Journal of Biodentistry and Biomaterials

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ETIOLOGIA DA ERUPÇÃO ECTÓPICA EM DENTES PERMANENTES - REVISÃO

SISTEMÁTICA
Etiology of ectopic eruption in permanent teeth - A Systematic review

Milena Sierra Drumond da Costa1

Robson Campos Burigo1
Ana Flávia Bissoto Calvo2
Tamara Kerber Tedesco3
Thaís Gimenez3
José Carlos Pettorossi Imparato2

1- Aluno de Mestrado, Programa de Mestrado em Odontologia, área de Odontopediatria,

Centro de Pesquisas Odontológicas São Leopoldo Mandic, Faculdade São Leopoldo
Mandic.
2- Professor, Programa de Mestrado em Odontologia, área de Odontopediatria, Centro de
Pesquisas Odontológicas São Leopoldo Mandic, Faculdade São Leopoldo Mandic.
3- Professor Titular, Programa de Pós-Graduação em Odontologia, Universidade
Ibirapuera.

Autor para correspondência:

Ana Flávia Bissoto Calvo
Rua Dr. José Rocha Junqueira, n° 13, Ponte Preta
Campinas (SP), Brasil. 13045-755
E-mail: [email protected]

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RESUMO

Objetivo: Realizar uma revisão sistemática ABSTRACT

sobre a etiologia da erupção ectópica em
dentes permanentes. Materiais e Métodos: Objective: To perform a systematic review
Foram avaliados estudos publicados até about the etiology of ectopic eruption in
fevereiro de 2019 nas bases de dados PubMed permanent teeth. Materials and Methods: We
e Scopus. A literatura não-publicada foi evaluated studies published until February
realizada usando a plataforma OpenGray. Os 2019 in the PubMed and Scopus databases.
critérios de elegibilidade foram: (1) ser dentes Unpublished literature was performed using
permanentes; (2) ser um estudo clínico; e (3) the OpenGray platform. The eligibility criteria
ser sobre erupção ectópica. Dois revisores were: (1) to be permanent teeth; (2) be a
independentes participaram de todo o clinical study; and (3) be about ectopic
processo - triagem de estudos, extração de eruption. Two reviewers independently
dados e avaliação de risco de viés. A análise participated in the entire process - screening
dos dados foi realizada por uma descrição of studies, data extraction and risk of bias
qualitativa dos estudos incluídos. A avaliação assessment. Data analysis was done by a
metodológica e o risco de viés foram qualitative description of the included
realizados com ferramentas específicas para studies. Methodological evaluation and risk of
cada tipo de estudo: estudos de coorte e bias were carried out with specific tools for
estudos transversais. Resultados: Cinco each type of study: cohort studies and cross-
estudos foram incluídos em 504 artigos sectional studies. Results: Five studies were
avaliados inicialmente. Para os molares included from 504 articles initially evaluated.
superiores, há uma tendência para dentes For upper molars, there is a tendency for
maiores, variação no comprimento do arco larger teeth, variation in arch length (increase
(aumento ou diminuição), angulação mesial or decrease), mesial angulation of the tooth,
do dente, diminuição do ângulo ANB e decrease of ANB angle, and decrease of
diminuição da distância da tuberosidade maxillary tuberosity distance to the distal
maxilar ao aspecto distal do primeiro molar aspect of the maxillary first molar. For
superior. Para os caninos, os fatores são o canines, the factors are the vertical level of the
nível vertical do dente em relação ao plano tooth to the occlusal plane, distance and
oclusal, a distância e a angulação em relação angulation to the midline and the location of
à linha média e a localização do dente the ectopic tooth. A single study related a
ectópico. Um único estudo relacionou um genetic aspect, connecting ectopia to peg-
aspecto genético, conectando ectopia a shaped incisors and incisor-premolar
incisivos conóides e hipodontia incisivo-pré- hypodontia. Conclusion: The influence of
molar. Conclusão: A influência de fatores local factors on ectopic eruption is evident.
locais na erupção ectópica é evidente. However, more studies investigating the
Entretanto, mais estudos investigando a multifactorial etiology, with methodological
etiologia multifatorial, com qualidade quality, should be performed.
metodológica, devem ser realizados.
Descriptors: Tooth Eruption, Ectopic.
Descritores: Erupção Ectópica de Dente. /
/etiology. Dentition, Permanent.
etiologia. Dentição Permanente.

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INTRODUCTION MATERIALS AND METHODS

Dental eruption is closely related to This systematic review follows the

biological factors so disturbances during this guideline "Preferred reporting items for
process may be associated with genetic, systematic reviews and meta-analyzes
systemic or local factors 1. In the prevalence (PRISMA)" 18 for the writing.
of ectopic eruption, the upper canines are the Two reviewers independently
most affected, not considering the third participated in the entire process - screening
molars, for this reason they are the most of studies, data extraction and risk of bias
studied cases 2-5. assessment (MSDC and RCB). Discrepancies
In the literature, the predictive factors were solved by a third reviewer (TG).
for ectopic eruption are local factors and
genetic origin. About local factors, is Information sources
emphasized sagittal/transversal maxillary We investigated elegible studies until
alterations, position/angulation of the February 12th 2019 that addressed the
affected tooth and skeletal alterations 6, 8-12. In etiology of ectopic eruption in permanent
genetic factors, the presence of the same teeth. The databases used were PubMed and
disturbance in members of the same family Scopus. Unpublished literature was
and other concomitant dental anomalies such performed using the OpenGray platform and
as agenesis, microdontia and dental the references of the included articles were
transposition 13-17. manually verified.
Even with several studies in the area,
the etiology of the ectopic eruption remains Search details
controversial and not established. The It was developed in the PubMed
identification of the etiological factors of database based on the PICO question: "What
ectopic eruption is important to facilitate an are the etiological factors of ectopic eruption
early diagnosis of the affected patients 8, in permanent teeth?" using keywords and
which can prevent adverse effects such as Mesh Terms (Figure 1) and boolean operators
dental resorption and/or extensive OR and AND. The strategy was adapted to the
orthodontic treatments 7. other databases used.
Therefore, this study aimed to perform
a systematic review about the etiology of
ectopic eruption in permanent teeth.

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For studies with the same data set only

((((((((tooth eruption, ectopic[MeSH
the study considered more complete was
Terms]) OR Ectopic Tooth
included.
Eruption) OR Ectopic Tooth
Eruptions) OR Eruption, Ectopic
Data collect
Tooth) OR Eruptions, Ectopic Two reviewers (MSDC and RCB)
Tooth) OR Tooth Eruptions, independently selected and collected data in
Ectopic)) AND structured tables in Excel (Office 2016 for
((risk*[Title/Abstract] OR Windows). Conflicts or doubts were solved by
risk*[MeSH:noexp] OR risk a third researcher (TKT). Kappa value was

*[MeSH:noexp] OR cohort calculated after selection of the first 50

studies.
studies[MeSH Terms] OR
The information extracted was:
group[Text Word] OR groups[Text
authors, year, title, type of study, sample
Word] OR grouped [Text Word])))
number, site, age, gender, which tooth, which
Figure 1 - Search details for PubMed arch, ectopy diagnosis method, results and
database. outcomes evaluated.

Study selection and eligibility criteria Assessment of methodological quality

All the titles and summaries of studies Methodological appraisal was carried
were initially evaluated based on the out with specific tools 19 for each type of study:
inclusion criteria: (1) to be in human cohort studies and cross-sectional studies by
permanent teeth; and (2) be about ectopic two researchers (TG and AFBC). This tool is
eruption. used to assess the methodological quality of a
The full papers of the included studies study and to determine the extent to which a
were then read to ensure that: (1) were not study has addressed the possibility of bias in
clinical case reports, critical/narrative its design, conduct and analysis. It consists
reviews, opinion articles or letters to the in 11 (cohort) and 8 (cross-sectional)
editor; (2) were not about third molars; (3) questions with 4 possible answers each: yes,
normorreative patients were evaluated; (4) no, unclear and not applicable.
about etiological research; (5) performed some
diagnosis of ectopic eruption; (6) written in Data Synthesis
English.

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A qualitative description of the Synthesis of results

included studies was performed. A single study, through a familial
questionnaire, results in the genetic
RESULTS relationship of ectopic eruption with peg-
shaped incisors and incisor-premolar

Study selection hypodontia. The other studies reported local

The inclusion flow diagram of the aspects. For upper molars, there is a

studies is shown in figure 2. Medline/Pubmed tendency for larger teeth, variation in arch

and Scopus yielded 504 articles. Using length (increase or decrease), mesial

Pubmed as a reference, 168 were excluded by angulation of the tooth, decrease of ANB

duplicate. Thus, the two bases identified 336 angle, and decrease of maxillary tuberosity

unique articles. The OpenGray platform and distance to the distal aspect of the maxillary

manual search did not result in any articles. first molar. For canines, the factors are the

Based on the title and abstract, we excluded vertical level of the tooth to the occlusal plane,

66 more studies. 265 articles were excluded distance and angulation to the midline, the

after reading the full text, for reasons detailed location of the ectopic tooth, shorter and

in table 2. Thus, five studies remained for narrower palate and decreased arch length

analysis. (Table 1).

Study characteristics Assessment of methodological quality and

risk of bias
The year of publication ranged from
In cohort studies, sample recruitment
1983 to 2018. The most recent data collection
and identification of confounding factors, as
was in 2019. Four of the five articles used a
well as follow-up time, are not clearly shown.
control sample in the studies, composed of
And in the cross-sectional studies, the three
male and female subjects. The place of the
studies did not demonstrate or did not clearly
sample occurred at hospital, dental office and
demonstrate all the necessary information, as
university. These studies were conducted in
can be seen in Tables 2 and 3.
Sweden, Finland, Europe and South Korea.
The mean age of the patients ranged from 8.6
to 22.8 years. The teeth evaluated with
ectopic irruption were: upper canine, upper
first and second molar; through panoramic
radiography, lateral radiography and casts
analysis, a single study used a familial
questionnaire (see Table 1).
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Figure 2 - Flow diagram.

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DISCUSSION as dental resorption and / or extensive

orthodontic treatments 7. In cases with early
Despite the limited amount of studies diagnosis, perform less invasive procedures
included in this systematic review, there is a with the objective to prevent or intercept the
clear relationship of local factors to ectopic ectopic eruption, such as deciduous tooth
eruption, confirming these predictive factors extraction 20.

already presented in the literature 6, 8-12. In The suspicion of genetic relationship is

general terms, the spatial position on the also raised in this study 13, with peg-shaped
tooth in the arch can inform about the incisors and incisor-premolar hypodontia.
occurrence of the ectopic eruption. Except for Other previous studies have also cited this
third molars, the most affected teeth are relationship, starting from coincident dental
upper molars and canines. The cause of the anomalies and frequently associated with
eruptive disturbance in these teeth is related ectopic eruption, such as agenesia, peg-
to local factors, as the results of this shaped teeth, delayed teeth development. The
systematic review have included, among genetic etiology is well cited in the literature,
them, absence / excess of space in the dental but it is not studied in depth 13-17.

arch, dental angulation, changes in skeletal Perhaps, other studies with this
measurements, premature deciduous tooth approach can be carried out, in order to
loss. This infers that the upper teeth are more confirm or not the genetic relation. Since
affected because of a higher probability of there is a large number of reports of ectopic
such events occurring for the ectopic eruption in patients with cleft lip and palate
21-23. However, the methodology used in the
eruption.
However, the studies deal with certain single study found about genetic 13 it is not so
difficulties, considering that the dental good at the methodological quality,
eruption is a biological event that has a high considering that only a family questionnaire
number of variables involved, in other words, and clinical examination were used, genetic
it is difficult to identify the common patterns. sequencing could have been used to search
The local factors predictors can be for a specific marker for alteration. In
independent or still related, which is complex addition, it is necessary to consider the local
to dissociate, since the patients are in the confounding factors that these patients may
growth and development phase, which present, characteristics that they present and
demands its attendance. already related to ectopic eruption, such as
Knowing the etiological factors, much agenesis, peg-shaped teeth, supernumerary
can be done to patients, in order to avoid teeth and maxillary atresia.
irreversible damage in advanced cases, such

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For the studies included in this studies do not answer the requirements for
systematic review, methodological quality and high scientific evidence.
risk of bias are negative. The majority of the
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