.

Main results: No studies were found that met the inclusion criteria.

Authors' conclusions: This review has revealed that currently, there is no evidence to support one surgical technique over the other in terms of dental health, aesthetics, economics and patient factors. Until high quality clinical trials with participants randomly allocated into the two treatment groups are conducted, methods of exposing canines will be left to the personal choice of the surgeon and orthodontist.