Table 5. Summary of findings (SoF) table according to the grades of recommendations, assessment, development, and evaluation (GRADE) approach to narrative synthesis.
| Certainty assessment | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| N. of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Publication bias |
Other factors: great magnitude effect | Impact | Certainty |
| Increased rate of canine eruption | |||||||||
| Abbreviations: NRCTs, nonrandomized controlled trials; RME, rapid maxillary expansion. a 4 studies: 3, 7, 13, 14. b 3 studies: 3, 7, 13. C 2 study: 7.13. d All the studies included showed risk of bias; they were NRCTs with great problems in relation to the effect of confounders, selection of participants, lack of blinding, reproducibility, and bias in selection of the result. e There was inconsistency in the estimates of the studies: two estimates were more in favor of eruption with agenesis and 1 estimative favored impaction with agenesis. One estimate favored RME before bone grafting. f The evidence came from studies with only two types of orthodontic treatments that were applicable to cleft lip and palate, limiting the applicability to other orthodontic treatments. g Based on the ideal size of the information (OIS), the number of events was lower than 300 for the dichotomous variable. h Suspicion of publication bias due to possible estimates not published which may not have been statistically significant. The outcomes demonstrated the effect of great magnitude for the estimates: large RR~50% and very large RR~80%. | |||||||||
| 4 a | NRCTs | Very serious d | Not serious | Not serious | Not serious | Strongly suspected h | Large effect i | All studies reported association between increase in rate of tooth eruption and bone graft. The individuals who received bone grafts before canine eruption had less experience of tooth impaction | Very low |
| Successful bone graft | |||||||||
| 4 a | NRCTs | Very serious d | Not serious | Not serious | Not serious | Strongly suspected h | Very large effect i | All studies reported greater experience of successful surgery. Two studies experienced unsuccessful surgery with need for reoperation | Low |
| Canine impacted due to agenesis of the lateral incisor | |||||||||
| 3 b | NRCTs | Very serious d | Very serious e | Not serious | Serious g | Strongly suspected h | Large effect i | The majority of the studies (2 out of 3) found association between the rate of canine impaction and agenesis of the lateral incisor. One study found that agenesis was not associated with tooth impaction | Very low |
| Effect of orthodontic treatment before and after bone graft surgery | |||||||||
| 2 c | NRCTs | Very serious d | Very serious e | Serious f | Serious g | Strongly suspected h | Large effect i | One study found that individuals submitted to RME before bone graft had greater gain of space in the maxilla and better response of tooth eruption. One study reporter higher level of experience of gain in space of the maxilla and response of tooth eruption with postgraft RME | Very low |