What is the best treatment for impacted maxillary canines? Expose and wait or perform traction? A systematic review

Abstract

AIM: The aim of this systematic review was to seek evidence in the literature about the best treatment for cases of impacted maxillary canines. MATERIAL AND METHODS: This review has been registered at PROSPERO – International prospective register of systematic review under the number CRD42014007033. A systematic review was conducted in the Scopus, PubMed, Medline EBSCO, Embase, Web of Science, Cochrane, Clinical Trials and Greyliterature electronic databases, without limitations on the year of publication and language. Controlled clinical studies were included in this review, which were conducted with orthodontic patients with fixed appliances, without age limit, with the presence of impacted maxillary canines, in whom the procedures of surgical exposure only, or exposure followed by orthodontic traction were performed. Those excluded were computational studies, case reports, reviews of the literature, didactic books, editorial letters, in addition to studies including patients using systemic drugs, syndromic patients, with history of dental trauma, those who had previously used orthodontic appliances and had been submitted to previous previous treatment attempting exposure or traction of the canine. A process of scoring the methodological quality was used to identify which of the studies would be more suitable for evaluation. RESULTS: Seventeen articles met the inclusion criteria and the complete texts were evaluated. One article with low methodological quality was not considered and 16 were evaluated by qualitative evidence synthesis. Fourteen articles analyzed the technique of surgical exposure followed by orthodontic traction, 1 article evaluated the exposure technique only, and 1 presented an approach of comparison between the two techniques. CONCLUSION: The information analyzed presented good methodological quality ranging from moderate to high, and allowed one to conclude that in spite of presenting satisfactory results for impacted maxillary canines, there was insufficient evidence to support the use of the technique of surgical exposure and independent eruption.