Impacted Canines Research Articles

Management of root resorption of anterior teeth caused by impacted canines with emergency traction for replacement of central incisors

Management of root resorption of anterior teeth caused by impacted canines with emergency traction for replacement of central incisors

Evaluation of Artificial Intelligence as a Search Tool for Patients: Can ChatGPT-4 Provide Accurate Evidence-Based Orthodontic-Related Information?

Artificial intelligence (AI) is already a part of our reality. Many people started using ChatGPT in their daily life, replacing existing web browsers. The confidence people put in the ability of ChatGPT to provide accurate medical information is increasing. With that, the need for proper assessment tools for the safety and reliability of ChatGPT is also crucial. This study aimed to assess the accuracy, reliability, andquality of information provided by ChatGPT-4 on three specific orthodontic topics, namely, impacted canines, interceptive orthodontic treatment, and orthognathic surgery, as evaluated by five experienced orthodontists using a Likert scale ranking method. Using ChatGPT version 4, 20 most commonly asked questions were generated and answered on the following topics: impacted canines, interceptive treatment, and orthognathic surgery. The evaluation of the quality of the answers provided was done by five experienced orthodontists. Quality assessment was done using the Likert scale ranking method. The quality answers generated by a conversational AI system (ChatGPT4) were evaluated by five experienced orthodontists for three topics: impacted canines, interceptive orthodontics, and orthognathic surgery. The evaluators rated each question-answer pair on a five-point scale from "very poor" to "very good." The results showed that the AI system produced generally good quality information for all topics, with no significant difference between them. The inter-rater agreement among the experts was low, indicating some variability in their judgments. This study demonstrates that ChatGPT4 can provide generally good information on impacted canines, interceptive treatment, and orthognathic surgery. However, answers provided should be handled with caution due to variability and lack of reliability and should not be considered a substitute for professional opinion.

RELATIONSHIP OF THE IMPACTED MAXILLARY CANINE WITH THE MORPHOLOGY OF ADJACENT LATERAL INCISOR - A RETROSPECTIVE STUDY

Objective:This study aimed to inquireabout the location and inclination of the maxillary-impacted canine and its correlation with the morphology and root resorption of the adjacent lateral incisor by using CBCT. Study design: The samples under investigation comprised 92 diagnosed cases of maxillary impacted canine, consisting of 35 males and 57 females, who met the studys inclusion criteria. Among these cases, 87 were unilateral, while 5 presented bilateral impactions, totaling 97 impacted canines. The morphological measurement of the lateral, angles between the central axis of the lateral incisor to the midline and the palatal plane,in both the impacted and non-impacted sides, were measured and compared. Results: Statistically significant differences were obtained when comparing the morphological (crown length, root length, mesiodistal and buccolingual width of crown) and angular parameters (inclination to palatal plane, angulation to MSR) of the lateral incisor, root resorption of the lateral incisor with canine overlapping, canine cusp tip level with root resorption of the adjacent lateral incisor, canine angulation with root resorption of the adjacent lateral incisor. Conclusion:The association between the morphologic and angular features of the maxillary lateral incisors and maxillary canine impaction was confirmed. Key predictors of maxillary canine impaction were identified as the crown and root length of the lateral incisor, the mesiodistal and buccolingual widths of the lateral incisor crown, and the angulation of both the lateral incisor and canine to the midline.

Orthodontic and Surgical Management of Impacted Maxillary Canines: A Narrative Review

AbstractMaxillary canine impactions are a significant challenge for orthodontic and oral surgical practices. In this narrative review, we aim to evaluate surgical and orthodontic approaches for treating maxillary canine impactions, evaluate their effectiveness, and compare the two treatment modalities.We reviewed several studies on databases such as Google Scholar, PUBMED, and MEDLINE to update recent knowledge for canine impactions and their treatment. We reviewed and included studies that matched our research objectives, including orthodontic management, open and closed eruption techniques, and contact and tooth alignment surgery.Successful treatment results of canine impactions were reported increasingly in literature, and good clinical outcomes were observed in most cases. However, factors such as the severity of the impaction, patient age, and surgical experience were found to influence the choice of surgical technique and success rates. Complications associated with surgical management of maxillary canine impactions were also reported. These complications, which include tooth resorption, postoperative infection, ankylosis, and damage to adjacent structures, are generally rare but emphasize the importance of careful patient selection, surgical planning accuracy, and emphasis on diligent postoperative care.Findings highlight surgical procedures' effectiveness, outcomes, and challenges to help clinicians make informed decisions and improve patient care. The results underscore the importance of evidence-based decision-making and a multidisciplinary approach for successful clinical outcomes. Future research will focus on long-term stability, patient-reported outcomes, and exploring emerging techniques to further improve the management of maxillary canine impactions.

Evaluation of the Relationship between Impacted Maxillary Canine Teeth and Root Resorption in Adjacent Teeth: A Cross-Sectional Cone Beam Computed Tomography Study.

This study aims to determine the position of impacted maxillary canines on cone beam computed tomography (CBCT) images, to determine the presence of resorption in adjacent teeth, and to investigate the position and type of resorption of impacted canines if resorption is present. Patients over 14 years of age with maxillary canine teeth who had CBCT images taken for any dental reason were included in the study. Resorption of teeth adjacent to maxillary canines was analyzed according to transversal, vertical, and buccopalatinal positions on the CBCT. The study evaluated 162 maxillary canine teeth on tomography images of 134 patients. Of the affected adjacent teeth, 32.1% of the central incisor, 58.0% of the lateral incisor, and 19.1% of the first premolars showed mild-to-severe resorption. The relationships between transversal position and resorption in the central and lateral incisor, vertical position and resorption in the central incisor and buccopalatinal position and resorption in the first premolars were found to be significant. Maxillary canine teeth can cause mild-to-severe resorption of adjacent teeth, especially lateral incisors. For this reason, we think that a detailed examination with CBCT is essential in the early diagnosis of resorption of adjacent teeth.

Use of Orthodontic Mini-Implants in Conjunction with Elastics for Extrusion of Impacted Canines and Correction of Bimaxillary Protrusion.

Orthodontic extrusion of canines, although challenging, can yield excellent results without tooth extraction. Temporary anchorage devices (TADs), involving mini-implants in the alveolar bone, offer stable anchorage via biomechanics. This case report details orthodontic extrusion of bilaterally impacted maxillary canines using TAD mini-implants and elastics. The patient had bimaxillary protrusion, moderate crowding, deep bite, and vertical growth pattern, necessitating careful treatment planning. The combination of TAD mini-implants with Class-II elastics simplified biomechanics. The treatment achieved efficient results, maintained adjacent teeth positioning, and improved patient compliance.

LASER assisted soft tissue procedures for orthodontic treatment.

Light Amplified Stimulated Emission of Radiation (LASER) therapy has been the subject of numerous researches as an auxiliary method in orthodontic practice. Therefore, it is of interest to assess the clinical evaluation of laser assisted soft tissue procedures for orthodontic treatment. The soft tissue surgical procedures carried out were aestheticre-contouring, gingivectomy, maxillary frenectomy, operculectomy and surgical exposure of impacted canines. The clinical outcomes evaluated in each patient were post-operative pain, bleeding during surgical procedure. In our study, clinical evaluation of outcomes in both categories revealed reduced pain at 1 hour and 24 hour after surgical procedures in patients who underwent surgery with LASER.. Soft tissue Laser can be an alternative to conventional surgery for soft tissue surgeries in orthodontics with better pain relief and reduced bleeding.

Department of Oral Surgery, Periodontal Diseases and Oral Mucosal Diseases, Poznań University of Medical Sciences, Poznań, Poland

Introduction and aim. Anomalies in dental characteristics such as size, shape, number, structure, and eruption are commonly observed in clinical conditions. One such anomaly is the presence of supernumerary teeth found in various regions of the dental arch. Although frequently asymptomatic, supernumerary teeth are routinely identified during radiographic evaluations. Among the most common causes of impacted maxillary incisors is the presence of supernumerary teeth. Description of the case. Herein, we present a rare case of lower left canine impaction subsequent to a supernumerary fusion to the mandibular left incisor in a 10-year-old Caucasian female. Conclusion. This case contributes to the current knowledge regarding supernumerary fused teeth, emphasizing the importance of early intervention and multidisciplinary collaboration in effectively managing such developmental dental irregularities.

Unleashing hidden canines: a novel fast R-CNN based technique for automatic auxiliary canine impaction

Unleashing hidden canines: a novel fast R-CNN based technique for automatic auxiliary canine impaction

Morphological evaluation of maxillary arch in unilateral buccally and palatally impacted canines: a cone-beam computed tomography (CBCT)-based study in Northern Iran.

This study investigated the association between the maxillary impacted canines' position and the maxilla's morphological features in an Iranian population based on cone-beam computed tomography (CBCT) images. In this cross-sectional descriptive-analytical study, 47 CBCT images of unilateral buccally impacted maxillary canines and 47 CBCT images of unilateral palatally impacted maxillary canines were examined. Several morphological variables were compared between the impacted and non-impacted sides, and between the buccal and palatal impaction types. Gender and age were not significantly associated with the canine impaction type. The alveolar bone height at the impacted side was significantly greater in the buccally impacted group than in the palatally impacted group (p = 0.016). In a comparison of the impacted and non-impacted sides, all variables of alveolar bone thickness at depth of 2 mm, maxillary arch width, and palatal volume had significantly smaller values in the impacted side in both buccally and palatally impacted groups (p < 0.05). The alveolar bone was significantly thicker at the depth of 10 mm in the impacted side of the buccal group (p = 0.024). The maxillary arch perimeter was significantly smaller in the impacted side of the buccal group (p = 0.008). The palatal depth did not significantly differ between the groups. Among the studied variables, the alveolar bone thickness showed contrary results at different depths. The palatal volume and maxillary arch width were significantly smaller on the impacted side in both buccal and palatal groups, and the arch perimeter showed the same results only in the buccal group.

Does 3D simulation impact clinical reasoning for orthodontic treatment planning of impacted maxillary canines?

Clinical reasoning is an essential competence to develop in the diagnosis and treatment planning of impacted maxillary canines to ensure good treatment outcomes. It involves skills of radiographic interpretation and mental visualization. To master these, postgraduate students learn to interpret 2D and 3D X-rays to locate these canines accurately. This process demands the creation of mental models of the impaction and resolving it either by envisioning the canine's movement to its correct position or considering its removal. To facilitate this cognitive exercise, a 3D-printed simulator, derived from Cone Beam Computed Tomography scans, serves as a tool to allow students to experiment with various movement simulations, helping them select the most viable treatment approach.This project aimed to assess the differences in expert and novice orthodontists’ clinical reasoning for impacted maxillary canines, and whether the addition of a 3D simulator would affect their reasoning. Thirteen (13) novices randomly assigned to a control and intervention group and three (3) experts took part in a Think-Aloud exercise to diagnose and treatment plan a case of bilaterally impacted maxillary canines. Experts and intervention group novices had the 3D simulator in addition to standardized patient records. Their responses were recorded and analyzed according to a coding scheme reflecting the clinical reasoning process. While experts demonstrated quick clinical judgment and found the 3D simulator redundant, novices were more uncertain and required additional cues. Novices using the 3D simulator described more elaborate treatment plans and had increased awareness of potential complications as compared to the control group.

Computer-assisted open exposure of palatally impacted canines for orthodontic eruption: A randomized clinical trial

ObjectiveThis randomized clinical trial aimed to assess the feasibility of computer-assisted open exposure of palatally impacted canines. Materials and methodsPatients aged 11–30 years who required orthodontic eruption for the full palatal impaction of their canines were included in this study. Exclusion criteria were psychosocial and dental contraindications of orthodontic treatment, congenital craniofacial disorders, and trauma in the patient's history in the vicinity of the surgical site. Virtual planning software was used to register the intraoral scans and cone-beam computed tomography data and to design a surgical template. In the test group, exposure of the canines was guided by a surgical template, whereas in the control group, the surgeon relied on the surgical plan to localize the impacted canine. The success of the intervention, duration of surgery, and complications, including excessive hemorrhage, damage to the canine or neighboring anatomical landmarks, and postoperative inflammation of the surgical site were assessed. Postoperative pain was reported by the patients using the visual analog pain scale (VAS). ResultsSurgery was deemed successful in all patients in both groups. During healing, no complications were observed. The duration of surgery decreased significantly in the test group (4 min 45.1 s ± 1 min 8.4 s) compared to that in the control group (7 min 22.3 s ± 56.02 s). No statistically significant differences were observed between the VAS scores of the two study groups. ConclusionsThe application of virtual planning and static navigation is a viable approach for the open exposure of palatally impacted canines. Clinical trial registration numberNCT05909254. Clinical significanceComputer-assisted surgery is a feasible method for open exposure of palatally impacted canines, which decreases the duration of surgery compared to the freehand method.

Root resorption of maxillary lateral incisors associated with maxillary impacted canines: Cone-beam computed tomography and panoramic radiography study

: The position of maxillary impacted canine (MIC) and the presence of lateral incisor root resorption (RR) remains a challenge for interceptive orthodontics and surgical treatment planning. The use of panoramic radiographs will be compared with CBCT in the diagnosis of RR and emphasize the importance of accurate diagnostic imaging.: To compare the diagnostic accuracy of Cone Beam Computed Tomography and Panoramic Radiography in detecting lateral incisor RR associated with MIC. To evaluate, with respect to sector position of impacted canines, the agreement between panoramic radiographs and CBCT in detecting lateral incisor RR.: A cross-sectional retrospective descriptive study on panoramic and CBCT radiographic records between January 2014 and December 2020. The study setting was Section of Diagnostic Imaging at a University Oral Health Centre. All patients requiring radiographs are referred to this section by all dental departments of the dental hospital. The study sample consisted of CBCT and panoramic images of impacted maxillary canines of patients older than 9yrs. Patients with odontogenic and non-odontogenic pathology in the canine and incisor area, those with previous diagnosis of external root resorption verified from the patient’s treatment records, and patients who have had any form of orthodontic treatment; removable or fixed appliances were excluded. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 27. Pearson's chi-squared test was used to analyse the agreement between panoramic radiographs and CBCT in locating canine sector position. All tests were conducted at 5% significance level. Fifty patients records were analysed in our study. The median age of the sample was 15 years and the IQR was 12.5-19. Our sample consisted predominantly of females (n=40) compared to males(n=10). A total of 65 MIC were assessed with 16 bilateral impactions (n=32) and the unilateral impactions (n=33). Of the 65 MICs, 46% were located on the right side and 54% were located on the left side. The CBCT examination showed that 58% (n = 38) of MIC were located palatally, 34% (n=22) labially and 8% (n=5) in the mid-alveolus (between the teeth). The majority of MIC occurred in sector 4 in 2-D pan (26%, n=17) and 3-D pan at (32%, n=21). Pearson's chi-squared test results showed a statistically significant difference in the agreement between 2-D pan and 3-D pan in locating canine sector position (p=0.001).: The detection of root resorption in our study underscores the importance for clinicians to examine panoramic radiographs thoroughly beyond the counting of teeth. Although panoramic radiographs are the routine diagnostic tool in contemporary dental practice, their limitation in definitive diagnosis of root resorption should be augmented with the use of CBCT.

Impacted maxillary canine: Assessment of prevalence, severity and location of root resorption on maxillary incisors: A retrospective CBCT study

The maxillary permanent canine is one of the most frequently impacted teeth, which often requires multidisciplinary management. A common complication of canine impaction is root resorption of the adjacent dentition. The aim of this retrospective study was to report the prevalence of root resorption of maxillary incisors adjacent to impacted maxillary canines from small volume CBCT images by trained clinicians. A secondary objective was to report the location and severity of root resorption. CBCT images of patients with impacted maxillary canines (unilateral and bilateral) who attended a joint orthodontic/surgical multidisciplinary clinic were screened. Descriptive statistics were used to investigate associations of patient characteristics and presence of root resorption. Generalized estimating equations (GEE) logistic regression model were used to identify predictors of root resorption. In all, 148 impacted maxillary canines (122 patients) were analysed. The majority of patients were under 18 years of age (71.6%) with impacted canines present in more females (68.2%) than males (31.8%). Maxillary lateral incisors showed the highest prevalence of root resorption (38.5%). The apical region was the most common location of resorption for lateral incisors (20.9%) with a variable degree of severity evident: slight (10.1%), moderate (15.6%), and severe (12.8%). Although no significant predictors of root resorption were identified, a weak association was evident for age and root development. In this cohort of patients, the roots of maxillary lateral incisors are most likely to suffer from root resorption in the presence of an impacted maxillary canine. Clinicians should consider the extent, location and severity of resorption of adjacent teeth when planning treatment decisions and mechanics in cases of impacted maxillary canines.

Digital Model in Orthodontics: Is It Really Necessary for Every Treatment Procedure? A Scoping Review

Digital models and three-dimensional technology in orthodontics have become an integral part of everyday clinical practice. Nevertheless, there is currently no consensus regarding in which cases a digital model is really necessary. Therefore, this scoping review aims to identify and assess which orthodontic procedures require a digital model. This review’s reporting was based on PRISMA guidelines. A literature search was undertaken using five electronic databases on 17 February 2024. A total of 87 studies met the inclusion criteria and were qualitatively analyzed by three reviewers. The following aspects of orthodontic treatment were identified and discussed with regard to digital model application: diagnosis, treatment procedures, retention, and outcome evaluation in orthodontics. Based on the studies assessed, despite some limitations regarding radiation exposure justification and the accuracy of the integration methods of 3D data, there is evidence that digital models lead to more accurate orthodontic diagnosis and treatment planning. In cases of impacted canines, aligner treatment, mini-implants insertion (when angle definition and orientation are essential), and primary care for cleft lip and palate, a partial digital model produced by an integration of some of the 3D data (face scan, intraoral scan, CBCT) that we can acquire is beneficial. A full digital model that combines all the 3D information should be used in orthognathic surgery cases, in which prediction and accurate performance are highly advocated.

Prevalence of impacted and transmigrated canines in orthodontic patients - A radiographic study.

The canine plays a vital role in dentofacial aesthetics and function. It supports the base of the alar and upper lip, which are crucial for smile aesthetics. When impacted, these functions are lost, leading to low self-esteem and overall poor health-related quality of life. The present study was conducted to find the prevalence of impacted and transmigrated canines in orthodontic patients and also to find the most prevalent type of canine impaction. This retrospective study was conducted in a hospital setting at Dental College. A total of 3050 OPGs (Orthopantomagram) of patients who visited dental hospitals for orthodontic treatment constituted the final sample. Demographic details regarding age, gender, and place of residence were collected from the patients. Evaluation of sample radiographs on the standard light box was performed to collect data regarding impacted and transmigrated canines. Statistical analysis was performed using descriptive statistics and Chi-square test. Prevalence of impacted canine was found to be 2.46%. Impacted canine prevalence of 1.53% and 2.85% was reported in males and females, respectively. Only two female patients had transmigrated mandibular impacted canines. Comparison of arch showed a statistically significant (P value 0.02) higher prevalence in the maxillary arch, which was 1.54%, and in the mandibular arch, it was 0.92%. The present study reported significantly more unilateral impactions (P value 0.00) than bilateral impactions. The overall prevalence for impacted canine was 2.46%. Prevalence was higher in female patients. Early diagnosis of impacted canines is vital for planning orthodontic treatment in such patients.

Management of Unilateral Impacted Maxillary Permanent Canine: A Case Report

Introduction The management of maxillary canine is very complex because it must be carefully planned and carried out as a team. The handling of impacted canine cases must be seen from a clinical and radiological point of view. Maxillary canine impaction can be caused by a lack of space or inadequate seed placement. The time to treat canine impaction is usually between the ages of 11 and 14. Objective The aim of this case report was to describe the management of an impacted maxillary left canine of a teenage girl. Successful treatment requires complete diagnostics, such as radiographs, good teamwork, and precise treatment planning of the dental team. Case Report An 11-year-old female patient with class I molar relationship, bimaxillary protrusive, and impacted left upper canine visited the clinic for orthodontic treatment. Extraction of four first premolars (bicuspids) was carried out, and exposure by the periodontist was completed on the maxillary left canine for the installation of a traction device (gold chain traction). Conclusion The appropriate timing, treatment plan, and proper surgical exposure preparation in handling this case produced optimal and ideal results.

Evaluation of the Relationship Between the Maxillary Sinus and Nasopalatine Canal of Maxillary Impacted Canines by Cone Beam Computed Tomography

Introduction. One of the critical parameters evaluated while planning orthodontic treatment for impacted canines in clinical practice is the relationship between impacted canines and adjacent anatomical structures. The nasopalatine canal (NPC) and maxillary sinus are anatomical formations that may be in close proximity to impacted canines. This study aimed to determine the relationship between palatally impacted canines, the maxillary sinus, and the NPC. Methods. A total of 105 impacted canines from 93 patients were evaluated using cone beam computed tomography (CBCT) images. The relationship between the impacted canine teeth, maxillary sinus, and NPC was assessed inside, outside, and at the border of the maxillary sinus floor and NPC walls. The millimetric distance between the impacted canine teeth and the borders of the maxillary sinus, the NPC, and the cortical bone of the palate was measured. Additionally, NPC morphology was assessed on the axial and sagittal CBCT images. Results. Of all the impacted teeth, 47.6% (3.8% inside, 43.8% at the border) were associated with the sinus, while 42.8% (15.2% inside, 27.6% at the border) were associated with the NPC. A significant moderate negative correlation (-0.32) was observed between age and the distance between impacted left canine teeth and the cortical bone of the palate. Additionally, when a Y-shaped NPC was present, the impacted canines were predominantly situated outside the canal. Conclusions. In this study, nearly half of the canines were located inside or at the border of the maxillary sinus and the NPC. Therefore, clinicians should carefully evaluate the relationship of impacted teeth with the maxillary sinus and the NPC during both orthodontic treatment and the extraction of impacted teeth.

Do erupting maxillary canines resorb adjacent teeth? A study focusing both on the ipsilateral and contralateral sides among individuals with unilaterally impacted canines.

To determine the prevalence of root resorption of teeth adjacent to permanent maxillary canines on both sides, by cone-beam computed tomography (CBCT), in pretreatment adolescent subjects with unilaterally impacted maxillary canines, and to define predictive factors for the root resorption. This retrospective sample included 76 adolescents (38 boys, 38 girls, mean age 12.3 ± 2.1 years; range 8-17 years) who had CBCT after detection of a unilateral impacted maxillary canine before any active orthodontic treatment. Both ipsilateral and contralateral sides were examined, and 14 qualitative and quantitative variables were collected. Descriptive statistics were calculated, and multiple logistic regression was used to predict root resorption. On the impaction side, 57.9% of canines resorbed at least one adjacent tooth compared with 13.2% on the contralateral side (P < .001). On the impaction side, resorption was slight in 59.6%, moderate in 5.8%, and severe in 34.6% of the cases. On the contralateral side, resorption was slight in 91.7%, moderate in 0%, and severe in 8.3% of the cases. On both sides, upper lateral incisors were the teeth most frequently resorbed, followed by the upper first premolars and upper central incisors. The presence of contact between the canine and the adjacent roots was the only statistically significant risk factor for resorption for both ipsilateral and contralateral sides. Orthodontists should look for root resorption on both sides in cases of unilaterally impacted maxillary canines.

Treatment duration by morphology and location of impacted maxillary canines: A cone-beam computed tomography investigation

This study aimed to identify whether patients with impacted maxillary canines take longer to treat than orthodontic patients without an impacted canine. We also sought to identify factors that are predictive of increased treatment duration in patients with impacted maxillary canines and treated by surgical exposure. A retrospective investigation of 37 patients with an impacted maxillary canine, treated by surgical exposure and fixed appliance therapy, was undertaken. In addition, an age- and sex-matched control group of 39 patients (without impacted canines) was also collected. Patient age, sex, and total treatment duration were recorded. For patients with an impacted canine, patient records and pretreatment cone-beam computed tomography datasets were assessed. Point coordinates identifying relevant landmarks were recorded, and a geometric method was used to calculate variables describing canine location, orientation, and apical morphology. Controlling for age and sex, linear regression identified a statistically significant increase in treatment duration of 46.7 and 41.5 weeks for palatal and labial/midalveolar impacted canines, respectively, vs controls (P<0.002). Age and sex of patients with impacted canines collectively affected treatment duration (P= 0.04), with females of increased age being treated faster than younger males. Rotation of the impacted canine crown had a highly significant effect on treatment duration, with every degree of rotation increasing treatment duration by 0.32 weeks (P<0.001). There was a significant degree of multicollinearity between the other radiographic variables. Collectively, radiographic variables describing canine displacement significantly prolonged treatment duration (P<0.001) and explained 29.8% of the variability in total treatment time. The apical morphology of impacted maxillary canines was significantly associated with increased treatment duration (P= 0.01) and explained 11.3% of the overall treatment variability (P= 0.01). Increased total treatment duration of surgically exposed impacted maxillary canines is associated with increasing mesiopalatal canine crown rotation, worsening displacement, and hooked apical morphology.