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Ross G, Abu Arqub S, Mehta S, Vishwanath M, Tadinada A, Yadav S, Upadhyay M. Estimating the 3-D location of impacted maxillary canines: A CBCT-based analysis of severity of impaction. Orthod Craniofac Res 2023; 26:81-90. [PMID: 35478265 DOI: 10.1111/ocr.12581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/05/2022] [Accepted: 04/20/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The objective of the study was to quantify the 3-D location of impacted canines by measuring their linear and angular deviations in relation to adjacent structures and further evaluate impaction severity. METHODS CBCT images of 314 impacted canines were analysed in the sagittal, coronal and axial planes. Linear and angular measurements were recorded. Canine inclination was identified in coronal and sagittal planes. An evaluation system was constructed for analysis. Upright canine was considered as the appropriate position for fully erupted maxillary canine. Outcomes were compared between right and left sides and by gender. For categorical variables, chi-square tests were used while Mann-Whitney U test was used for continuous variables. Regression models were used to measure severity. RESULTS Impactions were greater in females (119/207; 57.5%). No significant differences between unilateral (100/207; 49.3%) and bilateral (107/207; 51.7%) (P > 0.05). Out of 314 impactions, 105 (33.4%) were mild, 118 (37.58%) moderate and 91 (28.98%) severe. Severe impactions were primarily buccal (44/ 91; 48.3%), in the occlusal ½ of the adjacent incisor root (38/ 91, 41.7%), mesial to the distal border of central incisor (47/91, 51.6%), with sagittal angle value + >45 ̊ (46/ 91, 50.5%) and mesial tip + >30 ̊ (86/ 91, 94.5%). CONCLUSIONS Severely impacted canines had their crowns buccal, closer to occlusal plane and mesial to the distal border of the central incisor with greater than 45-degree buccal inclination and greater than 30-degree mesial tip. The sagittal angle can have a significant impact on the severity of impaction. A new classification system was proposed to quantify severity.
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Affiliation(s)
- Greg Ross
- Private Practice, Orthodontics of South Miami, South Miami, Florida, USA
| | - Sarah Abu Arqub
- Division of Orthodontics, University of Connecticut Health, Farmington, Connecticut, USA
| | - Shivam Mehta
- Department of Developmental Sciences/Orthodontics, Marquette University School of Dentistry, Milwaukee, Wisconsin, USA
| | - Meenakshi Vishwanath
- Department of Growth and Development, Orthodontic Center, University of Nebraska Medical Center, College of Dentistry, Lincoln, Nebraska, USA
| | - Aditya Tadinada
- Associate Dean for Graduate Research, Program Director of the Oral and Maxillofacial Radiology, Director of Student Research University of Connecticut Health, Farmington, Connecticut, USA
| | - Sumit Yadav
- Division of Orthodontics, University of Connecticut Health, Farmington, Connecticut, USA
| | - Madhur Upadhyay
- Division of Orthodontics, University of Connecticut Health, Farmington, Connecticut, USA
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Sharhan HM, Almashraqi AA, Al-fakeh H, Alhashimi N, Abdulghani EA, Chen W, Al-Sosowa AA, Cao B, Alhammadi MS. Qualitative and quantitative three-dimensional evaluation of maxillary basal and dentoalveolar dimensions in patients with and without maxillary impacted canines. Prog Orthod 2022; 23:38. [PMID: 36274114 PMCID: PMC9588850 DOI: 10.1186/s40510-022-00434-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background This study aimed to three-dimensionally evaluate the qualitative and quantitative maxillary basal, dentoalveolar, and dental dimensions in patients with unilateral or bilateral maxillary impacted canines relative to their normal peers.
Materials and methods This is a retrospective comparative study. Cone-beam computed tomography images of one hundred and fifty adult patients were divided into three equal groups: unilateral, bilateral, and control groups. Each had 50 patients that were three-dimensionally analysed. The quantitative measurements involved three basal (molar basal width, premolar basal width, and arch depth), seven dentoalveolar (molar alveolar width, premolar alveolar width, inter-molar width, inter-premolar width, inter-canine width, arch length, and arch perimeter), and two dental (canine length and width) measurements. The qualitative measurements included four bone density areas (buccal, lingual, mesial, and distal) around the maxillary impacted canines. Result Differences between the three groups were statistically different for the quantitative measurements involving the two basal variables (molar basal width and premolar basal width) and all measured dentoalveolar variables; these were smaller in the unilateral and bilateral groups compared with the control group (p < 0.001). Unilateral and bilateral impacted canine groups showed significantly wider and shorter canines than the control group (p < 0.001). The qualitative measurements (the four bone density areas) around unilateral and bilateral impacted canine groups showed significantly greater density than the control group (p < 0.001). There was no significant qualitative or quantitative difference between the unilateral and bilateral impacted canines. The three groups had no significant variations in terms of arch depth. Conclusion Maxillary unilateral and bilateral canine impactions are associated with reduced basal and dentoalveolar dimensions as well as wider and shorter maxillary canines compared to normal peers. The quality of bone around unilateral and bilateral impacted maxillary canines is higher than in non-impacted cases. Unilateral and bilateral canine impactions have quite similar qualitative and quantitative parameters.
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Mousa MR, Hajeer MY, Burhan AS, Heshmeh O. The Effectiveness of Conventional and Accelerated Methods of Orthodontic Traction and Alignment of Palatally Impacted Canines in Terms of Treatment Time, Velocity of Tooth Movement, Periodontal, and Patient-Reported Outcomes: A Systematic Review. Cureus 2022; 14:e24888. [PMID: 35572459 PMCID: PMC9097934 DOI: 10.7759/cureus.24888] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 01/24/2023] Open
Abstract
The objective of the current review was to evaluate the effectiveness of traditional and accelerated methods of palatally impacted canine's (PIC) traction in terms of treatment duration, velocity, periodontal, and patient-reported variables. An electronic search for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) published between January 1990 and October 2021 was conducted in nine databases. Five major orthodontic journals were hand searched for additional studies. The participants were patients with unilateral or bilateral PICs who received conventional or accelerated orthodontic treatment with fixed appliances. Cochrane’s risk of bias tool (RoB 2 tool) for RCTs and ROBINS-I tool for CCTs were used to assess the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines were used to assess the overall quality of the evidence. Nine articles (eight RCTs and one CCT) were included in this review (371 patients). There was no clarity in most studies about the possible effect of the mechanical traction method on treatment outcomes. The treatment duration decreased (about three to six months) when the open surgical method was used with traditional techniques and the traction velocity increased significantly (about 1-1.5 mm/month) when acceleration methods were used. No significant differences were found between the conventional intervention groups, as well as between the traditional and accelerated groups, in terms of most periodontal variables (p > 0.005). No significant differences were found in the pain levels associated with traditional PICs' traction when comparing different exposure methods in the short-term follow-up (1-10 days), while contradictory results were found in the pain incidence between these methods. The relationship between the pain/discomfort levels and the type of mechanical traction method was not evaluated. According to the GRADE, the quality of evidence supporting these findings ranged from low to very low. The combination of the open surgical technique with various designs of either superelastic wires or elastic traction means can lead to a reduction in the orthodontic treatment duration of PICs. The use of direct anchorage by miniscrews to move the PICs away from the adjacent teeth roots can lead to a reduction in root resorption and shorten the treatment duration. The evidence supporting these findings ranged from low to very low. The use of different types of mechanical means for conventional PICs' traction, with the use of open or closed traction techniques, does not lead to significant differences in periodontal outcomes between intervention groups. Contradictory results exist regarding the severity of the perceived pain in relation to the surgical exposure type, and the relationship between this variable and the mechanical traction method is still unclear. The use of accelerated methods for PICs' traction can lead to an increase in the velocity of traction movement with no significant differences in periodontal outcomes between accelerated and conventional methods. The evidence supporting these findings ranged from low to very low. More high-quality randomized CCTs are needed to establish good evidence in this field. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42021274476) during the first stages of this review.
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Affiliation(s)
- Mahran Raheel Mousa
- Department of Orthodontics, Faculty of Dentistry, Damascus University, Damascus, SYR
| | - Mohammad Y Hajeer
- Department of Orthodontics, Faculty of Dentistry, Damascus University, Damascus, SYR
| | - Ahmad S Burhan
- Department of Orthodontics, Faculty of Dentistry, Damascus University, Damascus, SYR
| | - Omar Heshmeh
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Damascus University, Damascus, SYR
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Calil LR, Janson G, Silva VMD, Freitas MRD, Almeida ALPFD, Garib D. Periodontal status of maxillary central incisors after orthodontic traction: a longitudinal follow-up. J Appl Oral Sci 2022; 30:e20210492. [PMID: 35352790 PMCID: PMC8983035 DOI: 10.1590/1678-7757-2021-0492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/04/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the clinical and radiographic periodontal status of impacted permanent maxillary central incisors (Mx.1) after a long term of orthodontic traction. METHODOLOGY This split-mouth study evaluated a sample of 11 patients (five females, six males) treated with Mx.1 unilateral traction one to 28 years after the removal of orthodontic appliances. The traction Group (TG) consisted of 11 Mx.1 and the Comparison Group (CG) comprised 11 spontaneously erupted contralateral Mx.1. High-resolution CBCT exams of central incisors were performed using Accuitomo (J. Morita, Kyoto, Japan). Cross-section imagens passing through the center of maxillary central incisors were used to measure buccal and lingual alveolar bone level. Presence of fenestration, root dilacerations, root coverage, and position of the root apex were also assessed in the same images. Clinical parameters included periodontal probing depth, attachment level, gingival bleeding index, plaque index, degree of gingival recession, amount of gingival mucosa, and evaluation of interproximal papilla and black triangle. Digital model analysis included an assessment of clinical crown height and width. Intergroup comparisons were performed using paired t-, McNemar's, and Wilcoxon tests (p<0.05). RESULTS Compared to CG, we found a significantly thinner labial bone plate thickness in TG at the middle (p=0.000) and apical (p=0.009) root level. We also observed an apical displaced labial bone crest level in TG (p=0.000). The Traction Group showed a greater frequency of root dilacerations and gingival recessions, a decreased amount of keratinized mucosa, and a decreased clinical attachment level at the labial aspect compared to contralateral teeth. CONCLUSIONS A decreased thickness and height of labial alveolar bone and gingival recessions were found in maxillary central incisors 15 years after orthodontic traction. Though incisor traction might cause some periodontal impact, differences are acceptable under a clinical point of view considering the cost-benefit ratio.
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Affiliation(s)
- Louise Resti Calil
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Bauru, São Paulo, Brasil
| | - Guilherme Janson
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Bauru, São Paulo, Brasil
| | - Vinicius Merino da Silva
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Bauru, São Paulo, Brasil
| | - Marcos Roberto de Freitas
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Bauru, São Paulo, Brasil
| | | | - Daniela Garib
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Bauru, São Paulo, Brasil
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Gómez Meda R, Abella Sans F, Esquivel J, Zufía J. Impacted maxillary canine with curved apex: Three-dimensional guided protocol for autotransplantation. J Endod 2021; 48:379-387. [PMID: 34929261 DOI: 10.1016/j.joen.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/08/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Maxillary canines play a crucial role in dental and facial aspect, arch expansion, and efficient occlusion. When surgical exposure measures cannot be executed or the patient does not agree to take the treatment, autotransplantation should be considered. The aim of this case report was to describe a novel surgical technique using virtually planned three-dimensional(3D)-printed templates for guided apicoectomy and guided drilling of the recipient site for an autotransplantation of an impacted maxillary canine with a curved apex. METHODS A 42-year-old male complaining of pain and increased mobility in the maxillary left primary canine came to the clinic. Autotransplantation of the impacted canine was completed using altered methods from guided implant surgery to manufacture 3D-printed templates. Following a full-thickness mucoperiosteal flap elevation, the surgical template for the guided osteotomy and apicoectomy was inserted. This 3D-printed guided allowed the clinician to perform a quick and precise removal of the curved apex, providing an atraumatic extraction of the impacted canine throughout the cyst. Three further 3D surgical guides for implant burs and a 3D replica tooth were printed to modify the recipient socket. After the final position, the tooth was semi-rigid splinted to the adjacent teeth. RESULTS Follow-up at 2 years showed complete regeneration of the palatal defect and remodeling of the bone surrounding the maxillary canine. CONCLUSIONS Digitally planned procedures can facilitate the complex execution of an autotransplantation reducing the treatment chair-time and the morbidity for the patient as well as increasing the predictability of the result.
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Affiliation(s)
| | - Francesc Abella Sans
- Department of Endodontics, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.
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Annarumma F, D'Emidio M, Rodi G, Battista G, Papi G, Migliorati M. The effectiveness of miniscrews in the three-dimensional control of a palatal impacted canine: "Canine Only" approach. Case report. Int Orthod 2021; 19:716-725. [PMID: 34728159 DOI: 10.1016/j.ortho.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/26/2021] [Indexed: 11/19/2022]
Abstract
Treatment time and mechanics required to solve palatally impacted canines are usually challenging. Different biomechanics and protocol approaches are available, and among these, the use of skeletal anchorage as reactive unit can be noteworthy. The purpose of this article is to show a treatment of a palatally impacted canine by the means of a double miniscrew and cantilever system only. Two miniscrews with bracket heads were applied in a 16 years old patient; different cantilevers were used to solve the impaction and bring the canine in the right position. Results: the impacted canine was successfully moved into proper position with good three-dimensional control. Both miniscrews worked successfully as anchorage for the entire treatment. The palatally impacted canine was successfully treated utilizing two miniscrews and cantilever approach.
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Affiliation(s)
| | | | | | | | - Giulia Papi
- Genova University, Orthodontic Department, Italy.
| | - Marco Migliorati
- Genova University, Adjunct Prof. Orthodontics, Italy Largo R. Benzi 10, 16100 Genova, Italy
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7
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Björksved M, Ryen L, Lindsten R, Bazargani F. Open and closed surgical exposure of palatally displaced canines: a cost-minimization analysis of a multicentre, randomized controlled trial. Eur J Orthod 2021; 43:498-505. [PMID: 34386824 DOI: 10.1093/ejo/cjab052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate the costs of open and closed surgical exposure and subsequent orthodontic treatment for the correction of palatally displaced canines (PDCs). TRIAL DESIGN A multicentre, two-arm parallel group randomized controlled trial. METHODS One hundred twenty adolescents between 9 and 16 years of age, from three orthodontic specialist centres, were randomized to one of the two surgical exposure interventions. The randomization was conducted according to a two-arm parallel group 1:1 allocation ratio, using computerized lists with block randomization. In both the surgical techniques, whole mucoperiosteal flaps were raised, and bone covering the PDCs was removed. In the open technique, glass ionomer was built up on the PDC crown - reaching above the mucosa through a hole punched in the flap - to allow the canine to erupt autonomously. After eruption, the canine was orthodontically moved above the mucosa. In the closed technique, an eyelet was bonded onto the PDC, the flap was repositioned and the canine was orthodontically moved beyond the mucosa. The trial ended when the PDC was successfully aligned in the dental arch.Cost analysis was performed including costs for surgery, orthodontic treatment, emergency visits, and material, as well as costs for transports and time spent in connection with every appointment. BLINDING Patients and caregivers could not be blinded due to obvious limitations of the clinical setting, while outcome assessors and data analysts were blinded. RESULTS A cost-minimization analysis was performed since both exposure groups succeeded equally well in terms of treatment effects. The two different surgical exposures and following orthodontic treatments did not differ significantly in terms of costs. GENERALIZABILITY AND LIMITATIONS Costs are estimated in the Swedish setting, which needs to be considered if applying the results in other settings. Calculations of total cost do not include finishing, debonding, retention, and follow-up. CONCLUSION There is no significant difference in costs between closed and open surgical exposure with following orthodontic treatments in PDCs. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02186548.
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Affiliation(s)
- Margitha Björksved
- Department of Orthodontics, Public Dental Health Service, Eskilstuna, Sweden.,Postgraduate Dental Education Center, Department of Orthodontics, SE-701 11 Örebro, Sweden.,School of Medical Sciences, Örebro University, SE-701 82, Sweden
| | - Linda Ryen
- University Health Care Research Center, Örebro University, SE-701 82, Sweden
| | - Rune Lindsten
- The Institute for Postgraduate Dental Education, Department of Orthodontics, SE-551 11 Jönköping, Sweden.,Centre for Oral Health, School of Health and Welfare, Jönköping University, Sweden
| | - Farhan Bazargani
- Postgraduate Dental Education Center, Department of Orthodontics, SE-701 11 Örebro, Sweden.,School of Medical Sciences, Örebro University, SE-701 82, Sweden
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Björksved M, Arnrup K, Bazargani SM, Lund H, Magnusson A, Magnuson A, Lindsten R, Bazargani F. Open vs closed surgical exposure of palatally displaced canines: a comparison of clinical and patient-reported outcomes-a multicentre, randomized controlled trial. Eur J Orthod 2021; 43:487-497. [PMID: 34114630 DOI: 10.1093/ejo/cjab015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To compare treatment time, patients' perceptions during orthodontic treatment, dental fear and side effects, between open and closed surgical exposures in patients with palatally displaced canines (PDCs). TRIAL DESIGN Multicentre, randomized controlled trial, with random 1:1 allocation of two parallel groups. MATERIALS AND METHODS One hundred and twenty patients from three different orthodontic centres were randomized into one of the two intervention arms, open or closed surgical exposure. Both techniques had mucoperiosteal flaps raised and bone removed above the PDCs. In open exposure, tissue was removed above the canine, and glass ionomer - reaching above soft tissue - was built on the crown. The canine was then left to erupt spontaneously, prior to orthodontic alignment. At closed exposure, a chain was bonded to the canine and orthodontic traction was applied under the mucosa until eruption. Orthodontic alignment of the canines was undertaken after eruption into the oral cavity, with fixed appliances in both groups. All participants were treated according to intention to treat (ITT). BLINDING Due to the nature of this trial, only outcome assessors could be blinded to the intervention group. RESULTS One hundred and seventeen patients completed the trial. All PDCs were successfully aligned. Total treatment time was equal in the two techniques, mean difference -0.1 months (95% CI -3.2 to 2.9, P = 0.93). The closed group experienced more pain and discomfort during the active orthodontic traction. Dental fear, root resorption and periodontal status did not show any clinically significant differences between the groups. GENERALIZABILITY Results of this randomized controlled trial (RCT) can be generalized only to a similar population aged 9-16 years, if exclusion criteria are met. CONCLUSION The closed exposure group experienced more pain and discomfort mostly during active orthodontic traction. All other studied outcomes were similar between the two exposure groups. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02186548 and Researchweb.org, ID: 127201.
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Affiliation(s)
- Margitha Björksved
- Department of Orthodontics, Public Dental Health Service, Eskilstuna, Sweden.,Postgraduate Dental Education Centre, Department of Orthodontics, Örebro, Sweden
| | - Kristina Arnrup
- Dental Research Department, Public Dental Service, Region Örebro County, Örebro, Sweden.,School of Health Sciences, Örebro University, Örebro, Sweden
| | - Silvia Miranda Bazargani
- Postgraduate Dental Education Center, Department of Oral and Maxillofacial Radiology, Örebro, Sweden
| | - Henrik Lund
- Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Department of Oral and Maxillofacial Radiology, Göteborg, Sweden
| | - Anders Magnusson
- The Institute for Postgraduate Dental Education, Department of Orthodontics, Jönköping, Sweden
| | - Anders Magnuson
- Statistician, Clinical Epidemiology and Biostatistics Unit, Orebro University Hospital, Orebro, Sweden
| | - Rune Lindsten
- Postgraduate Dental Education Center, Department of Oral and Maxillofacial Radiology, Örebro, Sweden.,The Institute for Postgraduate Dental Education, Department of Orthodontics, Jönköping, Sweden
| | - Farhan Bazargani
- Postgraduate Dental Education Center, Department of Oral and Maxillofacial Radiology, Örebro, Sweden.,School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Grisar K, Fransen J, Smeets M, Hoppenreijs T, Ghaeminia H, Politis C, Jacobs R. Surgically assisted orthodontic alignment of impacted maxillary canines: A retrospective analysis of functional and esthetic outcomes and risk factors for failure. Am J Orthod Dentofacial Orthop 2021; 159:e461-e471. [PMID: 33785231 DOI: 10.1016/j.ajodo.2020.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/01/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The initial position of an impacted maxillary canine might influence the outcome of surgically assisted exposure and orthodontic alignment. Therefore, the purpose of this study was to evaluate existing correlations between the initial position of the maxillary canine and the outcomes of treatment. METHODS A retrospective cohort study was designed, containing data of 132 patients (47 males, 106 females; median age at the date of surgical exposure 14 ± 4.6 years; range, 10-39 years) with a total of 153 impacted maxillary canines. The sample was based on orthodontic referrals over 4 years at the Department of Oral and Maxillofacial Surgery, Rijnstate Hospital, Arnhem, the Netherlands. The esthetic outcome, treatment duration, and success and failure rate were investigated in relation to the initial position of the maxillary canine as assessed on pretreatment panoramic radiographs (vertical and anteroposterior sector position and angulation of the canine [α-angle]). The esthetic evaluation was performed using the Maxillary Canine Aesthetic Index. The success of treatment was defined as achieving a fully functional eruption of the canine, with an esthetically excellent result, without the need for reinterventions. Failure of treatment was defined as the need for reintervention or removal of the canine. RESULTS In 96% of the impacted canines, a successful orthodontically assisted eruption was achieved. Age, vertical distance, and angulation are predictors of the esthetic outcome of impacted canines after treatment. Age, bilateral impaction, sector, vertical distance, and angulation are predictors of treatment duration. Age, vertical distance, and buccolingual position are predictors of the need for reintervention. CONCLUSIONS Pretreatment radiographic variables can help in predicting the outcome and treatment duration of surgically exposed maxillary impacted canines.
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Affiliation(s)
- Koenraad Grisar
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, and Department of Oral and Maxillofacial Surgery, Leuven University Hospitals, Leuven, Belgium.
| | - Jasper Fransen
- Department of Oral and Maxillofacial Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Max Smeets
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, and Department of Oral and Maxillofacial Surgery, Leuven University Hospitals, Leuven, Belgium
| | - Theo Hoppenreijs
- Department of Oral and Maxillofacial Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Hossein Ghaeminia
- Department of Oral and Maxillofacial Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, and Department of Oral and Maxillofacial Surgery, Leuven University Hospitals, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, and Department of Oral and Maxillofacial Surgery, Leuven University Hospitals, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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10
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Baruah DJ, Marikenchannanavar A, Durgekar SG. Mini-implant and Modified Nance Button Assisted Alignment of a Horizontally Impacted Maxillary Canine - A Case Report. Turk J Orthod 2021; 34:68-75. [PMID: 33828881 PMCID: PMC7990279 DOI: 10.5152/turkjorthod.2021.20051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/05/2020] [Indexed: 11/22/2022]
Abstract
Orthodontic alignment of a horizontally impacted canine placed high and deep in the maxilla represents a challenging clinical scenario. This article describes a case report of a 16-year-old postpubertal male patient who was concerned about an unesthetic smile. The clinical and radiographic investigations revealed that the patient had retained deciduous canines and bilaterally impacted maxillary canines. The right impacted canine had a good prognosis. The left canine was horizontally impacted in the labial side with a Kau-Pan-Gallerano index score of 19, which indicates a "difficult" degree of treatment. The initial treatment plan was application of distal traction to the impacted left canine from reinforced anchorage unit to change its inclination from horizontal to vertical before erupting it toward occlusion. In this case report, we demonstrated the use of a mini-implant and a modified Nance button-assisted forced eruption of an impacted canine. The 12-month follow-up review showed that the results were maintained during the time, and the previously impacted teeth showed intact gingival attachments. A conservative surgical exposure of the impacted canine and well-planned biomechanics helped us achieve a desirable, esthetic outcome.
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Affiliation(s)
- Dip Jyoti Baruah
- Clinical practitioner, Pearly White Multispeciality Dental Clinic and Orthodontic Centre, Assam, India
| | - Aravind Marikenchannanavar
- Department of Orthodontics and Dentofacial Orthopaedic, K.L.E. Society’s Institute of Dental Sciences and Hospital, Bangalore, Karnataka, India
| | - Sujala Ganapati Durgekar
- Department of Orthodontics and Dentofacial Orthopaedic, K.L.E. Society’s Institute of Dental Sciences and Hospital, Bangalore, Karnataka, India
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Nonsurgical treatment of an adult with skeletal Class III malocclusion, anterior crossbite, and an impacted canine. Am J Orthod Dentofacial Orthop 2021; 159:522-535. [PMID: 33485716 DOI: 10.1016/j.ajodo.2020.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/01/2020] [Accepted: 01/01/2020] [Indexed: 10/22/2022]
Abstract
Class III malocclusion presents some complexity in terms of diagnosis and treatment and affects not only the jaws but the whole craniofacial complex. Besides, functional forward displacement of the mandible may be diagnosed in a patient presenting Class III malocclusion, as the 2 entities are not incompatible or mutually exclusive. This case report describes the multidisciplinary, nonsurgical, orthodontic treatment of an adult patient with a skeletal Class III malocclusion, anterior crossbite, and a palatally impacted canine, treated with fixed appliances and skeletal anchorage. To upright the mandibular molars, distalize the whole mandibular arch, and avoid excessive inclination of maxillary incisors to improve dentofacial esthetics, miniscrews were placed in the retromolar area. The treatment results were very satisfactory and remained stable after a reasonable retention period.
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Ardakani MP, Nabavizadeh A, Iranmanesh F, Hosseini J, Nakhaei M. Relationship of Angulation of Maxillary Impacted Canines with Maxillary Lateral Incisor Root Resorption. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2021. [DOI: 10.1590/pboci.2021.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Rodríguez-Cárdenas YA, Arriola-Guillén LE, Ruíz-Mora GA, Aliaga-Del Castillo A, Boessio-Vizzotto M, Dias-Da Silveira HL. Root changes in buccal versus palatal maxillary impacted canines of adults: A longitudinal and retrospective 3-dimensional study before and after orthodontic traction. Int Orthod 2020; 18:490-502. [PMID: 32513608 DOI: 10.1016/j.ortho.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Maxillary impacted canines (MIC) could suffer root changes after canine traction. The aim of this study was to evaluate the 3-dimensional root changes in buccal versus palatal MIC after orthodontic traction. MATERIALS AND METHODS This longitudinal and retrospective study included pre-treatment and after traction cone beam computed tomography scans (CBCTs) of 30 subjects with unilateral/bilateral MIC. A total of 43 MIC were divided into 2 groups: buccal (n=17) or palatal (n=26). Root changes in length and area after orthodontic traction were measured at sagittal, coronal and axial sections. Intergroup comparison was carried out by t or U Mann-Whitney tests, depending on normality. Multiple linear regression analysis was used to evaluate the influence of all predictor variables on root changes (P<0.05). RESULTS Significant difference between groups was found for root area changes in the upper limit of the cervical third at axial section that showed greater appositional values for the palatal impacted canine group (-1.18mm2) and resorptive values for the buccal impacted canine group (0.62mm2) (P=0.024). Position of impaction palatal influenced the increase of root area in the coronal section and in the upper limit of the cervical third at axial section. Age directly influenced the decrease of total length and root area in sagittal and coronal sections, respectively. CONCLUSION Orthodontic traction of MIC produced an important appositional root change in the palatal impaction group in the axial root area of the upper limit of the cervical third. Impaction position and age influenced the increase and decrease of root area and length of some specific radicular regions.
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Affiliation(s)
| | - Luis Ernesto Arriola-Guillén
- Division of Orthodontics and Division of Oral and Maxillofacial Radiology, School of Dentistry, Universidad Científica del Sur, Lima, Peru.
| | - Gustavo Armando Ruíz-Mora
- Division of Oral and Maxillofacial Radiology, School of Dentistry, Universidad Científica del Sur, Lima, Peru
| | - Aron Aliaga-Del Castillo
- Department of Orthodontics. Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | - Mariana Boessio-Vizzotto
- Division of Oral Radiology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Heraldo Luis Dias-Da Silveira
- Division of Oral Radiology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Lena Sezici Y, Gediz M, Akış AA, Sarı G, Duran GS, Dindaroğlu F. Displacement and stress distribution of Kilroy spring and nickel-titanium closed-coil spring during traction of palatally impacted canine: A 3-dimensional finite element analysis. Orthod Craniofac Res 2020; 23:471-478. [PMID: 32492259 DOI: 10.1111/ocr.12397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the stress distribution and initial displacements during traction of palatally impacted canine between Kilroy and nickel-titanium (NiTi) closed-coil springs by means of the finite element analysis. SETTING AND SAMPLE POPULATION A finite element method analysis of two traction methods for a maxillary impacted canine. MATERIALS AND METHODS The corresponding periodontal ligaments (PDLs), brackets, molar tubes and a 0.019 × 0.025-in base stainless-steel (SS) wire were modelled and imported to ANSYS SpaceClaim version 2020 R1. Traction was simulated under two different set-ups with equal force magnitude (60 g); (1) the Kilroy spring, which is made of 0.016-inch SS, and (2) the NiTi closed -coil spring. Von Mises stress distributions and initial displacements of the maxillary teeth were analysed. RESULTS In both mechanics, while the highest stress was seen on the impacted canine (Kilroy, 10.41 kPa; NiTi closed-coil, 5.27 kPa), the stress distribution decreased as the distance from the impacted canine increased. The Kilroy spring showed a greater total displacement (465.60 μm) on the impacted canine. The higher stresses on the adjacent lateral (5.29 kPa) and premolar (6.41 kPa) occurred with the Kilroy spring. CONCLUSIONS The Kilroy spring yielded higher stresses than the NiTi closed-coil spring on the impacted canine and the adjacent teeth. The difference between distribution of the stresses over the impacted canine induced greater displacement with the Kilroy spring, particularly in the vertical direction.
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Affiliation(s)
| | - Meltem Gediz
- Department of Orthodontics, Faculty of Dentistry, Ege University, Izmir, Turkey
| | | | - Gözde Sarı
- Department of Mechanical Engineering, Faculty of Engineering, University of Celal Bayar, Manisa, Turkey
| | - Gökhan Serhat Duran
- Department of Orthodontics, Gülhane Faculty of Dentistry, Health Sciences University, Ankara, Turkey
| | - Furkan Dindaroğlu
- Department of Orthodontics, Faculty of Dentistry, Ege University, Izmir, Turkey
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Root resorption of maxillary incisors after traction of unilateral vs bilateral impacted canines with reinforced anchorage. Am J Orthod Dentofacial Orthop 2018; 154:645-656. [DOI: 10.1016/j.ajodo.2018.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 01/01/2018] [Accepted: 01/01/2018] [Indexed: 11/18/2022]
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Grisar K, Claeys G, Raes M, Albdour EA, Willems G, Politis C, Jacobs R. Development and validation of the Maxillary Canine Aesthetic Index. Clin Exp Dent Res 2018; 4:216-223. [PMID: 30386643 PMCID: PMC6203826 DOI: 10.1002/cre2.133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 11/30/2022] Open
Abstract
Aesthetic appraisal is rarely included in the objective assessment of outcome studies of impacted maxillary canines treatment. The present study aimed to validate a new index for assessing the aesthetic appearance of maxillary canines and adjacent soft tissues. The Department of Oral and Maxillofacial Surgery at University Hospitals Leuven. Four oral-maxillofacial surgeons, two orthodontists, two prosthodontists, and two lay persons rated 11 maxillary canines and adjacent soft tissues according to the new index. Each of the examiners repeated the examination three times with a 2-week interval. Twelve relevant aesthetic variables were selected on the basis of the anatomic form, color, and surface characteristics of the canine crown and on the basis of the anatomic form, color, and surface characteristics of the adjacent soft tissues. Intraclass correlation (ICC) coefficient and Fleiss' kappa statistics were performed to analyze the intrarater and interrater agreement. The index proofed to be a reliable assessment tool. Considering the cumulative assessment of the Maxillary Canine Aesthetic Index (MCAI), the mean ICC value for the interrater agreement of the 10 examiners was 0.71, representing a good agreement. Intrarater agreement ranged from 0.10 to 0.91. Interrater agreement (Fleiss' kappa statistics) calculated for each variable ranged from 0.08 to 0.98. The MCAI is a tool in rating aesthetic outcome of impacted canine treatment and adjacent soft tissues. The MCAI can be used to evaluate the aesthetic outcome after surgical exposure or transalveolar transplantation of maxillary canines.
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Affiliation(s)
- Koenraad Grisar
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of MedicineUniversity LeuvenBelgium
- Department of Oral and Maxillofacial SurgeryUniversity Hospitals LeuvenBelgium
| | - Gilles Claeys
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of MedicineUniversity LeuvenBelgium
- Department of Oral and Maxillofacial SurgeryUniversity Hospitals LeuvenBelgium
| | - Margot Raes
- Orthodontics, Department of Oral Health SciencesUniversity of Leuven, University Hospitals LeuvenBelgium
| | - Emad Ali Albdour
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of MedicineUniversity LeuvenBelgium
- Department of Oral and Maxillofacial SurgeryUniversity Hospitals LeuvenBelgium
| | - Guy Willems
- Orthodontics, Department of Oral Health SciencesUniversity of Leuven, University Hospitals LeuvenBelgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of MedicineUniversity LeuvenBelgium
- Department of Oral and Maxillofacial SurgeryUniversity Hospitals LeuvenBelgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of MedicineUniversity LeuvenBelgium
- Department of Dental MedicineKarolinska InstitutetSweden
- Department of Oral and Maxillofacial SurgeryUniversity Hospitals LeuvenBelgium
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Pereira IF, Santiago FZM, Sette-Dias AC, Noronha VRADS. Taking advantage of an unerupted third molar: a case report. Dental Press J Orthod 2018; 22:97-101. [PMID: 28902255 PMCID: PMC5573016 DOI: 10.1590/2177-6709.22.4.097-101.oar] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/02/2017] [Indexed: 11/21/2022] Open
Abstract
Introduction: Treatments with dental surgery seek to displace tooth to the correct position within the dental arch. Objective: To report a clinical case that took advantage of an unerupted third molar. Case history: A male patient, 18 years of age, was referred by his dentist to evaluate the third molars. The clinical exam revealed no visible lower third molars. The computed tomography (CT) exam showed the presence of a supernumerary tooth in the region of the mandibular ramus, on the left side, and impaction of the third molar, which was causing root resorption on the second molar, thus making it impossible to remain in the buccal cavity. The preferred option, therefore, was to remove both second molar and the supernumerary tooth, in addition to attaching a device to the third molar during surgery for further traction. Results: After 12 months, the third molar reached the proper position. Conclusion: When a mandibular second permanent molar shows an atypical root resorption, an impacted third molar can effectively substitute the tooth by using an appropriate orthodontic-surgical approach.
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Affiliation(s)
| | | | - Augusto Cesar Sette-Dias
- Universidade Federal de Minas Gerais, Faculdade de Odontologia, Centro de Ciências da Saúde, Departamento de Clínica, Patologia e Cirurgia Odontológicas (Belo Horizonte/MG, Brasil)
| | - Vladimir Reimar Augusto de Souza Noronha
- Universidade Federal de Minas Gerais, Faculdade de Odontologia, Centro de Ciências da Saúde, Departamento de Clínica, Patologia e Cirurgia Odontológicas (Belo Horizonte/MG, Brasil)
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Bollero P, Danesi C, Ricchiuti MR, Milazzo A, Mampieri G, Agrestini C, Mucedero M. Long-term periodontal status of palatally and buccally impacted canines after closed surgical-orthodontic approach. ORAL & IMPLANTOLOGY 2018; 10:162-171. [PMID: 29876041 DOI: 10.11138/orl/2017.10.2.162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The aim of this study is to evaluate the periodontal status of palatally and buccally impacted canines exposed with closed technique, and to compare them with the controlateral canines that served as control teeth as well as to compare them each other. Methods 28 patients, 14 with unilateral palatally impacted canines and 14 with unilateral buccally impacted canines comprised the subjects of the study. Mean recall observational period was 2 years 4 months ± 1 year 1 month. Closed eruption technique without the tunnel was performed to expose both the palatally and the buccally impacted canines. Six periodontal variables were considered: probing pocket depth (PPD); width of keratinized tissue (KT); gingival thickness (GT); plaque index (PI); gingival bleeding index (GBI); gingival recession (REC). Results Palatally impacted canines exhibited significant greater PPD on the mesiolingual site compared to their controlaterals (P<0.05). Buccally impacted canines had significant increased KT compared to their contralaterals (P<0.05). Palatally impacted canines had significant greater PPD on the midbuccal site and on all the palatal sites when compared to the buccally impacted canines (P<0.05). Conclusion The changes observed in the periodontal status of impacted canines, although statistically significant, did not reach clinical significance.
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Affiliation(s)
- P Bollero
- Department of Systems Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | - C Danesi
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | - M R Ricchiuti
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | - A Milazzo
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | - G Mampieri
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | - C Agrestini
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | - M Mucedero
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy
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Renger S, Gremeret M, Gebeile-Chauty S. [Multiple uses of skeletal anchorages: taking advantage of mini-screws to improve aesthetics with active and passive appliances]. Orthod Fr 2018; 89:111-121. [PMID: 29676258 DOI: 10.1051/orthodfr/2018008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The main causes of failures in canine traction are anchorage defects, incorrect direction of force, uncontrolled forces. An adolescent female (10 years, 9 months) presents with two included canines on the maxillary arch, in a palatal position and her lateral incisors (12 and 22) are microdontic. Two mini-screws are inserted on the palate, in a mesial position to 16 and 26 to secure the traction of 13 and 23; in general, braces are bonded after this first step. After debonding, mini-screws remain to help stabilize the palatal plate during the retention period and to avoid unaesthetic metallic wires and hooks which sometimes cause occlusal interferences. DISCUSSION The alternatives are discussed: Ballista spring, mini-screw inserted in the palatal suture, Nance appliance… Conclusion: The multi-use of temporary anchorage devices during traction of palatally impacted canine(s) (especially in the case of bilateral inclusions) offer new alternatives by securing the canine displacement, eliminating almost all of the patient's compliance (no loss of sagittal anchorage). This type of small appliance increases the patient's comfort and decreases the complexity of activations. The global duration of treatment with braces can be decreased if no braces are needed during the first steps, and then retention can be more effective and more aesthetic, especially during smiling.
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Affiliation(s)
| | - Mélanie Gremeret
- Département d'orthodontie, Faculté d'odontologie, rue Guillaume Paradin, 69372 Lyon cedex 08, France
| | - Sarah Gebeile-Chauty
- Département d'orthodontie, Faculté d'odontologie, rue Guillaume Paradin, 69372 Lyon cedex 08, France
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Parkin N, Benson PE, Thind B, Shah A, Khalil I, Ghafoor S. Open versus closed surgical exposure of canine teeth that are displaced in the roof of the mouth. Cochrane Database Syst Rev 2017; 8:CD006966. [PMID: 28828758 PMCID: PMC6483459 DOI: 10.1002/14651858.cd006966.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Palatally displaced canines or PDCs are upper permanent canines, commonly known as 'eye' teeth, that are displaced in the roof of the mouth. This can leave unsightly gaps, cause damage to the surrounding roots (which can be so severe that neighbouring teeth are lost or have to be removed) and, occasionally, result in the development of cysts. PDCs are a frequent dental anomaly, present in 2% to 3% of young people.Management of this problem is both time consuming and expensive. It involves surgical exposure (uncovering) followed by fixed braces for two to three years to bring the canine into alignment within the dental arch. Two techniques for exposing palatal canines are routinely used in the UK: the closed technique and the open technique. The closed technique involves uncovering the canine, attaching an eyelet and gold chain and then suturing the palatal mucosa back over the tooth. The tooth is then moved into position covered by the palatal mucosa. The open technique involves uncovering the canine tooth and removing the overlying palatal tissue to leave it uncovered. The orthodontist can then see the crown of the canine to align it. OBJECTIVES To assess the effects of using either an open or closed surgical method to expose canines that have become displaced in the roof of the mouth, in terms of success and other clinical and patient-reported outcomes. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 24 February 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (in the Cochrane Library, 2017, Issue 1), MEDLINE Ovid (1946 to 24 February 2017), and Embase Ovid (1980 to 24 February 2017). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials assessing young people receiving surgical treatment to correct upper PDCs. There was no restriction on age, presenting malocclusion or type of active orthodontic treatment undertaken. We included unilaterally and bilaterally displaced canines. DATA COLLECTION AND ANALYSIS Two review authors independently screened the results of the electronic searches, extracted data and assessed the risk of bias in the included studies. We attempted to contact study authors for missing data or clarification where feasible. We followed statistical guidelines from the Cochrane Handbook for Systematic Reviews of Interventions for data synthesis. MAIN RESULTS We included three studies, involving 146 participants. Two studies were assessed as being at high risk of bias.The main finding of the review was that the two techniques may be equally successful at exposing PDCs (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.93 to 1.06; three studies, 141 participants analysed, low-quality evidence).One surgical failure was due to detachment of the gold chain (closed group). One study reported on complications following surgery and found two in the closed group: a post-operative infection requiring antibiotics and pain during alignment of the canine as the gold chain penetrated through the gum tissue of the palate.We were unable to pool data for dental aesthetics, patient-reported pain and discomfort, periodontal health and treatment time; however, individual studies did not find any differences between the surgical techniques (low- to very low-quality evidence). AUTHORS' CONCLUSIONS Currently, the evidence suggests that neither the open or closed surgical technique for exposing palatally displaced maxillary canine teeth is superior for any of the outcomes included in this review; however, we considered the evidence to be low quality, with two of the three included studies being at high risk of bias. This suggests the need for more high-quality studies. Three ongoing clinical trials have been identified and it is hoped that these will produce data that can be pooled to increase the degree of certainty in these findings.
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Affiliation(s)
- Nicola Parkin
- School of Clinical Dentistry, University of SheffieldAcademic Unit of Oral Health and DevelopmentClaremont CrescentSheffieldUKS10 2TA
| | - Philip E Benson
- School of Clinical Dentistry, University of SheffieldAcademic Unit of Oral Health and DevelopmentClaremont CrescentSheffieldUKS10 2TA
| | - Bikram Thind
- Solihull HospitalDepartment of Orthodontics and Maxillofacial SurgeryLode LaneSolihullUKB91 2JL
| | - Anwar Shah
- The Windmill OrthodonticsAlpha DentalMawson HouseBedaleUKDL8 1AW
| | - Ismail Khalil
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral Health, Division of DentistryOxford RoadManchesterUKM13 9PL
| | - Saiba Ghafoor
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral Health, Division of DentistryOxford RoadManchesterUKM13 9PL
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Silva ACD, Capistrano A, Almeida-Pedrin RRD, Cardoso MDA, Conti ACDCF, Capelozza L. Root length and alveolar bone level of impacted canines and adjacent teeth after orthodontic traction: a long-term evaluation. J Appl Oral Sci 2017; 25:75-81. [PMID: 28198979 PMCID: PMC5289403 DOI: 10.1590/1678-77572016-0133] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 08/02/2016] [Accepted: 08/11/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of this retrospective study was to evaluate the long-term effects of orthodontic traction on root length and alveolar bone level in impacted canines and adjacent teeth. MATERIAL AND METHODS Sample consisted of 16 patients (nine males and seven females), mean initial age 11 years and 8 months presenting with unilaterally maxillary impacted canines, palatally displaced, treated with the same surgical and orthodontic approach. Teeth from the impacted-canine side were assigned as Group I (GI), and contralateral teeth as control, Group II (GII). The mean age of patients at the end of orthodontic treatment was 14 years and 2 months and the mean post-treatment time was 5 years and 11 months. Both contralateral erupted maxillary canines and adjacent teeth served as control. Root length and alveolar bone level (buccal and palatal) were evaluated on cone-beam computed tomography (CBCT) images. The comparison of root length and alveolar bone level changes between groups were assessed by applying paired t-test, at a significance level of 5% (p<0.05). RESULTS There were no statistically significant differences in root length and buccal and palatal bone levels of canines and adjacent teeth among groups. CONCLUSIONS Impacted canine treatment by closed-eruption technique associated with canine crown perforation, has a minimal effect on root length and buccal and palatal alveolar bone level in both canine and adjacent teeth, demonstrating that this treatment protocol has a good long-term prognosis.
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Schubert M, Proff P, Kirschneck C. Successful treatment of multiple bilateral impactions - a case report. Head Face Med 2016; 12:24. [PMID: 27457490 PMCID: PMC4960832 DOI: 10.1186/s13005-016-0122-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Successful treatment of patients with multiple bilateral impactions can be an orthodontic challenge, but few reports on treatment planning and execution exist. CASE PRESENTATION In this case report, we describe the successful orthodontic treatment of a 16.3-year old female patient without systemic or genetic disease with initially nine persisting deciduous and nine impacted permanent teeth with complete root formation and closed apices in both jaws. After extraction of the deciduous and surgical exposure of the impacted permanent teeth, the Easy-Way-Coil™ system was used in conjunction with a skeletal anchorage (maxilla, BENEfit™ system) to guide the eruption of all impacted teeth. After a total treatment time of only 22.8 months all impacted teeth could be aligned successfully and a stable and functional class I occlusion was achieved. In addition, there were no adverse treatment effects such as anchorage loss, root resorptions or periodontal problems and an esthetic result could be achieved. CONCLUSIONS The presented treatment approach thus proved to be highly effective in cases with multiple bilateral impactions with minimal side effects and considerably reduced treatment time.
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Affiliation(s)
| | - Peter Proff
- Department of Orthodontics, University Medical Centre of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Christian Kirschneck
- Department of Orthodontics, University Medical Centre of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
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Esthetic judgments of palatally displaced canines 3 months postdebond after surgical exposure with either a closed or an open technique. Am J Orthod Dentofacial Orthop 2015; 147:173-81. [DOI: 10.1016/j.ajodo.2014.10.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 10/01/2014] [Accepted: 10/01/2014] [Indexed: 11/17/2022]
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Orthodontic traction in a patient with cleidocranial dysplasia: 3 years of follow-up. Am J Orthod Dentofacial Orthop 2014; 146:108-18. [PMID: 24975005 DOI: 10.1016/j.ajodo.2013.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 09/01/2013] [Accepted: 09/01/2013] [Indexed: 12/12/2022]
Abstract
This case report describes the treatment and long-term follow-up care of a patient diagnosed with cleidocranial dysplasia who had multiple impacted permanent and supernumerary teeth. The aim of the treatment was to provide an adequate esthetic and functional reconstruction of the occlusion with good periodontal care. The patient was treated with a multidisciplinary therapeutic protocol including orthodontic and surgical procedures, and traction of 11 permanent teeth. The proposed objectives of good occlusion, normal function, healthy periodontium, and balanced profile were achieved, and the 3-year follow-up records showed stable results.
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Chandhoke TK, Agarwal S, Feldman J, Shah RA, Upadhyay M, Nanda R. An efficient biomechanical approach for the management of an impacted maxillary central incisor. Am J Orthod Dentofacial Orthop 2014; 146:249-54. [PMID: 25085308 DOI: 10.1016/j.ajodo.2013.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 09/01/2013] [Accepted: 09/01/2013] [Indexed: 11/29/2022]
Abstract
Treatment of an impacted maxillary central incisor poses a unique challenge to the orthodontist because of its position within the esthetic zone, requiring careful management of the soft tissues and an effective biomechanical setup for alignment. This article describes a novel method of extending an extrusion wire from cross tubes attached on the base archwire for forced eruption of impacted central incisors. The effectiveness and versatility of this method are demonstrated with 2 patients.
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Affiliation(s)
- Taranpreet K Chandhoke
- Assistant professor, Division of Orthodontics, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut, Farmington, Conn.
| | - Sachin Agarwal
- Resident, Division of Orthodontics, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut, Farmington, Conn
| | - Jonathan Feldman
- Assistant professor, Division of Orthodontics, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut, Farmington, Conn
| | | | - Madhur Upadhyay
- Assistant professor, Division of Orthodontics, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut, Farmington, Conn
| | - Ravindra Nanda
- Professor and head, Department of Craniofacial Sciences, Alumni Endowed Chair, School of Dental Medicine, University of Connecticut, Farmington, Conn
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Ayers E, Kennedy D, Wiebe C. Clinical recommendations for management of mesiodens and unerupted permanent maxillary central incisors. Eur Arch Paediatr Dent 2014; 15:421-8. [PMID: 24994110 DOI: 10.1007/s40368-014-0132-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 05/20/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Un-erupted maxillary incisors may result secondary to supernumerary teeth. Despite the removal of such mesiodentes, orthodontic traction of a permanent un-erupted maxillary incisor may be required. REVIEW The literature regarding the impacted maxillary central incisor(s) was reviewed and all pertinent publications on the subject assessed. The review specifically relative to mesiodentes, surgical exposure and orthodontic management was interpreted together with the clinical experience of a number of the authors' cases. From this analysis a set of recommendations was developed. RECOMMENDATIONS (1) A sufficient arch space has to be ensured or orthodontically created for permanent maxillary central incisor(s). (2) Early surgical extraction of a mesiodens or mesiodentes (ideally before 7 years of age), with simultaneous closed surgical exposure of the permanent impacted maxillary incisor with bonding of an attachment with gold chain. (3) Re-evaluation after 2-3 months to assess for any natural eruption of the maxillary central incisor. (4) Application of orthodontic traction in the event of non-eruption. CONCLUSION Early diagnosis of the presence of mesiodentes is imperative. Appropriate surgical and/or orthodontic traction is often indicated with regular post-surgical follow-up assessments.
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Affiliation(s)
- E Ayers
- Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada,
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Parkin NA, Milner RS, Deery C, Tinsley D, Smith AM, Germain P, Freeman JV, Bell SJ, Benson PE. Periodontal health of palatally displaced canines treated with open or closed surgical technique: A multicenter, randomized controlled trial. Am J Orthod Dentofacial Orthop 2013; 144:176-84. [DOI: 10.1016/j.ajodo.2013.03.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 03/01/2013] [Accepted: 03/01/2013] [Indexed: 10/26/2022]
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Becker A, Chaushu S. Palatally impacted canines: The case for closed surgical exposure and immediate orthodontic traction. Am J Orthod Dentofacial Orthop 2013; 143:451-9. [DOI: 10.1016/j.ajodo.2013.02.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Palatally impacted canines: The case for preorthodontic uncovering and autonomous eruption. Am J Orthod Dentofacial Orthop 2013; 143:450-8. [DOI: 10.1016/j.ajodo.2013.02.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Koutzoglou SI, Kostaki A. Effect of surgical exposure technique, age, and grade of impaction on ankylosis of an impacted canine, and the effect of rapid palatal expansion on eruption: A prospective clinical study. Am J Orthod Dentofacial Orthop 2013; 143:342-52. [DOI: 10.1016/j.ajodo.2012.10.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 10/01/2012] [Accepted: 10/01/2012] [Indexed: 10/27/2022]
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Smailiene D, Kavaliauskiene A, Pacauskiene I, Zasciurinskiene E, Bjerklin K. Palatally impacted maxillary canines: choice of surgical-orthodontic treatment method does not influence post-treatment periodontal status. A controlled prospective study. Eur J Orthod 2013; 35:803-10. [DOI: 10.1093/ejo/cjs102] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
This article reviews periodontal disease and gingival disease and also explores issues relating to mucogingival defects such as gingival hyperplasia, gingival recession, and exposure of impacted canines.
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Affiliation(s)
- H Jung Song
- Private Periodontal Practice, Edmonds, WA, USA.
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Ho KH, Liao YF. Pre-treatment radiographic features predict root resorption of treated impacted maxillary central incisors. Orthod Craniofac Res 2012; 15:198-205. [PMID: 22812442 DOI: 10.1111/j.1601-6343.2012.01545.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine independent predictors of root resorption for surgical-orthodontic treatment of impacted maxillary central incisors. SETTING AND SAMPLE POPULATION The Department of Dentistry at Show Chwan Hospital, Changhua, Taiwan. Eighty patients with unilateral osseous-impacted maxillary central incisors receiving a surgical-orthodontic treatment. MATERIAL AND METHODS This is a retrospective observational study. Root resorption and its predictors were abstracted from patients' charts, pre-treatment cephalometric radiographs, and post-treatment periapical radiographs. Predictors included demographics, treatment duration, crown angle, crown height, crown depth, and root dilacerations. RESULTS The patients' mean age was 9.2 ± 2.3 years (6.4-20.6 years), and 60% were females. Impacted maxillary central incisors had greater root resorption than naturally erupted contralateral incisors (Δ = -2.8 mm, p < 0.001). Independent predictors of root resorption for impacted maxillary central incisors were shown by linear regression analysis to be crown height (β = -0.2, p < 0.01), crown depth (β = -0.3, p = 0.001), treatment duration (β = 0.2, p < 0.01), and root dilacerations (β = 3.1, p = 0.001). CONCLUSIONS Impacted maxillary central incisors had greater root resorption during surgical-orthodontic treatment than their naturally erupted contralateral incisors. Predictors of a greater root resorption were highly and deeply impacted incisors, longer treatment, and root dilacerations. These predictors may help to inform patient and family counseling before treatment.
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Affiliation(s)
- K H Ho
- Department of Dentistry, Show Chwan Hospital, Changhua, Taiwan
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Treatment of an upper impacted cuspid using ultrasonic surgery and a modified RPE. A case report. Prog Orthod 2012; 13:84-91. [PMID: 22583591 DOI: 10.1016/j.pio.2011.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 04/07/2011] [Accepted: 04/08/2011] [Indexed: 11/21/2022] Open
Abstract
This case report describes the possibility to use a modified rapid palatal expander like anchorage to reposition an included maxillary cuspid. Moreover it is enphasized the use of an ultrasonic device during surgery to expose the impacted tooth.
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Caprioglio A, Vanni A, Bolamperti L. Long-term periodontal response to orthodontic treatment of palatally impacted maxillary canines. Eur J Orthod 2012; 35:323-8. [PMID: 22531665 DOI: 10.1093/ejo/cjs020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
One of the most important aspects to take into consideration when evaluating the outcome of treatment of impacted maxillary canines is the final periodontal status. The aim of the present study was to evaluate the long-term periodontal response of palatally impacted maxillary canines aligned using a codified procedure and the 'Easy Cuspid' compared with contralateral spontaneously erupted teeth. The periodontal conditions of the adjacent teeth were also considered. From an initial sample of 124 patients, 33 patients (24 females and 9 males) were selected. All patients who had undergone surgical orthodontic treatment conducted in accordance with a standardized protocol were recalled for follow-up at an average of 4.6 years after the end of treatment. The average treatment time was 29 months and the mean eruption time of the previously impacted tooth was 3.1 months. The average probing depth values showed no significant clinical differences. Probing depths recorded at the vestibular surface of the lateral incisor (P < 0.05) and at the midpalatal/midlingual aspect of the first premolar were statistically significant in comparison with the control elements. Student's t-test was used to compare the test and control group values. Coefficient of reliability was set at P < 0.05. The use of a closed-flap surgical technique in association with a codified orthodontic traction system (Easy Cuspid) allowed alignment of palatally impacted canines without damage to the periodontium.
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Brusveen EMG, Brudvik P, Bøe OE, Mavragani M. Apical root resorption of incisors after orthodontic treatment of impacted maxillary canines: a radiographic study. Am J Orthod Dentofacial Orthop 2012; 141:427-35. [PMID: 22464524 DOI: 10.1016/j.ajodo.2011.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 10/01/2011] [Accepted: 10/01/2011] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The purpose of the study was to evaluate impacted maxillary canines as risk factor for orthodontic apical root resorption. METHODS The sample comprised 66 patients treated with fixed appliances. Thirty-two patients with a unilateral impacted maxillary canine, which was distanced from the roots of the incisors at a preliminary phase of treatment before bonding, formed the impaction group, and 34 patients without impactions served as the controls. Root shortening was calculated by using pretreatment and posttreatment intraoral radiographs. Inclination of the eruption path of the impacted canine relative to the midline, axis of the lateral incisor, and nasal line, root development, and the medial and vertical positions of the impacted tooth were recorded on orthopantomograms and lateral cephalometric films. The follicle/tooth ratio was evaluated by using periapical radiographs. RESULTS No significant difference in apical resorption of the maxillary incisors was detected between the impaction and control groups, or between the incisors of the impacted and contralateral sides in the same subject. Likewise, no difference in the severity of root resorption was found between the incisors of impacted side alone and the incisors of the control group. Mesial and vertical inclinations of the impacted canines were negatively related to a lateral incisor's root resorption. No correlations were found between resorption and medial or vertical position of the crown of the canine. The follicle/tooth ratio was significantly related to the mesial inclination of the impacted canine, but not to root resorption. CONCLUSIONS An impacted maxillary canine, after being distanced from the incisor roots, does not seem to be a risk factor for apical root resorption during orthodontic treatment.
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The impacted maxillary canine: a proposed classification for surgical exposure. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:222-8. [DOI: 10.1016/j.tripleo.2011.02.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 02/09/2011] [Accepted: 02/14/2011] [Indexed: 11/19/2022]
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Alessandri Bonetti G, Incerti Parenti S, Daprile G, Montevecchi M. Failure after closed traction of an unerupted maxillary permanent canine: Diagnosis and treatment planning. Am J Orthod Dentofacial Orthop 2011; 140:121-5. [PMID: 21724096 DOI: 10.1016/j.ajodo.2009.09.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Revised: 09/01/2009] [Accepted: 09/01/2009] [Indexed: 10/14/2022]
Abstract
This report describes the treatment of a 13-year-old girl with unerupted maxillary permanent canines. It illustrates how recognizing an unexpected problem influenced the decision-making process. Despite 6 months of closed-eruption traction, the left canine had not erupted. However, the neighboring teeth were intruded, suggesting a diagnosis of canine ankylosis. When the site was surgically reopened, the wire chain used for the orthodontic traction appeared to be osseointegrated. It was renewed, and traction was applied for another 16 months, and the tooth was successfully brought into the arch. Bone tissue passing through the chain might have prevented forced eruption. In young patients with unerupted maxillary permanent canines, failure of closed traction can be attributed to ankylosis, and this accounts for tooth extraction as the treatment of choice. However, this clinical report suggests that additional measures might be warranted before the definitive diagnosis of ankylosis can be made and the tooth extracted.
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Exposure of unerupted palatal canines: A survey of current practice in the United Kingdom, and experience of a gingival-sparing procedure. Br J Oral Maxillofac Surg 2010; 48:641-4. [DOI: 10.1016/j.bjoms.2009.08.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 08/27/2009] [Indexed: 11/21/2022]
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Abstract
BACKGROUND The authors conducted a literature review regarding the clinical and radiographic diagnoses of impacted maxillary canines, as well as the interceptive treatment (including surgical and orthodontic management) used to prevent or properly treat impacted canines. TYPES OF STUDIES REVIEWED The authors reviewed clinical and radiographic studies, literature reviews and case reports. They selected only studies that pertained to the prevalence, etiology and diagnosis of impacted maxillary canines, as well as the most recent studies regarding surgical and orthodontic techniques for the proper management of impacted maxillary canines. RESULTS Impacted canines can be detected at an early age, and clinicians might be able to prevent them by means of proper clinical diagnosis, radiographic evaluation and timely interceptive treatment. Surgical techniques that can be used to manage impacted canines vary depending on whether the impactions are labial or palatal, and orthodontic techniques vary according to clinical judgment and experience. CLINICAL IMPLICATIONS Canine impaction is a common occurrence, and clinicians must be prepared to manage it. With early detection, timely interception, and well-managed surgical and orthodontic treatment, impacted maxillary canines can be erupted and guided to an appropriate location in the dental arch.
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Chaushu S, Dykstein N, Ben-Bassat Y, Becker A. Periodontal Status of Impacted Maxillary Incisors Uncovered by 2 Different Surgical Techniques. J Oral Maxillofac Surg 2009; 67:120-4. [DOI: 10.1016/j.joms.2008.08.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2008] [Revised: 07/03/2008] [Accepted: 08/20/2008] [Indexed: 11/16/2022]
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Parkin N, Benson PE, Thind B, Shah A. Open versus closed surgical exposure of canine teeth that are displaced in the roof of the mouth. Cochrane Database Syst Rev 2008:CD006966. [PMID: 18843740 DOI: 10.1002/14651858.cd006966.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Palatal canines are upper permanent canine (eye) teeth that have become displaced in the roof of the mouth. They are a frequently occurring anomaly, present in 2% to 3% of the population. Management of this problem is both time consuming and expensive and involves surgical exposure (uncovering) followed by fixed braces for 2 to 3 years to bring the canine into alignment within the dental arch. Two techniques for exposing palatal canines are routinely used in the UK: one method (the closed technique) involves orthodontically moving the canine into its correct position beneath the palatal mucosa and the second method (the open technique) involves orthodontically moving the canine into its correct position above the palatal mucosa. OBJECTIVES To establish if clinical, patient centred and economic outcomes are different according to whether an 'open' or 'closed' technique is employed for uncovering palatal canines. SEARCH STRATEGY MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Oral Health Group's Trials Register were searched (to 29th February 2008). There were no restrictions with regard to publication status or language. SELECTION CRITERIA Patients receiving surgical treatment to correct upper palatally impacted canines. There was no restriction for age, presenting malocclusion or the type of active orthodontic treatment undertaken. Unilateral and bilaterally displaced canines were included.Trials including participants with craniofacial deformity/syndrome were excluded. DATA COLLECTION AND ANALYSIS Two review authors independently and in duplicate assessed studies for inclusion. The Cochrane Collaboration statistical guidelines were to be followed for data synthesis. MAIN RESULTS No studies were found that met the inclusion criteria. AUTHORS' CONCLUSIONS This review has revealed that currently, there is no evidence to support one surgical technique over the other in terms of dental health, aesthetics, economics and patient factors. Until high quality clinical trials with participants randomly allocated into the two treatment groups are conducted, methods of exposing canines will be left to the personal choice of the surgeon and orthodontist.
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Affiliation(s)
- Nicola Parkin
- Department of Oral Health and Development, School of Clinical Dentistry, University of Sheffield, Wellesley Road, Sheffield, UK, S10 2SZ.
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