Closed vs open surgical exposure of palatally displaced canines: Patients’ perceptions of recovery, operating time, and complications—A 2-center randomized controlled trial

Abstract

Introduction

The objective of this trial was to compare, in a 3-week follow-up, patients’ perceptions of recovery, surgery time, and complications related to surgical exposure of palatally displaced canines (PDCs) with either the closed or the open techniques.

Methods

This study was a 2-center, 2-arm parallel randomized clinical trial with a 1:1 allocation ratio. A total of 100 participants with PDC from 2 university clinics, aged <16 years, with unilateral or bilateral PDCs with cusp tip position in sectors II-IV, were randomly allocated to either closed-exposure or open-exposure techniques. Outcomes related to surgery and surgery/dressing removal interventions were analyzed by blinded assessors. Patients’ perceptions during both interventions and the week postinterventions were evaluated using take-home questionnaires, which included 3 question types: visual analog scale (VAS) questions about pain/discomfort, binary questions about analgesic intake, and open questions about complications. Surgical duration and professional-reported complications were assessed in patient journals. Mixed models with random intercepts were used to examine the effects of treatment on VAS scores (Gaussian model) and the use of analgesics (logistic model). Linear regression was used to examine the effect of the treatment on the operation. Statistical significance was set at <0.05.

Results

A total of 92 participants were included with no baseline differences between the intervention groups. There were no significant differences in patient perceptions between the centers. The open approach showed higher VAS scores for pain (coefficient, 8.58 [95% confidence interval, 2.29-14.88]; P <0.01) and discomfort (coefficient, 9.15 [95% confidence interval, 2.33-15.98]; P <0.01) from the exposure operation onwards, with nonsignificantly higher scores for patients with bilateral than unilateral PDCs. No pain/discomfort score differences were observed between treatment groups or between patients with bilateral or unilateral PDCs at surgery/dressing removal intervention. There were no differences in analgesic intake after surgery, but there was significantly more consumption after suture/dressing removal with the closed technique. Overall, a shorter duration was observed for the open technique, particularly when no flap surgeries were performed. Few complications were detected and were more common in the open group.

Conclusions

There was more pain and discomfort in the open group during surgery and the following week; however, no difference was observed during suture/dressing removal or the week after. There was increased analgesic intake in the closed group after suture dressing removal. Open surgical exposure required a shorter time, particularly when no flap surgery was performed. Complications were sparse and more common in the open group.

Registration

ClinicalTrials.gov (NCT05067712)

Protocol

Published before trial commencement.

Funding

University of Oslo.