Ectopic Canines Research Articles

The ectopic mandibular canines can start tooth formation in three different locations: a case series study based on single orthopantomograms from 47 individuals

IntroductionA former study on orthopantomograms from young children with abnormal dental development (not canine ectopia) demonstrated that the tooth bud of the mandibular canine, compared to a stable longitudinal canine axis, could be located normally, anteriorly or posteriorly, with close relation to the first premolar.AimThe aim of the present study is to analyse on orthopantomograms if the canine axis can demonstrate where the ectopic mandibular canine started tooth formation.MaterialsThe material consists of orthopantomograms with ectopic mandibular canines and presence of primary mandibular canines from 47 cases (29 cases 9–21 years old and 18 cases with unknown ages). The primary canines demonstrated from minor apical resorption to more severe apical resorption.MethodsBased on canine maturity, location of the canine axes and the interrelationships between the roots of the permanent canine and first premolar, the location from where the canine started tooth formation was determined. Canine maturity. Maturity stage below half root length and maturity stage above half root length revealed that 11 ectopic canines had less than half root length and 36 cases more than half root length. Canine axes. The canine axis, through the length of the primary canines Ax, is inserted on drawings of the orthopantomograms using the tracing programme Inkscape®. Interrelationship between roots. By visual inspection, the distance between the canine and first premolar was designated close distance, normal distance and extended distance.ResultsThe results are divided into 3 groups. Group 1: The initial site of the permanent ectopic canine is located within the canine axis (6 cases). Group 2: The initial site of the permanent ectopic canine is located posterior to the canine axis (36 cases). Group 3: The initial site of the permanent ectopic canine is located anterior to the canine axis (5 cases).ConclusionThe study explained that the canine axis could divide cases of ectopic canines into three groups according to the location from where tooth formation starts. For getting closer to the pattern of the ectopic canine eruption, it is necessary to analyse series of orthopantomograms taken from the same individual over several years.

Radiographic assessment of unerupted permanent maxillary canines and their relationship to the phases of dentition in mixed dentition Spanish children: a retrospective cross-sectional study.

Evaluate if there is a significant association between the position and inclination of the unerupted maxillary canine measured on a panoramic radiograph, and their relationship to gender, age of the patient and stage of dentition. 138 panoramic radiographs were examined for this retrospective cross-sectional investigation. Only patients living in Madrid, Spain with mixed dentition were included. These measurements were performed on radiographs, considering the inclination and position of the maxillary canines with regards to the midline, and height with respect to the occlusal plane. Spearman's correlation coefficient was used to analyze the relation among the canine angle and height. p < 0.05 was considered to be significant. The prevalence of patients with an altered canine angle was 10%, while 43.5% had an apparently abnormal position (overlapping at least half of the adjacent lateral incisor root). No statistically significant association was found between these two variables. In 5% of the patients, the maxillary canine was with an anomalous angle and position. Significant differences were obtained when comparing canine height between children with ectopic canines and normal canines (p = 0.032). No significant association was found between the position and inclination of the unerupted maxillary canine in our sample. Ectopic maxillary canines had a higher incidence in girls, although we did not find statistically significant differences between genders. We observed a higher prevalence of abnormal position and inclination of the permanent maxillary canine in early mixed dentition. Maxillary canines were significantly elevated, further from the occlusal plane, in children with ectopic canines.

Prevalence of Ectopic Canine in Different Sagittal and Vertical Skeletal Patterns.

The present investigation aims to find out the prevalence of ectopic canines among skeletal class I, II, and III malocclusions and to evaluate its variability among different genders and their growth patterns. The study sample included orthopantomograms (OPGs), lateral skull views, and study models of 999 patients collected from departmental archives. Among the selected samples, 258 were males and 738 were females. They were divided into skeletal class I, II, and III malocclusions sagittally and hypodivergent, normodivergent, and hyperdivergent groups according to their angle formed between point A-Nasion - point B (ANB) and angle formed between the Sella-Nasion (SN) plane and Gonion (Go) - Gnathion (Gn) plane (SnGoGn) values respectively. Of the 999 samples, 738 (73.9%) were female and 260 (25.8%) were male patients. When compared to men, females had a higher proportion of ectopic canines. An estimated 62.3% of skeletal class I, 29.1% of skeletal class II, and 8.6% of skeletal class III cases were found to have ectopic canines. An estimated 720 (72.1%) patients were found to have maxillary ectopic canines and out of the available sample, 474 patients have horizontal growth patterns, 335 have average growth patterns and 190 patients have vertical growth patterns. Labial impaction was the commonest (65.4%) followed by palatal (24.8%). Bilateral impaction was comparatively more (51.1%) than unilateral impaction (48.2%). Maxilla was more prevalent (72.1%) as compared to the mandible (16.3%) and for both the arches it was (11.6%). Ectopic canines were identified in a total of 62.3% of cases with skeletal class I, 29.1% of cases with skeletal class II, and 8.6% of cases with skeletal class III. The bilateral ectopic canine was mostly seen in skeletal class I and class III malocclusions, whereas, a unilateral presentation was mostly seen in skeletal class II malocclusions. Knowing the likelihood of a maxillary canine erupting ectopically will aid clinicians in starting with interceptive therapy since this condition necessitates complex orthodontic mechanics.

An easy way to treat buccal canine malocclusion: A case report

An ectopic tooth is one that is erupting in an aberrant route, whereas an impacted tooth is one that has failed to fully erupt into the oral cavity within its expected developmental time period and can no longer be expected to do so. The majority of canine eruption abnormalities occur in one of two directions: palatal or buccal displacement from the usual eruptive location 2. Permanent maxillary canine impaction or ectopic eruption affects about 1-2 percent of the general population. Canines that are palatally displaced are twice as common as those that are buccally placed. Buccally displaced canines, on the other hand, are very prevalent in practice and their etiology is related to a deficient dental arch perimeter 3,4. So, the purpose of this report is to show a case of a 15-year-old male with ectopic maxillary canines who was treated by extracting the four first premolars, using segmental T loops for retraction of ectopic canines. The goals were met at the end of treatment with optimal aesthetic balance and excellent occlusal connections, resulting in great long-term stability.

Everybody gets an expander

Seemingly every preadolescent patient that presents for an orthodontic consultation is prescribed rapid maxillary expansion (RME) treatment. Parents are forewarned of premolar extractions, lateral incisor root resorption from ectopic canines, or obstructive sleep apnea if they delay treatment. Are we exaggerating the need for Phase I RME in pursuit of two-phase treatment and increased revenue? Let's take a closer look at the history, trends, expectations, and proper timing of RME, with an emphasis on Phase I treatment.

Clinical predictors of potentially impacted canines in low-risk patients: A retrospective study in mixed dentition

To evaluate the null hypothesis that there is no difference in a set of clinical predictors of potentially impacted canines between low-risk patients with and without displaced canines. The normal canine position group consisted of 30 patients with 60 normally erupting canines ranked in sector I (age, 9.30 ± 0.94 years). The displaced canine group comprised 30 patients with 41 potentially impacted canines ranked in sectors II to IV (age, 9.46 ± 0.78 years). Maxillary lateral incisor crown angulation, inclination, rotation, width, height, and shape, as well as palatal depth, arch length, width, and perimeter composed a set of clinical predictors, which were evaluated on digital dental casts. Statistical analyses consisted of group comparisons and variable correlations (p < 0.05). There was a significant association between sex and mesially displaced canines. Unilateral canine displacement was more prevalent than bilateral displacement. The crown of the maxillary lateral incisors was significantly angulated more mesially and rotated mesiolabially in low-risk patients with displaced canines, who also had a shallower palate and shorter anterior dental arch length. Lateral incisor crown angulation and rotation, as well as palatal depth and arch length, were significantly correlated with the canine displacement severity. The null hypothesis was rejected. Maxillary lateral incisor angulation inconsistent with the "ugly duckling" stage as well as a shallow palate and short arch length are clinical predictors that can significantly contribute to the early screening of ectopic canines in low-risk patients.

Pulp Revascularization After Autotransplantation of the Mandibular Canines With Partially Resected Roots: Report of 5 Cases With Follow-ups Between 26 and 80 Months

IntroductionTransmigrated (migrated through the midline) mandibular canines constitute a treatment challenge. Advanced transmigration can be successfully treated by autotransplantation. In developing canines, pulp revascularization is typical after transplantation. On the contrary, the pulp of teeth with completed apex formation does not undergo revascularization. In this case, root canal treatment becomes compulsory and decreases the success of autotransplantation. The aim of this observational retrospective study was to evaluate whether partial resection of the root (performed during the autotransplantation of mature canines) would enable revascularization of the pulp after the surgery. MethodsFive transmigrated mandibular canines with complete apex formation before the surgery were evaluated. During the autotransplantation surgery, the resection of 2 to 4 mm of the root apex was performed to open the path for revascularization of the pulp after surgery. The transplanted teeth were observed during healing after the surgery for the presence of pulp obliteration. Clinical and radiographic examinations were performed. ResultsAll treated canines survived the minimum observation period of 2 years (ranging from 26 to 80 months, mean: 55 months) without pulp healing complications. The survival was 100%, and the success was 80%. In one canine, the external cervical root resorption was diagnosed and treated 1 year after the surgery. At the final examination, transplanted canines presented radiographic features of pulp obliteration, normal mobility, and healthy periodontal tissues. ConclusionsThe surgical protocol proved to be successful in promoting revascularization to maintain pulp vitality, in all cases. The outcomes confirm that autotransplantation, combined with the resection of the root, constitutes a valid treatment for mature ectopic canines.

Association of vertical growth pattern with canine impactions in Dravidian subjects.

Canine impaction, ectopic canines, canine transposition, canine transmigration, and agenesis are all caused by disturbances during development and eruption of the teeth. The position of the canines is of utmost importance, and they should be carefully inspected as they follow the longest path during eruption in the oral cavity and their shape and position play a major role in occlusal guidance. The prevalence of canine impaction may also be connected to the pattern of facial growth. The objective of this study was to analyze the association of vertical growth pattern and canine impaction in Dravidian population. The dental records were consulted for information. The patient information was gathered from the outpatient data records of patients who were treated with fixed orthodontic treatment at the private dental setup. Patients with canine impactions were shortlisted. Malocclusion, growth pattern, and type of impaction were recorded. The data obtained were tabulated and analyzed using statistical software. Out of 1385 subjects, 35 patients had impacted canines. Among 35 patients with impacted canines, 23 (65.71%) have a vertical growth pattern, 6 (17.14%) have an average growth pattern, and 6 (17.14%) have a horizontal growth pattern. According to the findings of this investigation, there was no gender-related difference in canine impaction. The canine impaction prevalence in Dravidian subjects was found to be 2.53%. Most of them with impacted canines had a vertical growth pattern.

Management of palatally ectopic canines part 2: Ankylosis hypotheses and southend experience

The second part of this series outlines different techniques which can be implemented by surgeons during ectopic canine exposure to initiate mobilisation and reviews multiple adverse outcomes including the phenomenon of ankylosis. Finally we present locally achieved outcomes to demonstrate success when adhering to principles evolved with consideration to the embryological processes in tooth eruption.

Management of palatally ectopic canines part 1: Importance of histological developmental understanding in improving outcomes

Successful mobilisation of palatally ectopic canines requires an understanding of the embryological and histological processes involved in tooth eruption, in order to optimise conditions for eruption and achieve a positive outcome. Part one of this two part series presents the reader with the important characteristics of the oral tissues which feature in the eruption process and discusses techniques in tissue handling when performing exposure of impacted teeth. The following paper will provide data on our experience in addition to reviewing the alternative methods available for exposure of teeth.

Orthodontic-Surgical Approach for Treating Skeletal Class III Malocclusion: About A Case Report

Class III skeletal malocclusions are considered to be ones of the most challenging deformities for orthodontists, they may present several forms, among which maxillary deficiency is the most frequent. This type of malocclusion is usually treated with combination of orthodontics and orthognathic surgery in order to obtain an adequate occlusion and facial esthetics. This report presents the treatment of a young female patient aged 16 years and 4 months with Class III skeletal malocclusion, and a severe anterior crowding with palatal displacement of the maxillary lateral incisors and ectopic canines, as well as an Angle Class I molar relationship occlusion on both sides associated with significant dento-alveolar compensation : The upper incisors were proclined while the lower incisors were vertical, and a maxillary midline shift .Clinical examination has also revealed a retrusive maxilla, underdeveloped cheekbones, and a flat facial profile. The treatment was performed in three phases: first, presurgical orthodontic preparation including extraction of the maxillary first premolars and mandibular second premolars in order to perform the orthodontic decompensation, secondly, orthognathic surgery which consists of maxillary advancement to improve soft-tissue projection of the midface, and finally, orthodontic finishing for the conclusion of the case. At the end of the treatment, the main objectives were successfully achieved, providing the patient with adequate masticatory function, pleasant facial esthetics and especially better self-esteem.

Lateral Incisor Root Resorption: A Consequence of Ectopic Maxillary Canine Teeth

Root resorption of permanent teeth is a recognized complication of ectopic maxillary permanent canines. This type of resorption is sometimes missed and can be diagnosed at the late presentation stage. Treatment of external resorption is complex and can require extraction of the affected tooth. This review provides an insight into the current evidence and guidance related to the interceptive treatment of displaced permanent maxillary canines to minimize the risk of resorption of adjacent teeth. Supported by two clinical cases, it looks into treatment options and long-term management of lateral incisors with external root resorption of varying severities. CPD/Clinical Relevance: Primary care practitioners are best placed to recognize displaced maxillary permanent canines in a timely manner, and so, root resorption of adjacent teeth may be prevented.

Mini-Implant-Assisted Simultaneous Torquing Extrusion Retraction Spring for Ectopic Canines

Orthodontic management of ectopic canines is quite challenging and time consuming due to the presence of thin buccal cortical bone. Sectional mechanics provide distal and extrusive force on canine but without any torque control. So, palatal root torquing during canine retraction is needed to increase the buccal cortical bone thickness and to avoid bone dehiscence and gingival recession. This article describes an innovative spring which provides 3-dimensional control by simultaneous retraction, extrusion, and torquing of ectopic canine.

Orthodontic rescue of a case of bilaterally ectopic canines causing root resorption of central and lateral incisors

A 14-year-old medically fit and well patient presented with bilaterally ectopic maxillary canines resorbing the central and lateral incisors. It is relatively rare that both maxillary ectopic canines cause resorption to the central and lateral incisors. Treatment options discussed with the patient are explored as well as case management and how potential complications were minimized. A good result was achieved at the end of the treatment, despite the complex nature of this case. CPD/Clinical Relevance: To demonstrate how a patient with bilaterally ectopic canines resorbing central and lateral incisors can be managed. This is clinically relevant to orthodontists and GDPs.

The Seven-year Journey of an Ectopic Canine: Multidisciplinary Management of a Dentigerous Cyst in the Early Mixed Dentition

The Aberdeen Royal Infirmary oral and maxillofacial surgery department is involved in the joint planning of cases with the orthodontic and restorative departments of the Aberdeen Dental Hospital to agree an optimal treatment plan for patients, with input from all three specialties. A 7-year-old girl was referred to the orthodontic department by her GDP due to non-eruption of the upper left central incisor. This was related to an associated dentigerous cyst. This presentation illustrates the phases of treatment involving marsupialization of the dentigerous cyst; surgical extraction and orthodontic treatment in order to provide the patient with the optimal outcome for her dentition. A retrospective assessment of the case is presented through photographs and radiological imaging outlining the chronology of the treatment and the outcome of marsupialization of the dentigerous cyst. It highlights this more conservative surgical approach as giving the best chances of preserving unerupted teeth in a younger patient. Marsupialization of a dentigerous cyst associated with UL1 and conservative management of cystic pathology led to preservation and natural mesial eruption of UL3 into the position of UL1. The unerupted UL1 associated with cystic pathology was extracted due to its ectopic position and root dilaceration. Seven years after diagnosis of the dentigerous cyst associated with the unerupted UL1, surgical and orthodontic management has facilitated the for patients tooth to erupt into the UL1 position. Restorative treatment is being planned following orthodontic treatment to restore for patients tooth to simulate the missing UL1. CPD/Clinical Relevance: This case encourages the appropriate referral of young patients with dentigerous cysts to achieve a satisfactory outcome.

442 COVID-19 And the Oral Surgery/Orthodontic Interface: Has A Delay in Treatment Complicated the Position of Unerupted And Ectopic Teeth Planned for Surgical Removal or Exposure?

Abstract Aim To evaluate whether there has been a change in clinical or radiographic position and the resultant occurrence of complications of unerupted and ectopic teeth due to delayed treatment during the COVID-19 pandemic Method Data was collected over a three-month period at the Royal United Hospital, Bath, Oral and Maxillofacial Surgery Department. This was via a questionnaire distributed to clinicians and prospectively completed for each surgical procedure planned for the removal or exposure of ectopic canines, premolars, and supernumerary teeth. Results A total of 20 surgical extractions or exposures were performed during the three-month period, with 33% (n = 6) having a marked difference between their expected and final position. Complications occurred in 66.6% (n = 4) of cases that demonstrated a discrepancy in location. These were an increased surgical time, increased removal of bone or a cancellation of intended treatment. This cancellation occurred as the tooth had erupted enough for non-surgical management. In cases where there was no discrepancy (n = 14), no complications were reported. Conclusions These findings suggest the delay in treatment caused by the COVID-19 pandemic has resulted in a clinically significant change in the position of ectopic teeth planned for surgical removal or exposure. Given these findings, it is crucial that clinicians be aware that radiographic investigations are diagnostic and recent. The threshold for repeat imaging in all cases which have been delayed should be low to avoid unexpected surgical complications arising from inaccuracy in tooth localisation.

Unusual Case Report: Ectopic Canines, Resorption and Hypodontia in Monozygotic Twins

Ectopic maxillary canines are present in 1–3% of the population and may consequentially cause root resorption in 66.7% of lateral incisors. Ectopic canines are thought to be of polygenic and multifactorial origin, although Msx1 and Pax9 are suggested genetic candidates. Hypodontia is present in up to 11.3% of the population and is associated with mutations in Msx1, Pax9 and Axin2. Previous studies have separately demonstrated similarities in hypodontia and ectopic canines in monozygotic twins. This report discusses similarities clinically and using cone beam computed tomography in 14-year-old male genetically identical twins. While hypodontia and ectopic canines have both previously been linked with a genetic origin, this report suggests there is also a genetic predisposition to root resorption. The association between hypodontia and ectopic canines is usually associated with the guidance theory and hypodontia of upper lateral incisors; however, this report highlights the occurrence of ectopic canines and hypodontia of premolar teeth. It also presents the sequelae of severe root resorption associated with ectopic canines and idiopathically in areas of non-impacted canines CPD/Clinical Relevance: The role of the general dental practitioner in early recognition of hypodontia and ectopic canines and the importance of referral for an orthodontic opinion is emphasized.

The diagnostic value of orthopantomograms in detecting resorption of lateral incisors associated with ectopic canines: a CBCT study.

To examine the diagnostic value of orthopantomograms (OPG) in the identification of root resorption of lateral incisors, secondary to an impacted canine, as confirmed by a cone-beam computed tomography (CBCT) scan. Retrospective observational cohort study. South Wales secondary care setting: Royal Gwent Hospital, Newport and Nevill Hall Hospital, Abergavenny. A total of 40 consecutive patients with impacted canines between January 2018 and December 2019 were selected. For each patient, one consultant orthodontist examined the OPG in isolation to detect the presence and extent of resorption of lateral incisors. The CBCT report was then studied to confirm the presence and extent of pathology. Sensitivity, specificity, accuracy, positive predictive values and negative predictive values were calculated. In total, 19 maxillary right canines, 18 maxillary left canines, one mandibular right canine and two mandibular left canines were examined. Impactions were more prevalent in the maxilla (92.5%) with higher predilection towards female patients (65%). There was higher prevalence of root resorption in the maxillary right quadrant (57.1%), in concordance with other studies. OPGs were found to have a sensitivity of 81.0% and a specificity of 10.5%, with an accuracy value of 47.5%. Positive and negative predictive values were found to be 50.0% and 33.3%, respectively. The extent of root resorption was incorrectly estimated from the OPG in 84% of cases. Correct estimation occurred in 16% of cases, with overestimation and underestimation occurring in equal proportion (42%). This study demonstrates the limitations of plain film radiographs and the merits of using CBCT in the accurate diagnosis of resorption of lateral incisors with an associated impacted canine. It also gives an indication into the location prevalence of resorption in a small cohort of patients. This preliminary study establishes the basis for future, larger-scale studies where outcomes can be generalisable at a population level.

A study of smile aesthetic perception among dental professionals, patients and parents towards impacted maxillary canine treatment options.

To evaluate the smile aesthetics of the different treatment options for impacted maxillary canines as perceived by orthodontists, dentists, patients and parents. Cross-sectional survey. Four rater groups were selected to complete the questionnaire consisting of an orthodontist group, a general dental practitioner group, a patient group consisting of patients aged 11-18 years who were considered to be 'Gillick competent' and a parent group consisting of parents/guardians who accompanied the patients to their orthodontic appointments. Four digitally manipulated images were created to imitate different treatment options available for the treatment of ectopic maxillary canines including: alignment of the impacted maxillary canine; substituted premolars; retained deciduous canines; or gaps present. The images were embedded into piloted questionnaires. Each participant completing the questionnaire was asked to mark the visual analogue scale (VAS) beneath each image according to their perception of attractiveness of each image. Quantitative scoring of the perceived attractiveness of the smile was assessed by one calibrated assessor measuring the distance from the start of the scale to the marked cross placed on the VAS. A two-way ANOVA (mixed between-within subject's ANOVA) was used to compare perception of differences in smile aesthetics. There were significant differences found in the VAS between the groups (P = 0.002) and between the treatment options (P < 0.001) There was no statistically significant difference found between the aligned canines and substituted premolars images by the patient (P = 0.2) or parent group (P = 0.5). All groups most disliked the treatment option where gaps were present at the end of treatment. The patient and parent groups showed similar perception in smile aesthetics for aligned canines and substituted premolars and all groups showed a strong dislike to the presence of gaps. The orthodontist group showed the most critical aesthetic perceptions.

Oral Health Impact Profile in Orthodontic Patients with Ectopic Canine: A Prospective Clinical Intervention of Four Treatment Modalities.

This study evaluated the oral health-related quality of life (OHRQoL) in Saudi subjects with ectopic canine, severe crowding, and class I normal occlusion. Moreover, we assessed the differences among orthodontic treatment modalities (OTM) in the ectopic canine group. Study design: Retrospective and prospective evaluation. A total of 96 subjects were assessed for OHRQoL using the Oral Health Impact Profile, English version (OHIP-16). Initial comparison of the baseline data of ectopic canine subjects was made with severe crowding (>8 mm) and class I normal occlusion with the matched number and age of the subjects in later groups. Moreover, a comparison of OHIP-16 scores among four OTM in the ectopic canine group, baseline, 1 day, and 28 days after treatment were performed. OHIP-16 scores of ectopic canine, severe crowding, and class I normal occlusion group were 33.06, 33.09, and 26.43, respectively. Subjects with ectopic canine and severe crowding reported a significantly greater negative impact in terms of embarrassment, avoiding smiling, and lack of self-confidence. OHRQoL had no significant changes among the four OTM groups (p > 0.05). Untreated malocclusion had a significant negative impact on OHRQoL. The negative impact was seen in several domains 1 day after treatment, and gradual improvement was noted 28 days after treatment.