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

• Periodontal status following treatment of labially impacted canines was reviewed.
• Excisional uncovering seems to result in a detrimental effect on the periodontium.
• An apically positioned flap seems to lead to periodontal outcomes similar to untreated teeth.
• Closed eruption's periodontal outcome has not been properly evaluated yet.
• No surgical technique can be supported over others in terms of periodontal health.

IntroductionGood 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.MethodsSearches 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.ResultsNinety-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.ConclusionsThe current literature is insufficient to determine which surgical procedure is better for periodontal health for uncovering labially impacted canines.