Effectiveness of Orthodontic Procedures, Alternative or Adjunctive To Extraction of the Primary Canines, For Interceptive Management of Palatally Displaced Permanent Canines: A Systematic Review

Abstract

Although Rapid Maxillary Expansion (RME), Trans-Palatal Arch (TPA) and Cervical-pull Headgear (HG) have been suggested as interventions in the mixed dentition to increase the rate of normal eruption of the palatally displaced permanent canines (PDCs), existing knowledge on the subject has been inconclusive. The aim of this study was to investigate their effectiveness in an evidence-based manner. Search without restrictions for published and unpublished literature and hand searching took place. Data on the prevalence of physiologic PDCs eruption from randomized controlled trials (RCTs) that investigated the use of RME, TPA and HG alternatively or adjunctively to extraction of the primary canines were reviewed. The individual study risk of bias was assessed using the Cochrane Risk of Bias Tool. From the initially identified records, finally, data from 5 RCTs (at high risk of bias) were included, involving the analysis of 480 PDCs in total with a follow up period of 5 years. RME, TPA and HG, used alternatively or adjunctively to extraction of primary canines, can significantly increase the rate of normal eruption of PDCs in the long term compared to no intervention, while no difference was observed in comparison to extraction. Only when HG was used after the extraction of the primary canine, was a statistically significant benefit shown compared to the extraction of the primary canine only group. RME, TPA and HG used alternatively or adjunctively to extraction of primary canines can significantly increase the rate of normal eruption of PDCs compared to no intervention. However, when compared to extraction, no differences were noted overall. Further research and better study standardization are warranted.