Orthodontic approach in dental trauma: systematic review and meta-analysis

Abstract

Introduction: There is a high prevalence of dental trauma in patients in need of orthodontic treatment, so it is important the knowledge about the orthodontic approach in cases of traumatized teeth. Thus, this study conducted a systematic review about orthodontic approach in dental trauma. Materials and Methods: Two investigators performed a systematic review with meta-analysis. MEDLINE/PubMed and Cochrane Library supplied relevant data from studies published between February 2004 and September 2015 on the relationship between dental trauma and orthodontic treatment. Results: Susceptibility to pulp necrosis was the dichotomous outcomes measure evaluated by risk ratio (RR) and the corresponding 95% confidence intervals (CI). The quality was evaluated using the Oxford Centre for Evidence-Based Medicine (EbM) guidelines. A search strategy and application of eligibility criteria enabled selection and evaluation of four studies on orthodontic treatment in traumatized teeth. In total, 1.696 patients (average age 11.6 years) with orthodontic treatment over 24.2 months were studied, and 484 had already suffered dental trauma and undergone orthodontic treatment. The primary observed sequelae after orthodontic treatment indicated greater susceptibility to pulp necrosis in traumatized teeth compared to no previous trauma. The patients with orthodontically treated traumatized maxillary incisors were more susceptible to pulp necrosis (RR: 7.6; 95% CI: 3.64 to 15.87; p= 0.00001) compared to patients with previous dental trauma to the maxillary incisors and no subsequent orthodontic treatment. Conclusion: There is no well-established protocol for these cases; such treatment must be careful and respect the healing period post-trauma, when these teeth are more susceptible to pulp necrosis and pulp obliteration. Descriptors: Tooth Injuries; Wounds and Injuries; Tooth Avulsion; Orthodontics, Corrective.

Evidence mapping and quality assessment of systematic reviews in dental traumatology

“…High ROB was observed in the majority of included SRs (n = 6) 17,39,41‐43,45 with one showing an unclear risk 32 . Two of the SRs with a priori registration showed high ROB 42,43 . Reporting error was found to be low in all of them except the study by Elkhadem et al 39 (Figures 4 and 5).…”

“…Out of the included SRs, the oldest one was published in 1999 12 and two were published between 2000 and 2010 16,17 . Forty‐four SRs had been published in last six years (2015‐2020) 18‐78 . Twenty‐eight of the SRs had been published in Dental Traumatology, 16,17,20‐27,29,30,36,39‐41,44,45,59,60,67,69,71,74,75,77,78 and five were from the Cochrane database 38,46,50,53,70 .…”

“…Among the SRs in the domain of Therapeutics, all belonged to the sub‐domain of treatment protocols for the permanent dentition 17,38‐46 . Two of these SRs were Cochrane reviews, 38,46 and three others had been registered in PROSPERO 42‐44 with the number of reviewers ranging from 2 to 7. Three SRs had search limits of language, 40,43,45 and two had restrictions of year and language 41,42 .…”

“…Two of these SRs were Cochrane reviews, 38,46 and three others had been registered in PROSPERO 42‐44 with the number of reviewers ranging from 2 to 7. Three SRs had search limits of language, 40,43,45 and two had restrictions of year and language 41,42 . The number of databases searched ranged from 1 to 8 with gray literature not searched in three of the included SRs 42,43,46 .…”

“…The domains of Therapeutics and Prognostics are inter‐related and comprised 45.3% of the included SRs 17,38‐65 . It was surprising to observe that within the domain of therapeutics, SRs were identified only in the sub‐domain of treatment protocols for the permanent dentition 17,38‐46 .…”