Assessment of clinical validity of KPG index for 3D classification of impacted maxillary canines by cone beam computed tomography in patients

OBJECTIVES

The primary objective of this study was to assess the validity of the KPG index in predicting the difficulty of treatment involving impacted maxillary canines. The secondary objective was to assess the reliability and reproducibility of the index.

MATERIALS AND METHODS

A retrospective study was conducted on 96 maxillary impacted canines (MIC) in 60 patients aged 13-35 years. Cone-beam computed tomography (CBCT) scans were used to predict the treatment difficulty of MIC using the KPG index. Patient case files were assessed for the actual difficulty encountered in treating MIC. Cohen's kappa correlation coefficient was used for intra-observer reliability and Kendell's W test was used for inter-observer reliability. Spearman's correlation coefficient test was used to assess the correlation between predicted and actual treatment.

RESULTS

Easy and moderately difficult cases exhibited a moderate correlation between actual and predicted treatment outcomes, whereas difficult cases displayed a weak correlation. The perfect correlation was observed exclusively in extremely difficult cases. The intra-observer reliability for assessing CBCT scans using the KPG guide was found to be 0.88, and the inter-rater reliability was 0.94.

CONCLUSION

The KPG index displayed 87%, 71%, 50% and 100% validity in easy, moderately difficult, difficult, and extremely difficult cases, respectively. This index showed good reliability and reproducibility. However, it is imperative to consider a multitude of other factors, including the patient's age, presence of associated root resorption in adjacent teeth, and duration of treatment, to make an informed decision between surgical exposure and extraction.

Morphological study of pulp cavity anatomy of canine teeth in domestic cats using micro-computed tomography

An understanding of the pulp cavity anatomy of individual teeth is essential for success during endodontic therapy. The objective of this study was to document pulp cavity anatomy and summarize numerical data of maxillary and mandibular canine teeth of domestic cats using micro-computed tomography (micro-CT). Thirty-nine canine teeth from eleven domestic cat cadaveric specimens were extracted and prepared for scanning. Segmentation of the pulp cavity was performed using the Avizo (v2022.2) software package. The morphological features of the pulp cavity including overall shape, configuration, presence of apical deltas and lateral canals was recorded. A quantitative analysis was performed on thirty-one teeth to explore associations between pulp cavity volume and length, apical delta length, maximum apical delta foramina number and cusp-to-tip length using a linear mixed model. Correlation between pertinent continuous variables was assessed using a Pearson's correlation test. Most pulp cavities exhibited varying curvature and ranged from a cylindrical configuration in the coronal third to an ovoid configuration in the middle to apical third. A ribbon-like flattened canal was observed in 6/31 teeth (19%). All canine teeth depicted an apical delta with various configurations except for two teeth that showed a single canal exiting at the apex. In 15/31 teeth (48%), the primary root canal within the apical delta could be clearly identified and in 16/31 (52%) the primary root canal was indiscernible. The results showed that the pulp cavities of maxillary canine teeth were significantly larger and longer and the cusp-to-tip length was longer, when compared to mandibular teeth. The apical delta length was negatively correlated to the volume of the pulp cavity. No specimens depicted lateral canals. This study revealed that the anatomy of the canine tooth pulp cavity in cats can vary considerably and should be a consideration when performing thorough debridement, shaping and obturation of the endodontic system.

Evaluation of the efficacy of the Lentulo spiral filler operated at four different speeds and with two different techniques in cadaveric canine teeth of dogs

This study evaluated the effect of filling technique and rotational speed on the efficacy of sealer cement placement using the Lentulo spiral filler. Cadaveric maxillary and mandibular canine teeth (n = 74) from age and breed matched fresh-frozen adult canine cadaver heads were utilized. Following routine mechano-chemical preparation, teeth were randomly divided into 8 treatment groups with varying rotational speeds [250-2,000 revolutions per minute (RPM)] and fill techniques (backfill technique versus pumping technique). The quality of the sealer cement fill was evaluated radiographically before and after master gutta percha cone placement. Percentage of voids present in the apical, midbody, and coronal portions of the tooth were subjectively scored as: no voids present, voids present in less than 25% of the area, voids present in 25-50% of the area, voids present in greater than 50% of the area. The apex was also scored as underfilled, adequately filled, or overfilled. Operating the Lentulo spiral filler at 2,000 RPM resulted in the best quality fill regardless of filling technique. The pumping technique with placement of the master gutta percha cone had a higher probability of success as compared to the backfill technique, but this finding lacked significance. Regardless of speed or technique, the apical region had the highest quality of fill. The addition of the master gutta percha cone improved the quality of fill. Therefore, we recommend using the Lentulo spiral filler at higher speeds with a pumping technique (followed by addition of a master gutta percha cone) to improve the quality of epoxy resin-based sealer cement placement.

Evaluation of maxillary canine and molar movement during the first phase of extraction space closure: a multilevel analysis

OBJECTIVE

This study was designed to analyze and compare the cusp and apex movements of the maxillary canines and first molars during canine retraction in the first step of extraction space closure, and to evaluate if these teeth follow a curvilinear (acceleration and/or deceleration) movement rate.

MATERIAL AND METHODS

Twenty-five patients (23.3 ± 5.1 years of age) were enrolled. The retraction of the maxillary canines was accomplished using nickel-titanium closed coil springs (100gf) on 0.020-in stainless steel archwire. Oblique cephalograms were traced and superimposed on the anatomic best fit of the maxilla (before the retraction [T0], and after one month [T1], three [T3], five [T5] and seven [T7] months). Statistics was based in a normally distributed data. Multilevel procedures were used to derive polynomials for each of the measurements. Student's t-test and one-way repeated measures ANOVA were conducted. The level of significance of 5% was adopted.

RESULTS

Canine cusps and apexes did not follow a quadratic curve regarding horizontal movement (neither accelerate nor decelerate). Canine and molar cusps showed more horizontal movement than apexes (4.80 mm vs. 2.78 mm, and 2.64 mm vs. 2.17 mm, respectively).

CONCLUSIONS

Canine did not accelerate or decelerate overtime horizontally; the cusps and apexes of the canines and molars showed more horizontal movement and larger rate at the beginning of canine retraction, followed by significantly smaller and constant movement rate after the first month.

Radiographic Outcome of the Endodontic Treatment of 55 Fractured Canine Teeth in 43 Dogs (2013-2018)

Medical records from 4 private practice veterinary dentistry specialty clinics were reviewed for a 5-year period (2013-2018) to identify dogs that had a fractured canine tooth treated by root canal therapy and returned for subsequent follow-up evaluation. Evaluation criteria included the presence of complete medical records with diagnostic quality intraoral radiographs for each procedure visit with a minimum of 6 months between visits. Forty-three dogs with a total of 55 endodontically treated canine teeth were identified and evaluated. Root canal treatment outcome was defined as successful, no evidence of failure (NEF), or failure based on radiographic findings. Patient age, time from initial treatment to follow-up, obturation material used, radiographic quality of obturation (including voids, overfill, and retention of fractured endodontic files), radiographic evidence of periapical disease and/or presence of external inflammatory root resorption (EIRR), and the presence or absence of a full coverage metal crown were evaluated. Treatment was classified as successful in 51 (92.73%) teeth, NEF in 3 (5.45%) teeth, and failure in 1 (1.82%) tooth. The results suggest that endodontic treatment of fractured canine teeth in dogs is a successful treatment option that allows for retention of this functionally important tooth.

Follow Up on Simple (Closed) Extraction of Fractured Maxillary Canine Teeth in Domestic Ferrets (Mustela putorius furo)

Fractured canine teeth (especially maxillary canine teeth) are common in domestic ferrets (Mustela putorius furo). We evaluated (detailed oral/dental and radiographic examination under general anesthesia) 18 domestic ferrets affected by 23 complicated crown fractures of periodontally healthy permanent maxillary canine teeth over a 2-year period. Average age of the ferrets at the time of diagnosis was 2.6 years. Only three teeth were discolored on clinical examination. Out of 23 teeth, 22 were radiographically evaluated. No radiographic evidence of endodontic disease was observed in 11/22 canine teeth. Inflammatory root resorption was observed in 5/22, periapical lucency in 5/22 teeth, apical widening of periodontal ligament space in 6/22 teeth, and failure of the pulp cavity to narrow in 3/22 teeth. All animals were treated by simple (closed) extraction of the affected teeth. Histological examination of eight teeth was performed. Pulp appeared histologically vital in five (3/5 showed no radiographic evidence of endodontic disease), pulpitis was diagnosed in two (both without radiographic evidence of endodontic disease) and pulp necrosis in one case (dental radiographs revealed apical widening of periodontal ligament space and failure of the pulp cavity to narrow). All extraction sites healed uneventfully by the 2-week recheck examination. Long-term follow-up revealed development of post-extraction upper lip entrapment with mandibular canine tooth in eight out of 18 ferrets, which appeared clinically irrelevant. According to clients seven out of 18 ferrets showed an improved quality of life. Simple tooth extractions are warranted in ferrets affected by complicated crown fracture of the periodontally healthy permanent maxillary canine teeth.

Experiences and perceptions of infant dental enucleation among Somali immigrants in Sweden: a phenomenographic study

Objective: The aim of this study was to explore and describe ways of experiencing and perceiving the Eastern African practice of infant dental enucleation (IDE) among immigrants of Somali origin living in Sweden. Material and methods: Six informants, three men and three women aged 26-54 years, were recruited for semi-structured individual interviews. Phenomenographic analysis of the interview transcripts was performed. Findings: Informants described four ways of experiencing and perceiving IDE: as an effective, necessary treatment; as a disputed tradition; as an alternative to failure; and as a desperate measure. The experiences and perceptions were highly influenced by the contexts the informants had been in, namely, communities in which traditional treatments were used frequently, in which other people were influential over their daily lives, and in which negative experiences of formal health care were common, as well as other difficult circumstances beyond the informants' individual control. Conclusions: The findings contribute to deepened understanding of IDE and the importance of context to the practice of it. Further, the findings deepen understanding of the decision to have the practice performed on infants, which may help dental and health care personnel to adequately communicate with individuals of Somali origin about the harmfulness of IDE.

History, clinical findings and outcome of horses with radiographical signs of equine odontoclastic tooth resorption and hypercementosis

The progression of equine odontoclastic tooth resorption and hypercementosis (EOTRH) has not been completely evaluated, and currently, the only effective treatment is extraction of severely affected teeth. We aim to describe how the disease relates to the history and clinical findings and to report on the outcome in individual horses. This case series comprises data collected from 20 horses (age 14–29 years old) with radiographic findings of EOTRH in their incisor and/or canine teeth. Most horses affected with EOTRH in this study were admitted for dental problems, but some for other complaints such as colic. Of the 288 teeth evaluated radiographically, 224 teeth were abnormal. Radiographic findings were most frequently located in the apical aspect and reserve crown of the teeth, and lesions were also commonly found in clinically normal teeth. Histopathology of extracted teeth showed inflammation in the periodontal ligament and revealed that resorption often extended to the dentine. Some owners were unwilling to allow extraction of their horses’ severely affected teeth, even though this treatment has been shown to increase the wellbeing of the horse. As EORTH is a life-long condition, the progression of the disease has to be continuously monitored and the treatments adjusted accordingly.

Feline Dental Implants: Long-Term Follow-up of Two Cases

Dental implants have become an option for replacement of lost canine teeth in cats. Although cats appear to manage well after a canine extraction, complications such as lip entrapment can occur after maxillary canine tooth extraction. Even cats with a complicated crown fracture of the maxillary canine tooth that have had root canal therapy can develop lip entrapment. This can lead to painful lip ulcers and potential need for further dental treatment. Canine tooth replacement with a dental implant and prosthodontic crown is, in the authors' experience, a predictable option that can be offered to clients who would like to replace a lost canine tooth. This report will discuss 2 long-term cases of maxillary canines replaced by dental implants/crowns.

Apical Microleakage in Root Canals Obturated With 2 Different Endodontic Sealer Systems in Canine Teeth of Dogs

An apical dye leakage test was utilized to compare 2 endodontic sealer systems commonly used in veterinary endodontic treatment. Rotary instrumentation followed by injection of 2 different sealers (GuttaFlow 2 and AH Plus) and a single master cone obturation technique were compared. Following obturation and restoration, specimens were immersed in India ink for 48 hours. A tooth mineral clearing technique was utilized to render the tooth samples transparent. Subsequently, the apices were evaluated for prevalence and magnitude of apical dye penetration under magnification. Statistical analysis of the results revealed no significant differences in the prevalence or magnitude of apical dye penetration between groups.

Discriminant canine index - a novel approach in sex determination

CONTEXT

Assessment of sex has significant contribution in construction of a physical profile of the decedent along with other parameters like race, stature and age. Sex determination with aid of skeletal remains is difficult procedure when, only a part of the body is obtainable. To solve this difficulty, tooth size standards based on odontometric data can be used in age and sex determination. The present study was undertaken with the objective to evaluate the reliability of sex determination using discriminant canine index (DCI).

METHODS

A total of 120 subjects, with healthy periodontium and between the age groups of 15 to 40 years were selected randomly. Subjects with hard tissue abnormalities were excluded from the study. The maximum mesiodistal widths of left mandibular canines were measured intraorally with the help of divider and digital vernier caliper. Data was collected and analyzed statistically.

RESULTS

A significant increase in the mesiodistal width of canines in males (7.21 ± 0.45 mm) when compared to females (6.77 ± 0.29 mm) was observed. The discriminant canine index (DCI) has identified 68.3% of males and 76.7% of females correctly with an overall accuracy rate of 72.5%.

CONCLUSION

The present study indicated that the DCI can produce reliable results and can be used as an alternative for mandibular canine index (MCI), for sex determination.