Extraction of baby canine teeth for correcting poorly aligned adult canine teeth in children

Occasionally, permanent canine teeth (sometimes called eye teeth) do not erupt properly in the mouth. In around 3% of children, either one or both canines (left and right) remain buried under the gum in the roof of the mouth, out of alignment from the tooth's correct position (known as palatally displaced teeth).

If these permanent canine teeth remain displaced, they can cause problems such as damage to, or change the position of neighbouring teeth, and very occasionally lead to cyst formation or infection.

One possible treatment for this problem is to extract the primary (baby) canine in 10 to 13 year old children and hope that the buried canine corrects its alignment of its own accord (called spontaneous correction), by moving from a displaced position to the correct placement in the mouth.

This review looks at whether extracting palatally displaced canine teeth in children is successful in preventing further complications for patients. Only two of the studies found were considered suitable for inclusion, with a total of 125 participants. There were concerns about aspects of the design and reporting in both of the studies; therefore we have found no reliable evidence of the effects of extraction of the baby canine tooth or teeth. High quality clinical trials are required to guide decision making.

Authors' conclusions: 

There is currently no evidence of the effects of extraction of primary canine teeth in 10-13 year old children with one or two palatally displaced permanent canine teeth.

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Background: 

The permanent canine tooth in the maxillary (upper) jaw sometimes does not erupt into the mouth correctly. In about 1% to 3% of the population these teeth will be diverted into the roof of the mouth (palatally). It has been suggested that if the primary canine is removed at the right time this palatal eruption might be avoided. This is an update of a Cochrane review first published in 2009.

Objectives: 

To evaluate the effect of extracting the primary maxillary canine on the eruption of the palatally ectopic maxillary permanent canine.

Search strategy: 

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 20 April 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE via OVID (1946 to 20 April 2012) and EMBASE via OVID (1980 to 20 April 2012). There were no restrictions regarding language or date of publication.

Selection criteria: 

Trials were selected if they met the following criteria: a randomised or quasi-randomised controlled trial, involving the extraction of the deciduous maxillary canine and assessing eruption/non-eruption of the palatally displaced maxillary permanent canine.

Data collection and analysis: 

Data extraction was undertaken independently by two review authors. The primary outcome was the reported prevalence of eruption or non-eruption of the ectopic permanent canine into the mouth following observation or intervention. Results were to be expressed as risk ratios for dichotomous outcomes with 95% confidence intervals and mean differences for continuous outcomes. Heterogeneity was to be investigated, including both clinical and methodological factors. Authors of trials were contacted to request unpublished data.

Main results: 

Reports of two randomised controlled trials previously excluded from an earlier version of the review due to "deficiencies in reporting, insufficient data" have now been included. These two trials included approximately 128 children, with more than 150 palatally displaced canine teeth, and both were conducted by the same research group. Data presented in the trial reports are either incomplete or inconsistent. Both trials are at high risk of bias. It must be emphasised that both trials have serious deficiencies in the way they were designed, conducted, and reported, and attempts to contact the authors to obtain detailed information and clarify inconsistencies have been unsuccessful. Allocation to treatment appears to be at the level of the individual, but outcomes of successful treatment relate to included teeth and data are not reported for each treatment group. Adverse effects are not reported. Neither trial provides any evidence to guide clinical decision making.

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