A retrospective long-term pulpal, periodontal, and esthetic, follow-up of palatally impacted canines treated with an open or closed surgical exposure technique using the Maxillary Canine Aesthetic Index

Comparisons of Two Different Treatment Methods for Impacted Maxillary Canines: A Retrospective Study

Background: The impaction of the maxillary canine is a common occurrence, and orthodontists must be prepared to manage it. The purpose of this article is to present a study of the efficacy of a double-wire orthodontic appliance compared to a control group in the alignment of impacted maxillary canines in the dental arch. Methods: To diagnose an impacted maxillary canine, a panoramic radiograph was taken and a detailed analysis was performed by the same orthodontist. This article presents the results of 28 impacted maxillary canines with inclusion criteria of A2 (tooth angulation to the midline 16°-45°), V1 (vertical height of the tooth crown above the cementoenamel junction but less than half the length of the root of the maxillary lateral incisor), and O3 (medial position of the canine crown of more than half but less than the entire root width of the lateral incisor) positions in 21 patients (7 males and 14 females) with a mean age of 14.02 years (SD = 1.61) who were treated by the same orthodontist for impacted maxillary canines using a fixed double-wire orthodontic appliance. The analyzed data were compared with the control group (treated with a fixed orthodontic appliance and active ligature), which was matched for pretreatment age and the A2, V1, and O3 positions of the impacted maxillary canine. Results: With both methods, the impacted maxillary canines were aligned and guided into a correct position in the dental arch, but the mean active orthodontic traction of 31 ± 4.2 weeks in the SG was statistically significantly shorter (p < 0.05) in comparison to 37 ± 6.3 weeks in the CG, and the number of visits was statistically significantly (p < 0.05) fewer in the SG (5 ± 2) than in the CG (11 ± 5). Conclusions: The findings of this study are important to the field of orthodontics and show that the alignment of impacted maxillary canines with A2, V1, and O3 positions can be achieved with both methods, but with the double-wire appliance, the treatment time was shorter and the number of visits was statistically significantly fewer. The results of this study suggest that this approach may be more efficient and cost-effective compared to conventional methods.

Factors That Guide the Diagnosis and Treatment Planning for Impacted Canines Using Three-Dimensional Cone-Beam Computed Tomography: A Cross-Sectional Study

Objective. Impacted canines are one of the significant challenges in orthodontics that should be appropriately assessed to provide the best treatment to the patients. Materials and Methods. In the present study, 57800 patients were examined over six years to investigate the prevalence, diagnostic procedures, and treatment methodologies for impacted canine cases. Prevalence and diagnosis were tested using history taking, clinical examination, and three-dimensional cone-beam radiographs. The cases were tested for impaction site, gender, age, signs, and symptoms. The groups were classified for impaction location according to Mupparapu’s classification. Result. The causative factors and the treatment methodology selected were plotted according to age and gender distribution. The total prevalence was 3.9% of canine impaction cases in relation to the total sample cases. The results showed a strong correlation between the site of impaction toward the upper arch and with distribution following Mupparapu’s classification. The pain was the most detectable complication in all age groups, while root resorption was the least. Conclusion. Most of the younger age groups were sent for exposure and orthodontic traction, while the mid-aged groups elected for observation, and follow-up as their primary concern was esthetics. However, the adult patients were into exposure and traction to improve their function.

Assessment of Electrosensitivity of the Pulp of the Mandibular Second Molar after Surgical Removal of an Impacted Mandibular Third Molar

Despite the frequent discussion of complications associated with surgical removal of wisdom teeth in the scientific literature, increased mobility of the second molar, which can affect the clinical status of the pulp, is often downplayed or overlooked. This study aimed to evaluate surgical removal of an impacted third molar on the change in the electrosensitivity of the pulp of the mandibular second molar. Sixty patients consecutively presenting to the Department of Oral Surgery to remove an impacted mandibular third molar were included in the study. Clinical examinations of pulp sensitivity of second molars in both the study and control groups were evaluated before the procedure, seven days after the procedure, and eight weeks after the procedure. The surgical removal of an impacted mandibular third molar significantly affected the pulp sensitivity of the second molar.

Management of maxillary impacted canines: A prospective study of orthodontists' preferences

•

Children should be examined by the age of eight or nine years to assess for maxillary canine displacement and possible impaction.

•

Maxillary impacted canines are best approached and managed through interdisciplinary approach involving a pediatric dentist, orthodontist, oral surgeon, and periodontist.

•

The pediatric dentist can be the first specialist for early diagnosis and management of maxillary impacted canines, which can be achieved by facilitating the maxillary canine’s eruption and guiding it to its proposed location in the dental arch.

Background

Maxillary canines are considered the most commonly impacted teeth, after the third molars. Orthodontists have different preferences on how to approach maxillary impacted canines (MIC). The objective of this article was to investigate orthodontists’ approach to managing MIC.

Material and methods

A cross-sectional study comprising a comprehensive survey with 22 questions was sent to practicing orthodontists. This study explored the preferred diagnostic measures, surgical techniques, materials, and mechanics utilized to manage MIC;104 responses were returned.

Results

Palatal impaction was reported to be encountered more often than labial impaction by 60% of the respondents. In 62% of the respondents, an oral and maxillofacial surgeon was the specialist preferred to perform the surgical exposure. In 66%, the choice of required surgical techniques was reported as a joint decision between orthodontists and other specialists who perform the surgery. Cone-beam computed tomography (CBCT) was reported to be the diagnostic x-ray of choice. The gold button with a chain was the preferred bonded attachment in 86% of cases. Less than half of the respondents bonded the attachments themselves during surgical exposure. A clear plastic retainer was the preferred retainer in 61% of the respondents, and 43% of the respondents tended to use a closed exposure technique. Coe-pak^TM was the preferred surgical pack for orthodontists who prefer an open exposure technique. Piggyback (double wire) was the preferable mechanic to move a palatally impacted canine.

Conclusion

Our findings indicate that there are variations among orthodontists on how to manage MICs in terms of diagnostic methods, surgical management, materials, and mechanics.

Surgically assisted orthodontic alignment of impacted maxillary canines: A retrospective analysis of functional and esthetic outcomes and risk factors for failure

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.