Treatment of maxillary retained canine with implants: new perspectives

Association of mandibular canine impaction and anatomical factors: A multicentre retrospective panoramic study in Latin America

INTRODUCTION

Mandibular canine impaction is infrequent in dental eruption anomalies and treatment is very challenging. The aim of this multicenter retrospective panoramic study in Latin America was to evaluate panoramic radiographic imaging characteristics of mandibular canine impaction (impaction area, mandibular base contact, transmigration, impaction height and sex) and their associations.

MATERIAL AND METHODS

This cross-sectional study evaluated 212 digital panoramic radiographs from three radiological centres in Tingo Maria (Peru), Bogota and Tunja (Colombia). The study included children of both sexes with impacted mandibular canines. Mandibular alpha angle, contact with mandibular basal bone (MBB), impacted sector according to 10 sectors with an adaptation of the Ericson and Kurol method, presence of transmigration and the impacted height were measured and the relationship among these measures was analyzed. Fisher's exact test, Chi-square and binary logistic regression were used. (P<0.05).

RESULTS

The mandibular canine impaction showed contact with the MBB (32.08%), dental transmigration (36.79%), mainly located at an apical (40.09%) and sub-apical (36.79%) level. Transmigration mainly occurred in sectors 6 (33.30%) and 10 (25.60%) (P<0.001). It was found that for each year of increase in age, the possibility of contact with the MBB decreased (β=0.89, P=0.010), and as the alpha angle increased by one degree the probability of contact with the MBB decreased (β=0.97, P=0.001) and the probability of transmigration increased (β=1.05, P<0.001).

CONCLUSIONS

One third of the impacted canines were in contact with the MBB, while another third presented dental transmigration and were mainly located apically and subapically of the incisor roots. These imaging features should be taken into account when planning orthodontic treatment.

Multidisciplinary treatment of an impacted maxillary canine with immediate implant installation

Maxillary permanent canines are the second most frequent cases of impacted teeth; their resolution demands a multidisciplinary evaluation to delineate a viable treatment plan based on the individual esthetic and functional outcomes required. An impacted maxillary permanent canine which was ankylosed in a horizontal position was extracted followed by a regeneration technique, filling the bone defect with biomaterial. An implant was immediately installed in the alveolus of the extracted deciduous canine, and a connective tissue graft was buccally positioned. After the osseointegration period, a modified Palacci and Nowzari surgical technique was performed to gain papilla, and the implant was loaded with an interim restoration with a proper profile to manipulate the soft-tissue contour. Finally, the definitive restauration was cemented achieving the desired outcomes. The achieved clinical outcomes remain stable during a 2-year follow-up. A successful management of this challenge esthetic case lies in the details at surgical and prosthetic phases based in biological response of the peri-implant tissues.

Guided Bilateral Transcanine Implant Placement and Implant-Supported Oral Rehabilitation in a Patient with Progressive Systemic Scleroderma

When faced with a situation where an impacted tooth is in the way of a planned implant, one approach to avoid an invasive surgical procedure and potential associated complications is to place a transcanine implant. The aim of this report was to add a new case of a transimpacted tooth dental implant placement to the existing international literature and to share our experience of transcanine implantation in the maxilla followed by implant prosthodontic rehabilitation of a patient with progressive systemic scleroderma. A 55-year-old woman attended our office for oral cavity assessment and treatment planning for complete oral rehabilitation. Digital planning software was used, and implants were positioned according to a surgical template in regions 13, 16, 23, and 26 (Straumann, Basel, Switzerland) with screw-retained metal-ceramic bridges. Placement of the dental implants through impacted canines and the creation of interfaces other than implant-bone interfaces did not lead to postoperative pain or implant failure. Clinically, overall healing was observed, and the implants were successfully used for implant-supported prosthodontic rehabilitation of the jaw. Within the limitations of this case report, transcanine implantation could represent a valuable alternative to standard implant protocols.