Clinical outcomes of orthodontic traction–based treatment strategies for impacted maxillary central incisors: A systematic review

OBJECTIVES: To systematically identify, summarize, and qualitatively synthesize the available clinical evidence on orthodontic traction-based management strategies for impacted maxillary central incisors, with particular emphasis on treatment duration, eruption success, and periodontal outcomes. METHODS: A comprehensive literature search was conducted across six databases (PubMed®, Google Scholar, Embase®, Scopus®, Web of Science, and the CENTRAL). Randomized and non-randomized clinical studies evaluating orthodontic traction-based management strategies for impacted maxillary central incisors were included. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the Cochrane RoB 2.0 and ROBINS-I tools. The certainty of the evidence was evaluated using the GRADE approach. RESULTS: Six studies involving 264 patients were included in the analysis. The evidence suggests that active orthodontic intervention can achieve favourable eruption outcomes in selected clinical contexts. Treatment duration varied widely, ranging from approximately 10 to over 21 months, and was influenced by impaction height, root morphology, and patient age. Several studies suggested shorter treatment durations in protocols incorporating preoperative space creation and immediate traction. Closed-eruption techniques were frequently associated with favourable gingival outcomes, though labial bone loss around treated teeth was a common finding. The overall certainty of evidence was assessed as low for primary outcomes and very low for secondary outcomes, due to the risk of bias and heterogeneity in the included studies. CONCLUSIONS: Active orthodontic traction-based management strategies have been associated with favourable clinical outcomes in selected cases; however, the certainty of evidence remains low, and results should be interpreted cautiously due to heterogeneity in interventions, including surgical exposure, type of traction, and space creation protocols. Treatment efficiency may be influenced by creating preoperative space, and periodontal health should be a key consideration. The conclusions are based on low-certainty evidence, highlighting the need for more rigorous and long-term studies.