Risk factors and treatments for impacted permanent second molars

Background/purpose

Impaction of permanent second molar (PM2) is found occasionally. This study tried to explore the risk factors associated with the impacted PM2 teeth and show how to use different treatment modalities to correct the impaction of PM2 teeth.

Materials and methods

This study used three cases of PM2 impaction to show how to identify the risk factors of PM2 impaction and how to remove these risk factors to facilitate the eruption of impacted PM2 teeth to the correct occlusal positions.

Results

The first and second cases both showed delayed eruptions of two maxillary PM2 teeth. After resection of the dense fibrotic gingival tissues on the tooth eruption pathway, these two impacted maxillary PM2 teeth finally erupted to the normal occlusal positions by their inherent tooth eruption potential. The second case also had mesioangular impaction of two mandibular PM2 teeth. After odontectomy of teeth 38 and 48, the two impacted mandibular PM2 teeth also erupted to the normal occlusal positions by their inherent tooth eruption potential. The third case had impaction of teeth 17, 27 and 47. After extraction of four third molars and four selected premolars, orthodontic mesialization of four permanent first molars, and orthodontic traction using a mini-screw, the three impacted teeth finally erupted to the normal occlusal positions.

Conclusion

We conclude that after removing the obstacles on the tooth eruption pathway, the impacted PM2 teeth usually can erupt to their normal occlusal positions by their inherent tooth eruption potential with or without the assistance of orthodontic traction.

Are methods to quantify osseous exposure in orthopedic surgery reliable?

BACKGROUND

Our study examined if there were any limitations when using various measurement techniques in the literature to quantify osseous exposure. Additionally, we also examined if surface contour had any influence on obtained measurements, which no previous study has attempted.

MATERIALS AND METHODS

Three methods used to quantify osseous exposure area were identified, one in which involves manually applying mesh over exposure area. The other two use digital image capture software (ImageJ, Bethesda, MD). We simulated flat, convex, and mixed surface types using synthetic bone analogs. We assessed the degree of variability between mean values using an ANOVA or Kruskal-Wallis equality of populations rank test. Cronbach's alpha test of internal reliability was used to assess the internal reliability of measurement technique.

RESULTS

ANOVA test for difference in measurement techniques on all three surface types was statistically significant (p < 0.05). Cronbach's alpha test of internal reliability for each technique on the convex surface did not obtain adequate significance (alpha >0.70). Only the mesh method obtained adequate alpha value for significance when applied to the flat and mixed surface types.

DISCUSSION

Each of the three measurement techniques tested demonstrated poor internal reliability. We suggest taking care when comparing studies that use different quantification techniques when calculating osseous exposure for different surgical approaches. Future studies should explore alternative methods of osseous exposure quantification.

A Hands-On Surgical Event to Improve Medical Student Operating Room Confidence

INTRODUCTION

The negative perceptions and lack of exposure to surgery and the operating room (OR) have been known to divert students away from surgical specialties. This study describes the impact of a surgical subspecialty exposure event (OR Essentials), combined with surgical faculty and M4 mentorship on preclinical medical students' confidence at an academic medical center.

METHODS

OR essentials event teaches surgical skills to preclinical medical students through hands-on skill-based workshops in a simulated OR setting. Pre and postevaluations were administered to measure program impact.

RESULTS

One hundred four preclinical medical students participated. Following OR essentials, students reported a significant increase in confidence in the OR (P < 0.0001) and in basic surgical skills (P < 0.0001).

CONCLUSIONS

Early surgical exposure events like OR essentials provide opportunities to improve medical student confidence in the OR, which will hopefully support recruitment of future surgeons.

The diagnostic accuracy of cone-beam computed tomography and two-dimensional imaging methods in the 3D localization and assessment of maxillary impacted canines compared to the gold standard in-vivo readings: A cross-sectional study

BACKGROUND

Although the widespread cone-beam computed tomography (CBCT) is a diagnosing tool for impacted canines, the surgical exposure-based diagnostic accuracy of this 3D imaging modality has not been established yet. Therefore this study aimed to (1) compare the accuracy of CBCT- and 2D-based interpretations of impacted canine and its relationships with the neighbouring structures with the gold standard (GS) readings, (2) and calculate the diagnostic accuracy, sensitivity, and specificity values of the variables assessed using CBCT and 2D methods.

MATERIAL AND METHODS

Patients with unilateral impacted maxillary canines (IMCs) planned for surgical extraction between 2016-2018 were checked in-depth to include in this cross-sectional study. For each patient, 2D and 3D radiographic records were obtained and assessed by eight postgraduate orthodontic students. These assessments were compared with the GS readings based on surgical exposure and direct vision of the IMCs. To compare 2D- and CBCT-based assessments with the GS values, Cochran's Q tests, Friedman's tests, McNemar's, McNemar-Bowker's, and Wilcoxon tests were applied.

RESULTS

A total of 17 patients (6 males, 11 females; mean age: 20.52±3.98 years) were randomly selected and included in this study. Significant differences were found between the CBCT-based assessments and the GS only concerning shape and bony coverage of the IMC (P=0.001 and P<0.001, respectively). On the contrary, there were significant differences between the 2D-based assessments and the GS regarding all the assessed variables except for the ankylosis and the proximity to the adjacent teeth (P=0.424, and P=0.080, respectively). CBCT-based assessments had remarkably higher values of diagnostic accuracy, sensitivity, and specificity compared to 2D-based ones.

CONCLUSIONS

The diagnostic accuracy of CBCT outperformed 2D radiography in localizing the IMC (labiopalatal, mesiodistal, and vertical location), detecting root apex development of the IMCs, and the resorption of the adjacent incisors. Although both 2D and 3D techniques showed the same ability in the diagnosis of IMCs ankylosis, the diagnostic accuracy of CBCT was superior. However, both techniques inaccurately determined the shape of the impacted canine and the bony coverage.

Surgical exposure of the vertebral artery for endovascular access in a hybrid operating room

PURPOSE

Endovascular procedures are a desirable treatment option for neurovascular lesions in posterior circulation. However, endovascular access occasionally fails due to tortuosity of the proximal vertebral artery (VA), aortic arch, and/or VA ostium stenosis. We aimed to describe the creation of endovascular access via surgical exposure of the VA in a hybrid operating room to overcome anatomical difficulties hampering distal access to the VA through the transfemoral or transradial approach.

METHODS

We present six patients with seven posterior circulation lesions in whom distal access via the conventional approach to the VA was impossible. Surgical exposure of the VA was performed to provide endovascular access to these patients. Radiographic characteristics, operative techniques, and outcomes were reviewed.

RESULTS

Surgical exposure of the VA was performed in six patients with cerebral aneurysm (n = 4) and symptomatic stenosis of the VA ostium (n = 3). There were four female and two male patients, aged 73-82 years. Surgical exposure was usually performed beyond the tortuous segments of the VA. After endovascular access was provided, coil embolization was performed for cerebral aneurysms and/or balloon angioplasty and stenting was performed to treat the VA ostium stenosis. All puncture sites were closed by direct suture using a 7-0 Prolene suture. All procedures were completed without adverse events.

CONCLUSION

Endovascular access via surgical exposure of the VA is a feasible and safe alternative for patients in whom the femoral or radial route does not allow the navigation and stabilization of the guiding catheter into the proximal segment of the VA.

The Pararectus approach in acetabular fractures treatment: functional and radiologcial results

BACKGROUND

The surgical treatment of complex acetabular fractures is one of the most challenging procedures for orthopedic surgeons. The Pararectus approach, as a reasonable alternative to the existing surgical procedures, was performed for the treatment of acetabular fractures involving the anterior column. This study aimed to evaluate outcome using the Pararectus approach for acetabular fractures involving anterior columns.

METHODS

Thirty-seven with displaced acetabular fractures involving anterior columns were treated between July 2016 and October 2019 using the Pararectus approach. The functional outcomes (using the Merle d Aubigné and Postel scoring system, WOMAC and modified Harris scoring), the quality of surgical reduction (using the Matta criteria), and postoperative complications were assessed during approximately 26 months follow-up period.

RESULTS

Thirty-seven patients (mean age 53 years, range: 30-71; 28 male) underwent surgery. Mean intraoperative blood loss was 840 ml (rang: 400-2000 ml) and mean operating time was 210 min (rang: 140-500 min). The modified Merle d Aubigné score was excellent and good in 27 cases (73%), fair in 6 cases (16%), and poor in 3 cases (11%). The mean score was 88.5 (range:77-96) for the modified Harris Hip scores, and 22 (range:7-35) for the WOMAC scores after operation. Postoperative functional outcomes were significantly improved compared with preoperative outcomes (P < 0.0001). The quality of reduction was anatomical in 21 cases (57%), satisfactory in 9 cases (24%), and unsatisfactory in 7 cases (19%). At follow-up, four patients developed a DVT, and heterotopic bone formation was observed in one patient. The hip osteoarthritis was not observed.

CONCLUSION

The Pararectus approach achieved good functional outcomes and anatomical reduction in the treatment of acetabular fractures involving anterior column with minimal access morbidity.

Dental follicles promote soft tissue management in surgical exposure of labially impacted maxillary canine

Background

The present study aimed to report a technically improved operation on the surgical exposure of labially impacted maxillary canine, elaborating the management of soft tissue to achieve better aesthetic results, and post-treatment periodontal health.

Methods

Patients sought orthodontic treatment with unilateral labially impacted maxillary canines were selected in this study. The impacted teeth were assigned to the experimental group and contralateral unimpacted canines were assigned to the control group. The impacted canines were surgically exposed with dissected dental follicle (DF) stitching to muscle and mucosa surrounding the crowns. The gingival index (GI), probing depth (PD), the width of the keratinized gingiva (WKG), gingival scars (GS), bone loss (BL), and apical root resorption (ARR) were recorded after the removal of the fixed appliance. A two-sample t-test was used for independent samples for parametric variables.

Results

A total of 24 patients with unilateral maxillary canine impaction were successfully treated. The outcomes of GI, WKG, GS, BL, and ARR did not indicate statistical significance between the experimental group and the control group.

Conclusions

The preservation of DF promotes soft tissue management in combined surgical and orthodontic treatment of labially impacted maxillary canine to achieve better periodontal status.

Trial Registration Chinese Clinical Trial Registry ChiCTR2000029091, 2020-01-12.

Surgical Exposure of Impacted Teeth

Impacted incisors, canines, premolars, and second molar are problems encountered frequently by general dentists, orthodontists, and oral and maxillofacial surgeons. The etiology of impacted teeth is multifactorial. Traditional radiographs can be used for location of the impacted tooth but 3-D CBCT is superior in evaluating the tooth's position. Successful management requires an interdisciplinary approach with an orthodontist responsible for the overall success of the treatment plan. Surgical exposure of these impacted teeth is accomplished using an open or closed surgical procedure. Choosing the appropriate surgical procedure and orthodontic treatment plan will result in a stable, predictable, and aesthetic result.

Ectopic eruption of the second premolar: an analysis of four different treatment approaches

PURPOSE

Ectopic second premolars may lead to impaction and loss of space in the jaws, and in rare cases even to resorption of the first permanent molar. The aim of this study was to analyse different treatment strategies of ectopic second premolars and if possible give guidelines on when to favour different treatment approaches.

MATERIALS AND METHODS

The study was a retrospective, non-randomised, outcome analysis of treatment on 41 ectopic second premolars in 37 patients (24 females and 13 males). In all cases oral examination, radiographs (pre-, peri-, and post) and full medical history were obtained. The treatment options included: (a) spontaneous eruption, (b) spontaneous eruption + extraction of primary tooth, (c) surgical exposure, (d) surgical uprighting, and (e) surgical uprighting + orthodontic extrusion. For evaluation each tooth was scored according to: (1) stage of root development, (2) distance between edges of the premolar and first permanent molar, (3) depth of impaction, (4) inclination, (5) horizontal position of the tooth. The level of significance was set to 5%.

RESULTS

Only mild cases of ectopic second premolars are self-correcting. Based on the position of the tooth in the jaw different treatment options may be chosen, these may include: extraction of primary predecessor (impaction depth < 5 mm, inclination < 55°), surgical exposure of tooth germ (impaction depth < 5.5 mm, inclination < 95°) or surgical uprighting (impaction depth > 5.5 mm with no inclination limit).

CONCLUSION

If there is no sign of self-correction after a short observation period, it is important to consider active treatment to help guiding the tooth into the correct eruption pathway.

Comparative analysis of surgical exposure and freedom between the subtonsillar, endoscope-assisted subtonsillar, and far-lateral approaches to the lower clivus: A cadaveric study

The far-lateral (FL)approach is a classic technique for skull base surgeries involving the lower clivus (LC).Recently, a modified suboccipital midline approach known as the subtonsillar (ST) approach, along with the endoscope-assisted subtonsillar (EST) approach, has been described as a minimally invasive technique to treat LC lesions. However, there is no quantitative study on comparing these approaches together for reaching LC. We aimed to compare surgical exposure and freedom provided by ST, EST, and FL approaches for various targets at LC. These approaches were performed on each side of five cadaveric specimens (total 10 sides), and relevant parameters were quantified and compared using a repeated measures ANOVA test. FL approach yielded the greatest surgical area (237.8 ± 56.0 mm²) and exposure, including lengths of glossopharyngeal nerve (16.2 ± 1.9 mm), hypoglossal nerve (11.4 ± 2.4 mm), vertebral artery (23.9 ± 3.3 mm), followed by EST and ST approaches. For surgical freedom, FL approach provided the greatest angle of attack (90.0 ± 14.0° at jugular foramen, 95.1 ± 15.8° at hypoglossal canal, 83.4 ± 31.4° at bifurcation point of posterior inferior cerebellar artery and vertebral artery). Our systematic comparison suggests that EST approach, compared to ST approach, can significantly increase surgical exposure to the medial side of LC, but FL approach still provides the greatest surgical exposure and freedom at LC. Despite the limitations of a cadaveric study, our quantitative data can update the literature on currently available surgical techniques for reaching LC and better inform preoperative planning in this area. Further studies should be performed to evaluate these approaches in clinical practice.

Harvesting the 'SEAD': Long-Term Follow-Up of the Surgical Exploration and Discovery Program

OBJECTIVE

The Surgical Exploration and Discovery (SEAD) program was established to facilitate career decision-making by providing preclerkship students with comprehensive exposure to surgical specialties. Our short-term findings demonstrated that, compared to a control group, SEAD participants showed significantly greater career-related learning. The purpose of this study was to understand the long-term impact of the SEAD program.

DESIGN

This was a prospective cohort study. One group of students participated in a 2-week surgical curriculum (SEAD group) while another group read only the program manual (Manual group). Students were surveyed following their residency selection 3 years later. The outcome measures were final specialty preference (medical or surgical), program utility, and program satisfaction.

SETTING

Undergraduate Medical Education, Faculty of Medicine, at the University of Ottawa in Ottawa, Ontario, Canada.

PARTICIPANTS

A total of 18 medical students in the SEAD group, and 18 in the Manual group.

RESULTS

Survey response rate was 100%. There was no significant difference in the number of students who pursued surgical careers in the SEAD and Manual groups. All students who pursued a surgical residency were 'very interested' in surgery prior to SEAD-initial interest in surgery had a significant influence on final residency preference. Ninety-four percent (n = 17) of SEAD participants described the SEAD program as valuable to facilitating their career decision-making.

CONCLUSIONS

Although SEAD does not generate sustained new interest in surgical disciplines, graduating students believe the program is valuable in facilitating career decision-making and perceive the program as a worthwhile time investment. These findings were true for students who selected both surgical and medical specialties, suggesting that early, multifaceted, exposure to surgery is a valuable addition to career exploration even for students who ultimately don't pursue surgical specialties. Going forward, integrating a longitudinal mentorship program may further improve the value of SEAD.

Predicting the quality of surgical exposure using spatial and procedural features from laparoscopic videos

PURPOSE : Evaluating the quality of surgical procedures is a major concern in minimally invasive surgeries. We propose a bottom-up approach based on the study of Sleeve Gastrectomy procedures, for which we analyze what we assume to be an important indicator of the surgical expertise: the exposure of the surgical scene. We first aim at predicting this indicator with features extracted from the laparoscopic video feed, and second to analyze how the extracted features describing the surgical practice influence this indicator. METHOD : Twenty-nine patients underwent Sleeve Gastrectomy performed by two confirmed surgeons in a monocentric study. Features were extracted from spatial and procedural annotations of the videos, and an expert surgeon evaluated the quality of the surgical exposure at specific instants. The features were used as input of a classifier (linear discriminant analysis followed by a support vector machine) to predict the expertise indicator. Features selected in different configurations of the algorithm were compared to understand their relationships with the surgical exposure and the surgeon's practice. RESULTS : The optimized algorithm giving the best performance used spatial features as input ([Formula: see text]). It also predicted equally the two classes of the indicator, despite their strong imbalance. Analyzing the selection of input features in the algorithm allowed a comparison of different configurations of the algorithm and showed a link between the surgical exposure and the surgeon's practice. CONCLUSION : This preliminary study validates that a prediction of the surgical exposure from spatial features is possible. The analysis of the clusters of feature selected by the algorithm also shows encouraging results and potential clinical interpretations.

The risk of suprascapular and axillary nerve injury in reverse total shoulder arthroplasty: An anatomic study

PURPOSE

Implantation of a reverse total shoulder arthroplasty (rTSA) places the axillary and suprascapular nerves at risk. The aim of this anatomic study was to digitally analyse the location of these nerves in relation to bony landmarks in order to predict their path and thereby help to reduce the risk of neurological complications during the procedure.

METHODS

A total of 22 human cadaveric shoulder specimens were used in this study. The axillary and suprascapular nerves were dissected, and radiopaque threads were sutured onto the nerves without mobilizing the nerves from their native paths. Then, 3D X-ray scans of the specimens were performed, and the distance of the nerves to bony landmarks at the humerus and the glenoid were measured.

RESULTS

The distance of the inferior glenoid rim to the axillary nerve averaged 13.6mm (5.8-27.0mm, ±5.1mm). In the anteroposterior direction, the distance between the axillary nerve and the humeral metaphysis averaged 8.1mm (0.6-21.3mm, ±6.5mm). The distance of the glenoid centre to the suprascapular nerve passing point under the transverse scapular ligament measured 28.4mm (18.9-35.1mm, ±3.8mm) in the mediolateral direction and 10.8mm (-4.8 to 25.3mm, ±6.1mm) in the anteroposterior direction. The distance to the spinoglenoid notch was 16.6mm (11.1-24.9mm, ±3.4mm) in the mediolateral direction and -11.8mm posterior (-19.3 to -4.7mm, ±4.7mm) in the anteroposterior direction.

CONCLUSIONS

Implantation of rTSA components endangers the axillary nerve because of its proximity to the humeral metaphysis and the inferior glenoid rim. Posterior and superior drilling and extraosseous screw placement during glenoid baseplate implantation in rTSA place the suprascapular nerve at risk, with safe zones to the nerve passing the spinoglenoid notch of 11mm and to the suprascapular notch of 19mm.

Two-Photon Intravital Microscopy Animal Preparation Protocol to Study Cellular Dynamics in Pathogenesis

Two-photon intravital microscopy (2P-IVM) is an advanced imaging platform that allows the visualization of dynamic processes at subcellular resolution in vivo. Dynamic processes like cell migration, cell proliferation, cell-cell interactions, and cell signaling have an interactive character and occur in complex environments. Hence, it is of pivotal importance to study these processes in living animals, using for example 2P-IVM. 2P-IVM can be performed on a variety of tissues, from the skin of the animal to internal organs, and a variety of methods can be utilized to perform 2P-IVM on these tissues. Here, we discuss the protocols and considerations for four of those 2P-IVM methods, namely tissue explant imaging, skin imaging, surgical exposure imaging, and multi-day window imaging. We carefully compare and explain in depth how to set up each method. Lastly, in the notes section we mention some alternative solutions for the 2P-IVM methods described. In conclusion, this protocol can be used as a guide towards deciding which 2P-IVM method to use and to enable the setup of this method.

Nerve supply of the subscapularis during anterior shoulder surgery: definition of a potential risk area

PURPOSE

The purpose of the study was to evaluate the position of the subscapular nerves relative to surgical landmarks during exposure and to analyze the pattern of innervation of the subscapularis to avoid injury during anterior shoulder surgery.

METHODS

20 embalmed human cadaveric shoulder specimens were used in the study. The muscular insertions of the subscapular nerves were marked and their closest branches to the musculotendinous junction and the coracoid process were measured in horizontal and vertical distances. In addition, the innervation pattern of each specimen was documented.

RESULTS

14/20 specimens showed an innervation of the subscapularis with an upper, middle and lower subscapular nerve branch. Even though the nerve branches were in average more than 2 cm medial to the musculotendinous junction, minimal distances of 1.1-1.3 cm were found. The mean vertical distance as measured from the medial base of the coracoid to the nerve innervation point into the muscle was 0.7 cm for the upper nerve branch, 2.2 cm for the middle nerve branch and 4.4 cm for the lower nerve branch.

CONCLUSIONS

The subscapularis has a variable nerve supply, which increases the risk of muscle denervation during open shoulder surgery. Dissection or release should be avoided at the anterior aspect of the subscapularis muscle more than 1 cm medial to the musculotendinous junction. In approaches with a horizontal incision of the subscapularis, splitting should be performed at a vertical distance of 3.2-3.6 cm to the coracoid base to avoid iatrogenic subscapular nerve injuries.

Tongue base exposure during TORS without the use of a mouth prop

This study describes a novel exposure technique for base of tongue trans-oral robotic surgery (BOT TORS) and early experience with it. The technique discussed involves placement of a suture through the mobile tongue with distraction and suspension of the tongue to the operating table. TORS is then performed per previously described techniques. In our series, 13 patients with either benign or malignant mass lesions involving the tongue base were treated with TORS at a tertiary academic medical center. We reviewed the rates of adequate exposure, console time, adequacy of resection (in malignant cases), complication rates, and costs associated with this technique. In our series, adequate exposure was achieved in 92.3 % of patients. Mean console time was 36 min. Negative surgical margins were achieved in all cancer resections. Five minor complications (tongue lacerations) were observed. Per-case cost attributable to this technique is $3.81. We conclude that BOT TORS is feasible without the use of a mouth prop. Operative times are consistent with those reported by centers that routinely use mouth props for BOT TORS. This technique does not appear to compromise margin adequacy during oncologic resections. Its use may result in a significant cost savings when compared to the FK and other similar retractors.

Exposures of the wrist and distal radioulnar joint

This article reviews the superficial, skeletal, and ligamentous anatomy of the wrist. Standard and alternative exposures of the wrist joint and the distal radioulnar joint are discussed, emphasizing the importance of avoiding nerve injury. Standard exposure of the wrist joint is used in the treatment of carpal ligament injuries, fractures, and dislocations. Case presentations illustrate these techniques.

Composite compound odontoma-a case report

Composite Compound Odontoma is a rare odontogenic tumour most commonly occuring in the anterior region of maxilla. An 11-year-old female patient reported a complaint of missing left central incisor. Clinical and diagnostic investigation revealed an odontogenic mass in the region of 21. This rare case report appraises the clinical diagnosis, surgical and orthodontic intervention which was planned and performed for its management.

Comparative Analysis of the Mini-pterional and Supraorbital Keyhole Craniotomies for Unruptured Aneurysms with Numeric Measurements of Their Geometric Configurations

Objective

Keyhole craniotomy is a modification of pterional craniotomy that allows for use of a minimally invasive approach toward cerebral aneurysms. Currently, mini-pterional (MPKC) and supraorbital keyhole craniotomies (SOKC) are commonly used. In this study, we measured and compared the geometric configurations of surgical exposure provided by MPKC and SOKC.

Methods

Nine patients underwent MPKC and four underwent SOKC. Their postoperative contrast-enhanced brain computed tomographic scans were evaluated. The transverse and longitudinal diameters and areas of exposure were measured. The locations of the anterior communicating artery, bifurcation of the middle cerebral artery (MCAB), and the internal carotid artery (ICA) terminal were identified, and the working angles and depths for these targets were measured.

Results

No significant differences in the transverse diameters of exposure were observed between MPKC and SOKC. However, the longitudinal diameters and the areas were significantly larger, by 1.5 times in MPKC. MPKC provided larger operable working angles for the targets. The angles by MPKC, particularly for the MCAB, reached up to 1.9-fold of those by SOKC. Greater working depths were required in order to reach the targets by SOKC, and the differences were the greatest in the MCAB by 1.6-fold.

Conclusion

MPKC provides larger exposure than SOKC with a similar length of skin incision. MPKC allows for use of a direct transsylvian approach, and exposes the target in a wide working angle within a short distance. Despite some limitations in exposure, SOKC is suitable for a direct subfrontal approach, and provides a more anteromedial and basal view. MCAB and posteriorly directing ICA terminal aneurysms can be good candidates for MPKC.

Impacted Canines: Our Clinical Experience

Background

To discuss the management of impacted canines and the various approaches used for the same.

Materials and methods

The data of 33 cases, with 43 impacted canine teeth, seen and operated over a period of 3-year in Santosh Dental College and Hospital has been compiled. The diagnostic methods and treatment modalities undertaken are described and discussed.

Results

Canine impactions were more common in the maxilla as compared with mandible in our study, which was statistically significant. Impacted canine position was mostly palatal in maxilla and labial in mandible. Chi-square test yielded a p-value of 0.002 which shows that there is an association between arch and position. The treatment options used were surgical exposure and orthodontic repositioning, cyst enucleation with extraction of impacted canine and surgical removal of impacted canine.

Conclusion

Surgical exposure and orthodontic repositioning was successfully applied as first-line treatment for correcting ectopic positioned canine. In cases where exposure and subsequent orthodontic treatment was not indicated, the impacted canine was surgically removed to prevent future problems and surgical procedure was designed according to position of impacted canine.