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Strategies for Managing the Risk of Mucogingival Changes During Impacted Maxillary Canine Treatment.

ABSTRACT: Gingival recession is a frequent mucogingival defect in the adult population. It affects the esthetics and is related to hypersensitivity and a high risk of periodontal attachment loss. The connection between orthodontic treatment and periodontal health has been debated for a long time. A healthy periodontium can be preserved during safe orthodontic tooth movement even in patients with poor mucogingival anatomy. This article aimed to review the strategies around managing the risks of mucogingival and apical root changes owing to maxillary canine impaction, with a special focus on gingival recession and impacted maxillary canine treatment.Maxillary canines are the second most frequently impacted teeth after the third molars. They can be located in the labial or buccal aspect of the alveolar bone. If interceptive procedures fail, the next step is the challenging and time-consuming comprehensive orthodontic-surgical treatment. Determining the exact impacted canine location, its relation to the adjacent teeth and structures, the least invasive surgical approach, and the best path for traction are all a part of the standard diagnostic process. It has also been suggested that orthodontists should evaluate periodontal risks to achieve the best possible results. Clinical examination and cone beam computed tomography provide valuable information for the treatment plan that yields good results with a healthy periodontium.

SUBMITTER: El H

PROVIDER: S-EPMC7316479 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Project description:BackgroundThere are a few hypotheses for the origin of palatally impacted canines (PIC). Nevertheless, the results of different studies are controversial.ObjectiveConsidering the evidence available in the literature to determine the skeletal and dentoalveolar dimensions in patients with PIC using cone beam computed tomography (CBCT).Search methodsThis systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement. The literature search with no publication date restriction in five databases and hand searching was performed until April 2023.Data collection and analysisData assessing the skeletal and dentoalveolar characteristics of subjects with PIC evaluated with CBCT was extracted, and the studies' quality was evaluated with the Newcastle-Ottawa Scale (NOS). Skeletal and dentoalveolar characteristics of subjects with PIC were compared with non-impacted subjects or non-impacted sides. MedCalc software was used to perform the meta-analysis. Statistical heterogeneity was assessed using the chi-square and I-square tests.ResultsThe initial database search identified a total of 1153 studies. After applying the selection criteria, nine articles were included in the systematic review and meta-analysis. According to the NOS, all included articles were graded as "Good" quality. The meta-analysis showed a non-significant difference in measuring dentoalveolar height, alveolar first molar width, and basal lateral width. Controversial results were observed when evaluating both basal and alveolar first premolar widths. A significant difference was found when assessing anterior alveolar crest height and basal maxillary width.ConclusionsStudies demonstrated the reduction of both dentoalveolar and skeletal maxillary parameters of the patients with PIC. The meta-analysis indicated that PIC correlates to both vertical and transverse skeletal dimensions of the maxilla. However, the results remain controversial. The findings should be interpreted with caution due to different study designs and unbalanced groups in the included studies; therefore, further research is needed for more reliable conclusions.RegistrationThis systematic review and meta-analysis were registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42022362124).

Project description:BackgroundCaesarean sections (CS) account for 26% of all births in the UK, of which at least 5% are done at full dilatation, in the second stage of labour. Second stage CS may be complicated by the fetal head being deeply impacted in the maternal pelvis, requiring specialist skills to achieve a safe birth. Numerous techniques are used to manage impacted fetal head, however, there are no national clinical guidelines in the UK.AimTo explore health professionals' and women's views on the acceptability and feasibility of a randomised controlled trial (RCT) designed to explore approaches to managing an impacted fetal head during emergency CS.MethodsSemi-structured interviews with 10 obstetricians and 16 women (6 pregnant and 10 who experienced an emergency second stage CS). Interviews were transcribed and analysed using systematic thematic analysis.ResultsThe findings considered the time at which you obtain consent, how and when information about the RCT is presented, and barriers and facilitators to recruiting health professionals and women into the RCT. Obstetricians emphasised the importance of training in the techniques, as well as the potential conflict between the RCT protocol and current site or individual practices. Women said they would trust health professionals' to use the most appropriate technique and abandon the RCT protocol if necessary. Similarly, obstetricians raised the tension between the RCT protocol versus safety in reverting to what they knew under emergency situations. Both groups reflected on how this might affect the authenticity of the results. A range of important maternal, infant and clinical outcomes were raised by women and obstetricians. However, there were varying views on which of the two RCT designs presented to participants would be preferred. Most participants thought the RCT would be feasible and acceptable.ConclusionsThis study suggests an RCT designed to evaluate different techniques for managing an impacted fetal head would be feasible and acceptable. However, it also identified a number of challenges that need to be considered when designing such an RCT. Results can be used to inform the design of RCTs in this area.

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Strategies for Managing the Risk of Mucogingival Changes During Impacted Maxillary Canine Treatment.

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