Management of palatally impacted canines: the findings of a collaborative study

Factors Associated With Successful Surgical Exposure of Impacted Maxillary Canines

PURPOSE

Impacted maxillary canines occur in up to 3% of the population and their eruption is of great importance in establishing, maintaining the shape, aesthetics, and function of the dental arch. Hence, surgical exposure of canines for the purpose of aligning them is a common surgical procedure. This study identifies the frequency and the statistically significant factors associated with successful surgical exposure of impacted maxillary canines and the relative risk factors for repeat surgery.

METHODS

This is a retrospective cohort study of 182 patients who underwent surgical exposure of impacted maxillary canines and orthodontic alignment, over a 5-year period between 2014 and 2018. The variables recorded and analyzed included demographics (age and gender), type of surgery (closed or open exposure), grade of surgeon, and radiographic features on orthopantomogram (canine overlap of adjacent tooth root, vertical canine crown height, canine angulation to midline, position of canine root apex). Outcome data recorded were successful surgical exposure and orthodontic alignment and the need for repeat operation or surgical removal due to ankylosis. The data were analyzed to identify the statistically significant correlates of successful surgical exposure and the relative risk factors associated with repeat surgery.

RESULTS

A total of 182 patients and 232 bone-impacted maxillary surgical canine exposures were analyzed, as 50 patients had bilateral impaction. Mean age was 15 years (range = 10-38 years), with 122 (67%) female to 60 (33%) male ratio. Total of 222/232 (96%) impacted maxillary canine teeth were successfully surgically exposed and 10/232 (4%) required re-exposure surgery. Correlates of successful surgical exposures were open exposure technique (P < .002) and reduced distance of vertical canine crown height from alveolar bone margin (P < .033). Relative risk factors for repeat surgery were increased age, male, closed surgical exposure, grade of surgeon, central impaction, increased overlap of adjacent root, increased vertical height, increased angulation to midline, canine apex position above second premolar and procedure done under local anesthetics.

CONCLUSIONS

This is the largest impacted maxillary canine study to date which has identified the factors that result in successful surgical exposure, hence allow selection of the patients most suitable for this treatment. Secondly, patients with relative risk factors for repeat surgical intervention may be consented appropriately, triaged for a closer orthodontic follow-up and prioritized for surgery to reduce overall treatment time.

The effectiveness of minimally-invasive corticotomy-assisted orthodontic treatment of palatally impacted canines compared to the traditional traction method in terms of treatment duration, velocity of traction movement and the associated dentoalveolar changes: A randomized controlled trial

Objective: To evaluate the effectiveness of a minimally-invasive corticotomy-assisted treatment of palatally impacted canines (PICs) compared with the traditional method by evaluating treatment time, the velocity of movement, and the associated dentoalveolar changes. Materials and methods: Forty-six patients with palatally or mid-alveolar upper impacted canines were recruited and distributed into two groups: the corticotomy-assisted traction group (CAT group, mean age: 20.39±2.27 years) and the traditional treatment group (TT group, mean age: 20.26±2.17 years). The closed surgical approach was used in both study groups. The velocity of traction movement, traction duration and overall treatment duration were evaluated clinically. In addition, the bone support ratios and the amount of root resorption were assessed on cone-beam computed tomography (CBCT) images. Results: At the end of treatment, significant differences were found between the two groups regarding the velocity of traction movement, traction time, and overall treatment time (P<0.05). The mean velocity of traction movement in the CAT group was greater than the TT group ( x velocity=1.15±0.35 mm/month; 0.70±0.33 mm/month, P=0.027, respectively). The duration of the active traction and the overall orthodontic treatment in the CAT group were significantly shorter than the TT group by 36% and 29%, respectively. The mean bone support ratios of the aligned canines did not differ significantly between the two groups (88% vs. 89% in the CAT and TT groups, respectively). No significant differences were found between the two groups regarding the mean amount of root resorption on the adjacent laterals ( x resorption = 1.30±1.18 mm; 1.22±1.02 mm, P=0.612, in CAT and TT groups, respectively). Conclusions: The traction movement velocity of the palatally impacted canines can be increased using minimally-invasive corticotomy-assisted orthodontic treatment. The side effects of the acceleration procedure were minimal and almost similar to those of the traditional technique.

Open and closed surgical exposure of palatally displaced canines: a cost-minimization analysis of a multicentre, randomized controlled trial

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.

Open vs closed surgical exposure of palatally displaced canines: a comparison of clinical and patient-reported outcomes-a multicentre, randomized controlled trial

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.

Nonsurgical treatment of an adult with skeletal Class III malocclusion, anterior crossbite, and an impacted canine

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.

CBCT and Intra-Oral Scanner: The Advantages of 3D Technologies in Orthodontic Treatment

BACKGROUND

The aim is to demonstrate the validity of the monitoring through intraoral scanner of the dental movements and the real impact, advantages, and convenience, in terms of treatment time and efficiency gain, to frequently monitor a patient with the scanner application.

METHODS

A movement control of palatally impacted canines was performed, surgically treated with laser opercolectomy. Three-dimensional models of the patient's dental arch were obtained with intraoral scanner during a monitoring time of 4 months. The STL (Standard Triangle Language) files were superimposed with the 3D models extrapolated from the pre-operative CT (Computerized Tomography). The measurements of eruption, exposed palatal and vestibular areas, and distances between the canines and the incisors were performed, using digital technologies and with a digital caliber.

RESULTS

Descriptive and inferential statistical analysis of the data obtained from both conventional and digital monitoring has been realized and performing the T Student Test for paired data.

CONCLUSION

The advantages of digital monitoring are numerous, like the possibility to reduce the error of method caused by manual measurement on plaster casts and the possibility to compare the pattern and amount of eruption of the canine in the same patient overtime.

Surgical-Periodontal aspects in orthodontic traction of palatally displaced canines: a meta-analysis

The aim was to determine whether there is a difference in the periodontal aspect (gingival recession, probing pocket depth) of the palatally displaced canine (PDC) compared to the contralateral canine. Also, from a surgical perspective, sought to determine whether there is a difference (surgical duration, postoperative pain) between the surgical techniques. The word combinations were adapted for each electronic database: PubMed, LILACS, Scopus, Web of Science, Cochrane Library and gray literature. Studies that met the following criteria were considered eligible: (P) Patients who received orthodontic-surgical treatment for correction of PDC; (I) Performing orthodontic-surgical treatment for traction of the PDC; (C) Comparison of the tractioned canine with its contralateral or between the two techniques; (O) Gingival recession, probing pocket depth, postoperative complications and surgical duration; (S) Randomized and nonrandomized clinical studies or observational studies. The overall prevalence of gingival recession was estimated to be 10.53% [95% CI, 3.87% - 25.59%; I² = 88%]. No statistically significant difference (p > 0.05) was found between the means of the variables gingival recession, probing pocket depth and surgical duration. The evidence suggests that traction of palatally displaced canines can be considered a reliable and acceptable procedure.

Surgical exposure and orthodontic alignment of palatally displaced canines: can we shorten treatment time?

This review will discuss the influence of various factors on the time taken to orthodontically align a palatally displaced maxillary permanent canine following surgical exposure. Previously unpublished data from a clinical trial, involving participants with unilateral PDC randomly allocated to either a closed or open surgical exposure, will be included to strengthen the debate.

Forced-eruption time for palatally impacted canines treated with and without ostectomy-decortication technique

OBJECTIVES

To compare forced-eruption times for palatally impacted canines treated with and without the ostectomy-decortication technique and to assess the influence of palatally impacted canine pretreatment position and angle on forced-eruption time.

MATERIALS AND METHODS

The sample was composed of 118 patient-subjects with 151 palatally impacted canines treated with the ostectomy-decortication technique (n = 72) and without (n = 79). The orthopantomogram radiographs (OPGs) were analyzed for palatally impacted canine angle and horizontal and vertical position. Recovery time was measured from the start of forced eruption until the canine was within ±1 mm of final dental arch position.

RESULTS

The time of forced canine eruption with ostectomy-decortication technique was significantly shorter than without (6.6 vs 21.0 months). Pretreatment canine position significantly increased forced-eruption time in the ostectomy-decortication group but not in the control sample.

CONCLUSIONS

Forced-eruption time of palatally impacted canines using the ostectomy-decortication technique was 3.2 times more rapid than without. Forced-eruption time increased significantly as a function of pretreatment palatally impacted canine position severity in the ostectomy-decortication group but not in the control.

Open versus closed surgical exposure of palatally impacted maxillary canines: comparison of the different treatment outcomes-a systematic review

Objective

This study aims to compare the effectiveness of two different canine exposure techniques (open and closed) regarding periodontal outcomes, duration of surgical treatment and canine's eruption, patient's inconvenience, aesthetics, and orthodontic treatment complications.

Search methods

Electronic database searches of published and unpublished literature were performed. The reference lists of eligible studies were hand searched for additional studies.

Selection criteria

Randomized clinical trials (RCTs), quasi-randomized clinical trials (Q-RCTs) and non-randomized trials of prospective and retrospective design with patients of any age that compared group with palatally impacted canines treated by open exposure to a similar group treated by closed exposure technique were selected. There was not any restriction in language or year of publication.

Data collection and analysis

Study selection, data extraction, and risk of bias assessment were performed individually and in duplicate.

Results

Search strategy resulted in 159 articles and nine articles were selected for the final analysis. They were three non-randomized trials, one Q-RCT, and two reports of another Q-RCT and three reports of one RCT. The level of reported evidence was high for the RCT and one Q-RCT but poorer for the other trials. Four articles reported periodontal outcomes, three searched the duration of surgical procedure, two the duration of canine eruption, two investigated patient's inconvenience, two reported on failure rates and two addressed aesthetic outcomes. The results are inconsistent and there is considerable disagreement for the majority of the outcomes among studies.

Conclusion

According to existing articles we may conclude that there is no difference between the two techniques regarding the periodontal outcomes and aesthetic appearance. The surgical procedure is shorter in the open exposure group and the amount of postoperative pain during the first day is similar between the open and closed surgical exposure patients. However, these conclusions are based on two single trials with high level of evidence, while the rest of the studies present high risk of bias.

W Spring for Management of Impacted Teeth

Forced eruption of an impacted tooth necessitates a firm and versatile attachment for force application. The present article describes a simple modification of NiTi closed coil spring called W spring for predictable forced eruption of impacted teeth.

The Management of the Dilacerated Impacted Maxillary Central Incisor

The clinical problem of how best to manage a dilacerated, impacted maxillary central incisor will only be encountered rarely. The treatment aim should be to achieve results that are indistinguishable from normal appearance in a way that is appropriate for the patient. This article discusses the incidence of dilacerations in maxillary incisors and describes the treatment approaches available − orthodontic alignment or surgical removal and management of the resulting space, considering orthodontic repositioning, autotransplantation and various prosthetic replacements. Treatment indications, advantages and disadvantages, restorative and surgical implications, as well as the evidence-base relating to the various treatment modalities will be presented, along with clinical case examples. Clinical relevance: This paper discusses a problem that, if not managed appropriately, can lead to poor results for the patient. Even for practitioners who may not undertake the treatment mentioned, it will enable them to have more in-depth discussion with their patients should the situation arise.

Influence of repeat surgery on treatment time in the interdisciplinary management of impacted maxillary canines: A retrospective cohort study

PURPOSE

To evaluate the effect of repeat surgery on treatment time in the interdisciplinary management of impacted maxillary canines.

MATERIAL AND METHODS

This retrospective cohort study enrolled patients referred for computed tomographic examination for impacted maxillary canines within a 5-year observational period. The occurrence of repeat surgery was analysed with regard to treatment time, canine location, and surgical exposure technique.

RESULTS

A total of 55 patients with 79 impacted maxillary canines were analysed. Of those, 83.6% did not present with complications that would have prompted repeat surgery during their treatment. For patients requiring repeat surgery, time until clinically visible movement of the canine was significantly longer (p < 0.001), whereas time between initial movement and eruption into the oral cavity was significantly shorter (p < 0.001). Overall treatment time did not differ significantly (p = 0.13). An open surgical exposure technique was associated with a significantly lower occurrence of repeat surgeries (p = 0.03). Bilateral impaction of canines significantly prolonged overall treatment time (p = 0.01).

CONCLUSIONS

In the event of initial treatment failure during the interdisciplinary management of impacted maxillary canines, repeat surgery should be considered, which has limited effect on overall treatment time. An open surgical exposure technique is preferable.

Success rates of different management techniques for impacted mandibular canines and associated complications in children and adolescents

AIM

The aim of the present study was to investigate the success rate of various treatment modalities and complications associated with the occurrence and treatment of impacted mandibular permanent canines.

METHODS

Seventy-four southern Chinese children and adolescents who received treatment for impacted mandibular canines over a 27-year period were included in the analysis. Treatment modalities and complications that had been recorded in the clinical and surgical notes and that could be diagnosed from the available radiographs were noted.

RESULTS

The most commonly-performed treatment for the correction of an impacted mandibular canine was surgical removal of the impacted tooth (n = 59). In cases where surgical exposure of the impacted canine followed by bonding an attachment was performed (n = 7), the average time required for the canine to erupt postoperatively through the soft tissue was 12.2 months (±10.2 months). Lack of movement of the tooth after traction was the only complication reported in these patients (n = 3). The most frequently-reported postoperative sequela observed for all treatment modalities was swelling of the soft tissues around the surgical site (n = 6), and this was persistent even after 48 h.

CONCLUSIONS

The success rate after surgical intervention and orthodontic traction was 57.1%.

How to...mechanically erupt a palatal canine

Management of ectopic permanent maxillary canines represents one of the greatest challenges to orthodontists. This paper outlines a variety of techniques and mechanics which may facilitate expedient, predictable and safe eruption of palatal canines. While each method may be useful in isolation, the varying presentations of palatal canines ensure that the ability to apply an array of techniques is essential if successful outcomes are to be consistently achieved.

Surgical-orthodontic management of dental impaction

The aim of this study was to assess the management of impacted teeth using surgical-orthodontic techniques at a dental treatment centre in Casablanca and to suggest strategies designed to enhance treatment of dental impaction.

MATERIALS AND METHODS

The sample comprised 30 patients represented by their clinical files (mean age: 17 years; standard deviation: 8.141).

RESULTS

Impaction most often involved a single tooth (56.7%), generally the upper canine (66%). The location was buccal in 43.3% of cases and generally high (63.3%). Presurgical orthodontic treatment was required in 80 of these cases. A closed eruption technique is reported in 93.1% of cases. Mean treatment duration was 11.4 months. The success rate of the surgical technical technique was 70%.

DISCUSSION

A similarity exists between most of the variables studied and findings of other studies published on the same topic.

Paediatric minor oral surgical procedures under inhalation sedation and general anaesthetic: a comparison of variety and duration of treatment

AIM

To develop baseline data in relation to paediatric minor oral surgical procedures undertaken with both general anaesthesia and nitrous oxide inhalation sedation within a Hospital Dental Service.

STUDY DESIGN

Data were collected prospectively over a three-year period from May 2003 to June 2006 for patients attending the Departments of Paediatric Dentistry, Dundee Dental Hospital and Ninewells Hospital, NHS Tayside, Great Britain, for all surgical procedures undertaken with either inhalation sedation or general anaesthetic. Both operator status and the procedure being undertaken were noted. In addition, the operating time was recorded.

RESULTS

Data for 166 patients (F: 102; M: 64) with a median age of 12.50 (inter-quartile range 10.00, 14.20) years showed that 195 surgical procedures were undertaken. Of these 160 and 35 were with general anaesthetic and sedation respectively. The surgical removal of impacted, carious and supernumerary unit(s) accounted for 53.8% of all procedures, whilst the exposure of impacted teeth and soft tissue surgery represented 34.9% and 11.3% of procedures respectively. The median surgical time for techniques undertaken with sedation was 30.00 (inter-quartile range 25.00, 43.50) minutes whilst that for general anaesthetic was similar at 30.00 (inter-quartile range 15.25, 40.00) minutes (not statistically significant, (Mann Whitney U, W = 3081.5, P = 0.331).

CONCLUSIONS

The majority of paediatric minor oral surgical procedures entail surgical exposure or removal of impacted teeth. The median treatment time for most procedures undertaken with either general anaesthetic or nitrous oxide sedation was 30 minutes.

Periodontal response to early uncovering, autonomous eruption, and orthodontic alignment of palatally impacted maxillary canines

INTRODUCTION

The purpose of this study was to evaluate differences in periodontal status, root length, and visual assessment in patients with palatally impacted maxillary canines that were surgically exposed, allowed to erupt freely into the palate, and orthodontically aligned.

METHODS

Clinical examinations of the maxillary lateral incisors, canines, and adjacent premolars were performed on 16 patients with unilaterally impacted canines and 6 with bilaterally impacted canines treated in this manner. The average age was 23 years 7 months, and the average posttreatment observation period was 2 years 11 months. Data from the bilaterally impacted canines were not used in the central analysis.

RESULTS

Differences in probing attachment level were found at the distolingual region of the lateral incisor and at the distobuccal region of the premolar adjacent to the treated canine. Crestal bone height was lower at the mesial and distal regions of the lateral incisor adjacent to the previously impacted canine, and the roots of the treated canine and adjacent lateral incisor were shorter than those of the contralateral control teeth. Twenty-three orthodontists and 9 second- and third-year orthodontic residents could identify the previously impacted canine in the unilateral patients an average of 78.9% of the time, but to a statistically significant degree in 66% of all patients.

CONCLUSIONS

The overall consequences to the impacted canine of surgical exposure and free eruption are good compared with closed exposure and early traction, whereas consequences to the adjacent teeth, particularly the lateral incisor, are similar. Future research directly comparing the 2 methods with a larger sample and randomization could yield further insight.

Factors associated with the duration of forced eruption of impacted maxillary canines: A retrospective study

INTRODUCTION

More information is needed to better predict the duration, cost, success rate, and incidence of complications when treating impacted maxillary canines. The aim of this study was to identify factors that affect the number of visits required to complete the canine forced eruption phase.

METHODS

Data from diagnostic and treatment notes and radiographs of 87 consecutive adult and adolescent patients were analyzed by stepwise regression analysis.

RESULTS

The results indicated a strong direct correlation of the number of visits with the patient's age (P < .0001), the distance between the canine cusp tip and the occlusal plane (P <.0001), and the zone (P = .0058); mesially located cusps required more visits. A weaker inverse correlation was found with the beta angle (P = .0289), that is, and the angle between the canine and lateral incisor axes. No significant correlation was found with other variables, including sex and several linear and angular measurements made on panoramic and sagittal radiographs.

CONCLUSIONS

Age, distance from the canine cusp tip to the occlusal plane, zone, and beta angle appear to provide a rather accurate estimate (R2 = 0.42) of the number of visits needed to complete the forced eruption phase. This information allows for a prediction that might be sufficient to give the patient correct information and to estimate the final cost of the treatment.

Periodontal concerns associated with the orthodontic treatment of impacted teeth

Impacted teeth are common and are often treated with orthodontic eruption, but periodontal problems associated with the process can evade detection. Profound destruction of the periodontium of an impacted tooth or adjacent teeth can occur. This case report describes the orthodontic eruption of 4 impacted canines in a 19-year-old woman. An open surgical approach was used. Within 6 months of treatment, the maxillary right canine and the lateral incisor experienced severe periodontal destruction, resulting in questionable prognoses for the teeth. Plaque control, periodontal architecture, and subgingival microflora were examined as local etiologic factors of periodontal destruction associated with orthodontic eruption of impacted teeth. Plaque control measures were evaluated, and the consequences of orthodontic tooth movement in the presence of inadequate plaque control were considered. Areas of periodontal architecture made vulnerable by the surgical exposure of the impacted teeth were identified, and the effect of orthodontic force on the periodontium was explored. An increase in putative periopathogens in the subgingival microflora after orthodontic appliance placement was observed. Microbiologic monitoring for pathologic levels of periopathogens and antibiotic therapy were considered. Orthodontic treatment of impacted teeth might require additional professional and personal plaque control measures, 3-dimensional diagnostic imaging, and control of putative periopathogens to preserve the health of the periodontium.

Factors that relate to treatment duration for patients with palatally impacted maxillary canines

The objectives of this study were to determine the relationship between the initial position of a palatally impacted maxillary canine (as seen on a panoramic radiograph) and the duration of orthodontic treatment and to determine whether a difference in treatment duration existed between patients with bilateral palatally impacted canines and patients with unilateral impaction. A total of 47 adolescent subjects were chosen (9 subjects with unilateral impactions and 18 subjects with bilateral impactions). All subjects had full fixed orthodontic appliances placed. The treatment duration of this group was compared with that of a control group with similar characteristics but without the impacted canine. The results showed that the average duration of treatment was 22.4 months for the control group, 25.8 months for the unilateral-impacted group, and 32.3 months for the bilateral-impacted canine group. The length of treatment for the impacted canine sample was related to the age of the patient at the start of treatment; younger patients required a longer treatment. The younger the patient, the more severely impacted the canine. The bilateral-impacted canine group had at least 1 canine that was more severely impacted than the impacted canine in the unilateral-impacted group. If the canine was impacted less than 14 mm from the occlusal plane, treatment duration averaged 23.8 months; if the canine was impacted more than 14 mm from the occlusal plane, treatment duration averaged 31.1 months.

Palatally ectopic canines: closed eruption versus open eruption

This paper reviews the available evidence supporting 2 commonly used methods of surgically exposing palatally ectopic canines. The closed eruption method (a bonded attachment is placed at operation and the palatal flap is sutured back intact) is compared with the open eruption method (a window of palatal mucosa is excised and the canine allowed to erupt naturally). The choice of surgical technique is reviewed in terms of the long-term periodontal implications, the rate of repeat surgery, and treatment time.