Assessment of Patient-Centered Outcomes When Treating Maxillary Constriction Using a Slow Removable Versus a Rapid Fixed Expansion Appliance in the Adolescence Period: A Randomized Controlled Trial

Early Detection and Interceptive Orthodontic Treatment of Impacted Canine: A Case Report

Aim and background

Upper canines are the second most common teeth involved in impaction after the third mandibular molar. Accurate diagnosis at an appropriate age is important to reduce complications of the impacted tooth and its adjacent teeth. We present a case of early detection of an impacted left maxillary canine, which allowed spontaneous eruption through arch expansion.

Case description

An 11-year-old patient was referred for monitoring of an unerupted left maxillary canine. The tooth was palpable labially, but there was a lack of space for an eruption for the tooth, with 2 mm of discrepancy as assessed using the Tanaka and Johnston space analysis method. The patient had generalized gingivitis, multiple carious teeth, and dens evaginatus of upper incisors. An orthopantomogram (OPG) confirmed the clinical findings and impaction of the tooth. Localization of the tooth was done using the parallax technique with the addition of an intraoral periapical radiograph (IOPA). The tooth was in line with the arch. Due to this favorable position, an upper removable appliance (URA) with an acrylic plate, metal clasps on the upper first molars and premolars, and an expansion screw in the midline was constructed for the patient. The patient activated the screw with a weekly quarter turn. Preventive and caries management strategies were done simultaneously. The impacted left maxillary canine erupted after 10 months of using the URA.

Conclusion

Due to the high plasticity of bone structures in a growing child, interceptive orthodontic treatment using removable appliances works well. The impacted left maxillary canine erupted in place after 10 months of using the URA without the need for surgical or fixed orthodontic treatment.

Clinical significance

Early detection of impacted teeth in a growing child is important in order for us to intervene in the problem at an earlier stage to avoid further complications.

How to cite this article

Sockanathan L, Ahmad NS, Zakaria ASI. Early Detection and Interceptive Orthodontic Treatment of Impacted Canine: A Case Report. Int J Clin Pediatr Dent 2024;17(6):706-711.

Maxillary Expansion and Its Effects on Circummaxillary Structures: A Review

Transverse maxillary discrepancies are the most common. The narrowed upper arch is the most prevalent problem an orthodontist encounter while treating adolescent and adult patients. Maxillary expansion is a technique used to increase the upper arch's transverse dimension to apply forces to widen the upper arch. For young children, a narrow maxillary arch has to be corrected using orthopedic and orthodontic treatments. In an orthodontic treatment plan, it is crucial to update transverse maxillary defeat. There are various clinical manifestations associated with a transverse maxillary deficiency which include a narrow palate, crossbite mainly seen in posteriors (unilateral or bilateral), severe crowding in anterior teeth, and cone-shaped hypertrophy can be seen. Some frequently used therapies for constricted upper arch include slow maxillary expansion, rapid maxillary expansion, and surgically assisted rapid maxillary expansion. Slow maxillary expansion requires light and constant force, whereas rapid maxillary expansion needs heavy pressure for activation. The surgical-assisted rapid maxillary expansion has gradually become popular to correct transverse maxillary hypoplasia. The maxillary expansion has various consequences on the nasomaxillary complex. There are multiple effects of maxillary expansion on the nasomaxillary complex. Mainly, the effect is seen on the mid-palatine suture along with the palate, maxilla, mandible, temporomandibular joint, soft tissue, and anterior and posterior upper teeth. It also affects functions like speech and hearing. Information on maxillary expansion is provided in depth in the following review article, along with its various effects on the surrounding structure.

Pain, Discomfort, and Functional Impairments When Retracting Upper Anterior Teeth Using Two-Step Retraction With Transpalatal Arches Versus En-Masse Retraction With Mini-implants: A Randomized Controlled Trial

Background This study aimed to evaluate the levels of pain and discomfort associated with employing mini-implants as a temporary skeletal anchorage device compared to the traditional transpalatal arches (TPAs) during upper anterior teeth retraction in patients with upper dentoalveolar protrusion and to determine the level of acceptance of both techniques among patients. Methodology The study sample consisted of 38 patients (29 women and nine men) with an average age of 21.7 years. The patients were randomly and equally distributed into two groups. In the first group: upper anterior teeth were en-masse retracted using mini-implants (the TAD group), whereas, in the second group, TPAs were used during the two-step retraction of upper anterior teeth (the TPA group). Standardized questionnaires were distributed to all patients after 24 hours of mini-implant application. The questionnaire asked the patients to rate their pain perception, swelling sensation, eating difficulties, talking impairments, and cleansing difficulties on a four-point Likert scale on the third-day, one-week, two-week, and one-month follow-ups after the anchorage application. Wilcoxon matched-pairs signed-rank tests were used to evaluate intragroup changes, whereas Mann-Whitney U tests were employed to examine intergroup differences. Results Patients in the TAD group had higher pain and swelling levels than those in the TPA group, and differences were statistically significant at the first three assessment time points. The differences between the two groups were statistically insignificant regarding eating and talking difficulties, whereas differences were statistically significant for brushing difficulties. These impairments decreased to almost normal levels after one month of treatment initiation. Conclusions TPAs, when used for anchorage in the two-step retraction technique, were less problematic compared to mini-implants with en-masse retraction, where the sensation of pain or swelling around the mini-implants did not last for more than a week. The difficulties of cleaning, chewing, and speaking in the presence of mini-implants were temporary and mostly disappeared within two weeks of mini-implant application.

Analysis of the Frequency and Correlated Factors of Midpalatal Suture Maturation Stages in Young Adults, Based on Cone Beam Computed Tomography Imaging

BACKGROUND

The choice of whether to perform a palatal disjunction in constricted maxilla has traditionally been decided based on the age of the patients, although there are gradually increasing references to the fact that this is not a determining factor. The main goal of this study was to evaluate the frequency of the different stages of midpalatal suture maturation in a sample of young adults between 15 and 30 years of age. Other objectives also included analyzing the possible correlation the maturation stages could maintain with sex and age groups.

METHODS

142 Cone Beam Computed Tomography (CBCT) scans of young adults were performed. The images were divided into four age groups based on age ranges of 15-18, 19-22, 23-26, and 27-30 years. Each group consisted of 26, 41, 39, and 36 patients, respectively, which were classified using Angelieri's method. In addition, sex and age groups were considered as variables, and the possible correlation of the prevalence of each one, according to age and sex, was studied.

RESULTS

the sample was classified into 4.9% stage B; 52.1% stage C; 27.5% stage D; and 15.5% stage E. In addition, no statistically significant correlation between sex and the maturation stages was found, but more advanced stages did appear to be related to the chronological age of the subjects.

CONCLUSIONS

The frequency of maturational stages where the suture is shown to be consolidated did not appear to be as high as expected; therefore, the idea of rejecting transverse plane treatment in a conventional manner in an out-of-growth patient should be discarded.

Assessment of Patient-Centered Outcomes When Treating Palatally Impacted Canines Using Conventional Versus Accelerated Minimally Invasive Corticotomy-Assisted Orthodontic Treatment: A Randomized Controlled Trial

Objective

This study aimed to investigate whether there were any differences in pain levels, discomfort, and functional impairments when treating palatally impacted canines (PICs) using the conventional treatment method compared to the accelerated minimally invasive corticotomy-assisted method.

Materials and methods

Fifty-two patients (11 males and 41 females) with unilateral PICs were included. The patients were randomly assigned to the conventional traction group (26 patients, mean age of 20.37 ± 2.15 years) or the minimally-invasive corticotomy-assisted group (26 patients, mean age of 20.18 ± 2.18 years). The levels of pain, discomfort, and functional difficulties were assessed using a visual analog scale (VAS) after 24 hours (T1), four days (T2), seven days (T3), 14 days (T4), and 28 days (T5) following the surgical exposure procedure.

Results

There were no statistically significant differences between the two treatment groups for any patient-centered outcome at all assessment times (P>0.01). The levels of pain and discomfort were slightly greater in the conventional group than in the corticotomy-assisted group on the first day after surgical exposure, with no significant difference between the two groups (mean pain: 4.11, P=0.481; mean discomfort: 9.00, P=0.223). Pain and discomfort required seven days to reach low levels and four weeks to reach the lowest levels in both study groups. The levels of swelling, mastication difficulties, swallowing difficulties, limitation in jaw movements and speech changes were mild to moderate on the first postoperative day and the recovery time was four days postoperatively for swallowing difficulties and speech changes. In comparison, the recovery time was seven days for the other three outcomes in both study groups.

Conclusions

After one day of the surgical intervention, either by conventional or corticotomy-assisted methods, the patients reported mild to moderate pain, discomfort, and functional impairments. These disabilities gradually reached low levels during the first and second weeks to reach their lowest levels four weeks postoperatively in both study groups. The similarity between the conventional and the acceleration methods in pain levels and other oral disabilities may make corticotomy-assisted treatment a comfortable and effective method when treating adult patients with PICs. In addition, patient satisfaction with the corticotomy-assisted procedure was high.

Evaluation of the Oral Health-Related Quality of Life (OHRQoL) in Patients Undergoing Lingual Versus Labial Fixed Orthodontic Appliances: A Randomized Controlled Clinical Trial

Background Wearing fixed orthodontic appliances may negatively impact oral health-related quality of life (OHRQoL) during treatment. This study aimed to compare the OHRQoL of patients treated with labial or lingual appliances. Methodology A total of 38 patients (23 females, 15 males; mean age: 21.3 years) with class I malocclusion and moderate crowding in the upper and lower dental arches were included. These patients were planned to be treated on a non-extraction basis and were randomly divided into the following two groups: the lingual appliance (LA) group and the buccal appliance (BA) group. The Oral Health Impact Profile-14 (OHIP-14) questionnaire was used to measure the OHRQoL at the following six assessment times: before treatment (T0), one week after treatment (T1), one month after treatment (T2), three months after treatment (T3), six months after treatment (T4), and at the end of the active treatment (T5). Results In total, 19 patients in each group were included in the final analysis with no dropouts. In both groups, the overall OHIP-14 scores increased and peaked on the first week following appliance placement and then significantly decreased over time. The LA group had significantly greater overall OHIP‑14 scores than the labial group at T1 (p < 0.001) and T2 (p = 0.004) only. Conclusions The OHRQoL improved in both lingual and labial groups after treatment. Moreover, it was better in the labial group compared to the lingual group during the first month of treatment. In both groups, the greatest deterioration in OHRQoL occurred in the first week and gradually decreased over time.