Closed Versus Open Surgical Exposure of Palatally Displaced Canines: A Systematic Review and Meta-Analysis

Palatally displaced canines (PDCs) are a common orthodontic anomaly that frequently require surgical exposure to facilitate orthodontic alignment. Two primary techniques exist: open surgical exposure, where the canine is left to erupt spontaneously, and closed surgical exposure, where an attachment is bonded for immediate orthodontic traction. This meta-analysis aims to compare the efficacy of closed versus open surgical exposure for PDCs regarding pain, surgical time, complications, eruption time, and patient-reported outcomes. We systematically searched the following databases: PubMed, Cochrane Library, Scopus, and Web of Science. Studies were included if they compared open versus closed surgical exposure techniques for palatally displaced canines. R software was used for statistical analysis. Continuous outcomes were analyzed as mean differences (MD) or standardized mean differences (SMD) and dichotomous data as risk ratios (RR), with 95% confidence intervals (CI). Our review included six studies with 450 participants. Pooled analysis demonstrated that closed exposure was associated with significantly less pain at 1 day (SMD=-0.39, 95% CI -0.75 to -0.04) and less discomfort (SMD=-0.25, 95% CI -0.42 to -0.07). However, closed exposure required significantly longer surgical time (MD=5.09 minutes, 95% CI 1.35 to 8.82) and longer eruption time (MD=3.37 months, 95% CI 2.02 to 4.73). No significant differences were observed for analgesic consumption, gingival recession, or overall complications. Closed surgical exposure offers advantages in early postoperative pain and discomfort but requires longer surgical and eruption times. Both techniques appear comparable regarding complications and periodontal outcomes. The choice of technique should be individualized based on clinical factors, patient preference, and clinician expertise. Future large-scale RCTs with standardized protocols are warranted to further refine these findings.