35- Open vs Closed Exposure - Which Do Patients Prefer
Show notes
Explore the differences between open and closed exposure techniques for impacted canines:
- Study Details: Conducted by universities in Oslo and Jankoping, involving 100 young patients.
- Pain & Discomfort: Open technique caused more initial pain but equalized post-dressing removal.
- Analgesics Use: More in closed group after suture removal due to chain irritation.
- Surgery Duration: Open exposure faster, especially without flap.
- Complications: Open technique had more minor issues but no infections in either group.
Closed technique is more comfortable initially and safer; open technique is quicker but needs informed patients due to possible discomfort.
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Show transcript
00:00:00: ever wondered which surgical method helps patients recover faster, open or closed exposure for canines.
00:00:08: Hey guys!
00:00:09: Today we're looking at a study that compared both techniques not just by results but how patients actually felt afterward.
00:00:18: Let's see which method offered an easier recovery, shorter procedure and fewer complications.
00:00:27: When we talk about exposing impacted canines the question often arises should We use an open or a closed technique?
00:00:36: A new randomized clinical trial from the universities of Oslo and John coping provides valuable answers to that question.
00:00:44: This was a carefully designed two center RCT Including one hundred young patients all under sixteen who needed exposure of palatably displaced Canine's.
00:00:56: Half received a closed surgical technique where the flap is lifted, a chain is bonded to canine and the flap sutured back.
00:01:04: The other half received an open technique in which the crown was uncovered left exposed with a surgical dressing allowing tooth to erupt spontaneously.
00:01:15: The authors wanted three things – how much pain or discomfort do patients experience?
00:01:22: How long does surgery take?
00:01:24: And how often do complications occur?
00:01:27: Pain and discomfort were measured with a visual analogue scale over the first three postoperative weeks.
00:01:34: The open technique clearly caused more pain and discomfort, about nine millimeters higher on the Varscale during surgery AND through the first postoperate week.
00:01:43: Interestingly once the dressing or sutures.
00:01:45: where removed the difference disappeared, analgesic use followed similar pattern.
00:01:51: After the operation, both groups took similar amounts of pain medication.
00:01:56: But after dressing or suture removal patients from close group actually used more energisics.
00:02:04: That probably reflects irritation caused by chain lying under healing mucosa.
00:02:09: When it came to surgery time open exposure was faster especially when performed without a flap.
00:02:17: This is particularly evident in unilateral cases.
00:02:21: The trade-off, however was a higher rate of minor complications mostly bleeding and loss of surgical dressings.
00:02:28: In contrast the closed technique showed fewer problems mainly some discomfort from chain attachment.
00:02:35: Importantly no infections were reported in either group.
00:02:40: From methodological point of view this trial is well conducted.
00:02:44: Randomization and allocation concealment were solid, data analysis was blinded.
00:02:50: And the sample size was adequate.
00:02:52: The main limitation was that surgeons couldn't be blinded in that open technique differed slightly between centers with or without flap elevation which could influence comparison.
00:03:03: Still the findings are credible and clinically relevant.
00:03:07: What does this mean for us?
00:03:11: The open technique saves operating time, but produces more early post-operative pain and bleeding.
00:03:19: The closed techniques take longer yet it is clearly more comfortable for patients during the crucial first recovery week and appears slightly safer overall.
00:03:29: In short, closed exposure may be a better option when patient comfort is priority.
00:03:36: Open exposure remains a valid alternative if time or anatomy favours a simpler approach, provided patients are well informed about possible discomfort.
00:03:45: For me this study underscores the importance of discussing recovery expectations with patients and parents before surgery.
00:03:53: We can now give evidence-based answers about how much discomfort to expect How long it will last?
00:03:59: And what complications might arise.
00:04:01: To summarize more pain and discomfort with open exposure in the first week.
00:04:17: Overall, the closed technique remains my preferred approach when exposing palatially displaced canines particularly for anxious young patients and parents who value a gentle recovery.
00:04:30: Thanks for watching!
00:04:31: I'm Dr.
00:04:31: Martin Baxman.
00:04:32: Let's bring science back to orthodontics.
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