Periodontal status after surgical-orthodontic treatment of labially impacted canines with different surgical techniques: A systematic review

Introduction Good periodontal status is essential for a successful treatment outcome of impacted maxillary canines. Whereas the surgical technique used for tooth uncovering has been shown not to affect the final periodontal status of palatally impacted canines, its effect on labially impacted canines is still unclear. Methods Searches of electronic databases through January 2015 and reference lists of relevant publications were used to identify studies evaluating the periodontal status of labially impacted canines after combined surgical-orthodontic treatment. Two reviewers independently screened the articles, extracted data, and ascertained the quality of the studies. Results Ninety-one studies were identified; 3 were included in the review. No included study examined the periodontal outcome of the closed eruption technique. Excisional uncovering was reported to have a detrimental effect on the periodontium (bleeding of the gingival margin, 29% vs 7% in the control group; gingival recession, -0.5 mm [SD, 1.0] vs -1.5 mm [SD, 0.8] in the control group; and width of keratinized gingiva, 2.6 mm [SD, 1.4] vs 4.1 mm [SD, 1.5] in the control group). Impacted canines uncovered with an apically positioned flap had periodontal outcomes comparable with those of untreated teeth. Conclusions The current literature is insufficient to determine which surgical procedure is better for periodontal health for uncovering labially impacted canines.