Intrusive luxation of permanent teeth: a systematic review of factors important for treatment decision-making.

OBJECTIVES To conduct a literature review and assess the current strength of evidence of the available studies and to investigate factors important for treatment choice. METHODOLOGY Structured electronic and hand searches were performed, restricted to English records for all age groups. Only cohort studies comparing spontaneous eruption and surgical and orthodontic extrusion were assessed. Risk of bias assessment was made by the method introduced by the Cochrane collaboration and the Newcastle-Ottawa quality assessment scale for cohort studies, and the body of evidence was assessed by the GRADE approach. RESULTS One hundred seventeen studies were identified, but only three were suitable for inclusion; these were not meta-analyzed because of methodological and clinical heterogeneity. Spontaneous eruption had a low failure rate of 5-12%. CONCLUSION Given that infection can be controlled by endodontic therapy, it appears that spontaneous eruption results in the fewest complications in immature teeth, regardless of the degree of intrusion. Furthermore, there appear to be no significant differences between surgical and orthodontic extrusion in terms of adverse outcomes. Limitations of the majority of current cohort studies include selection bias (no confounding adjustment and no demonstration that outcomes were absent at the start of the study), reporting bias, and no information on whether investigators were blinded from the outcomes assessed. Furthermore, there is a serious indirectness in the current body of evidence regarding each outcome. Therefore, guidelines for treatment are currently not based on strong evidence.