Residents’ journal review

Interceptive management of palatally displaced canines

Alyammahi AS, Kaklamanos EG, Athanasiou AE. Effectiveness of extraction of primary canines for interceptive management of palatally displaced permanent canines: a systematic review and meta-analysis. Eur J Orthod 2018;40:149-56

Management of maxillary impacted canines requires a more complex and challenging treatment plan with generally greater cost and commitment. Thus, evidence-based information is needed regarding interceptive management of this condition. The practice of extracting maxillary deciduous canines to facilitate successful eruption of palatally displaced permanent canines has been promoted since the 1930s; yet the evidence from studies up to 2012 has been inconclusive. The authors of this systematic review and meta-analysis sought to analyze the quality of current evidence in randomized controlled trials supporting this practice. Fifteen databases were searched for studies of subjects in the mixed dentition with unilateral or bilateral palatally displaced maxillary permanent canines that compared, after 12 months of observation, the outcomes of extraction of deciduous canines with no treatment or delayed treatment. The risk of bias was assessed, the random-effects method of combining treatment effects was used for the meta-analysis, and the quality of the evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation approach. After initially identifying 2193 references, only 5 studies were chosen based on the inclusion criteria. The 5 studies included 214 patients followed for up to 48 months postintervention. The authors of all 5 studies found prevalences of successful canine eruption at 12 months after deciduous canine extraction. The conclusion of this review was that intervention in the mixed dentition of deciduous canine extraction may increase the likelihood between 50% and 69% of the successful eruption of palatally displaced canines in the long term. The small number of studies highlights the scarcity of relevant research and the need for better study standardization and well-designed randomized controlled trials.

Reviewed by Kaitlin Marsh

Posterior airway changes after orthognathic surgery

Gottsauner-Wolf S, Laimer J, Bruckmoser E. Posterior airway changes following orthognathic surgery in obstructive sleep apnea. J Oral Maxillofac Surg 2018;76.1093.e1-21

Maxillomandibular advancement (MMA) is a common treatment option for patients with obstructive sleep apnea (OSA), a disorder that affects up to 17% of men and 9% of women in the United States. OSA is frequently associated with decreased upper airway space and collapsibility of the upper airway, leading to hypoxemia. The authors of this systematic review aimed to compare the different methods of assessing the posterior airway space (PAS) in patients with OSA and investigate the correlation of PAS changes with polysomnography after orthognathic surgery. A PubMed search was performed to identify studies evaluating PAS radiographically in patients with OSA before and after MMA. All 15 studies included in the review reported decreased apnea-hypopnea index values after MMA surgery. The reviewers excluded 6 studies with patients who developed sleep apnea after MMA and did not have it preoperatively. Of the articles included in the review, 8 evaluated PAS using lateral cephalography, 3 used cone-beam computed tomography, 5 used conventional computed tomography, and 1 used magnetic resonance imaging. The lateral cephalogram was regarded as the most universal and consistent radiograph for measuring landmarks in the sagittal plane. The 3-dimensional studies varied in their definition of the inferior boundary of the PAS, making it difficult to compare them with similar studies. The changes in the apnea-hypopnea index values after surgery correlated with significant changes in most linear, areal, and volumetric PAS parameters. Current studies have clinical and methodologic diferences with regard to the definition of the PAS. There is a need for a standardized radiologic assessment of the PAS because it is difficult to compare the varying anatomic landmarks of this area when multiple parameters are evaluated.

Reviewed by Katherine Schwartz

Posterior airway changes after orthognathic surgery

Gottsauner-Wolf S, Laimer J, Bruckmoser E. Posterior airway changes following orthognathic surgery in obstructive sleep apnea. J Oral Maxillofac Surg 2018;76.1093.e1-21

Maxillomandibular advancement (MMA) is a common treatment option for patients with obstructive sleep apnea (OSA), a disorder that affects up to 17% of men and 9% of women in the United States. OSA is frequently associated with decreased upper airway space and collapsibility of the upper airway, leading to hypoxemia. The authors of this systematic review aimed to compare the different methods of assessing the posterior airway space (PAS) in patients with OSA and investigate the correlation of PAS changes with polysomnography after orthognathic surgery. A PubMed search was performed to identify studies evaluating PAS radiographically in patients with OSA before and after MMA. All 15 studies included in the review reported decreased apnea-hypopnea index values after MMA surgery. The reviewers excluded 6 studies with patients who developed sleep apnea after MMA and did not have it preoperatively. Of the articles included in the review, 8 evaluated PAS using lateral cephalography, 3 used cone-beam computed tomography, 5 used conventional computed tomography, and 1 used magnetic resonance imaging. The lateral cephalogram was regarded as the most universal and consistent radiograph for measuring landmarks in the sagittal plane. The 3-dimensional studies varied in their definition of the inferior boundary of the PAS, making it difficult to compare them with similar studies. The changes in the apnea-hypopnea index values after surgery correlated with significant changes in most linear, areal, and volumetric PAS parameters. Current studies have clinical and methodologic diferences with regard to the definition of the PAS. There is a need for a standardized radiologic assessment of the PAS because it is difficult to compare the varying anatomic landmarks of this area when multiple parameters are evaluated.

Reviewed by Katherine Schwartz

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Dec 10, 2018 | Posted by in Orthodontics | Comments Off on Residents’ journal review
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