Eruption Of Maxillary Canines Research Articles

Proposal for a grading system to determine the clinical status and sequence of permanent teeth eruption: A pilot study

ObjectivesThe objective of the study was to propose and test a new grading system to quantify the clinical eruption of teeth into the oral cavity. In addition, the study also aimed to apply the grading system to a sample population to determine the chronology and sequence of permanent tooth eruptions, comparing the results with an existing standard table. MethodsA cross-sectional study was designed, and 1220 children aged 5–18 years were selected from five schools in Chennai. The clinical status of permanent tooth eruption was graded using the newly proposed system. The sequence and chronology of permanent tooth eruptions were determined using Probit analysis and compared with those established by Logan and Kronfeld. The difference in stages of eruption between the sexes was analyzed using the ANOVA test. ResultsThe study sample included 515 boys and 705 girls. A total of 23,218 permanent maxillary and mandibular teeth were examined and graded. Of the 11,085 maxillary teeth, 367 were classified as grade 1, 660 as grade 2, and 10,058 as grade 3. Similarly, of the 12,133 mandibular teeth, 497 were grade 1, 793 were grade 2, and 10,843 were grade 3. The eruption of the maxillary canines, second molars, and mandibular second premolars was observed to have occurred earlier than in the traditional table of tooth eruption. The most significant differences in the stages of eruption between the sexes were observed in the 9–12 age group. ConclusionsThe newly proposed grading system was found to be simple, objective, less confusing, and more robust, compared with the existing systems in determining the clinical status of tooth eruptions. The ages of eruption of maxillary canines, second molars, and mandibular second premolars were earlier.

Apical incisor root resorption due to ectopic maxillary canine eruption: Association with time of diagnosis and type of intervention in a retrospective population-based cohort study.

The primary aim was to study upper incisor severe apical root resorption (RR) related to ectopic canine eruption and its association with timing of diagnosis and type of intervention conducted. The secondary aim was to correlate resorption with other dental anomalies. Digital journals and radiographic material of all ectopic maxillary canines registered in 2012 in the regional public paediatric dental clinics in the Council of Aarhus were inspected retrospectively. Data related to 10 variables were retrieved. Post-treatment radiographs were used for evaluation of incisor RR. A total of 260 ectopic maxillary canines were diagnosed in 2012. The majority were found in the 9-13-year-old age group (0.8% prevalence within the total population). In all, 244 canines were assessed for eligibility and 181 had adequate final radiographs for evaluation of RR. Among ectopic maxillary canines, 9.4% caused severe incisor RR to neighbouring teeth. Timely palpation for canine eruption significantly reduced the odds for upper incisor resorption by 80%. Multiple regression showed that when the permanent canine cannot be palpated and the deciduous has been extracted, delaying the first X-rays was associated with a 38% odds ratio increase for RR for each year of delay after the age of 10 years. No significant associations were found between incisor RR and intervention conducted or other dental anomalies. Palpation of erupting maxillary canines is crucial for timely diagnosis of ectopic eruption and initiation of treatment to avoid RR. If the canine cannot be palpated at 10 years of age, radiographic examination is highly recommendable.

Revealing the Effect of Impacted Canines on the Adjacent Teeth. A Three Dimensional Study Using CBCT.

The current cross-sectional study aimed to assess the relationship between impacted maxillary canines and their effect on root resorption of neighboring teeth using cone-beam computed tomography (CBCT). The study evaluated the effect of 24 impacted maxillary canines on the adjacent tooth roots. We used a CBCT to evaluate the position and size of the dental follicle of impacted maxillary canines and the severity of root resorption on adjacent teeth. We used a t-test to compare the significant differences between the width of the dental follicle and the severity of root resorption. The inter- and intra-rater agreements were assessed. A number of 12 impacted canines had resorbed the roots of adjacent teeth. Lateral incisors were most affected (83.3%), followed by central incisors (16.7%). Mild root resorption was found in 10 cases, while severe resorption was found in two cases. We found no relation between the size of the dental follicle and the degree of root resorption. The inter- and intra-rater agreements were high. In cases with maxillary impacted canines, special consideration should be directed to the roots of the maxillary lateral incisors. Our findings could not confirm any relationship between the size of the dental follicle width of the maxillary impacted canines and the degree of root resorption of the adjacent incisors. More studies are needed to assess the proximity and path of eruption of impacted maxillary canines and their effect on the neighboring teeth.

Evaluation of Dental Root Development Regarding Maxillary Canine Eruption Status after Secondary Alveolar Bone Grafting in Patients with Cleft Lip and Palate.

In children born with cleft lip and palate, the timing of the secondary alveolar bone graft (SABG) is crucial to its success; this involves estimating the eruption of the permanent maxillary canine. Altered dental eruption in this patient group gives impetus to the identification of dental developmental factors concerning maxillary canine eruption, which may steer the clinical decision of SABG timing. Records of over nine hundred patients who received SABG with pre- and post-operative cone beam computed tomography (CBCT) scans were analyzed for inclusion and divided into two groups (erupting or non-erupting canine after SABG). Roots of the maxillary canines and premolars were segmented from the cementoenamel junction then linear and volumetric measurements were performed. The pre- and post-operative root length and volume differences were calculated and compared statistically using independent sample tests and paired t-tests. No statistically significant differences were found in the volume change (%), or reciprocal of mean root length in the erupted and unerupted groups in the canine, first premolar, or second premolar roots except for an association between the post-operative dental root length of the canine and the maxillary canine eruption status. Therefore, assessment of root development from pre-treatment CBCT scans was not deemed worthy from a diagnostic perspective.

Association between maxillary canine impaction and other dental anomalies: radiological study of a mixed dentition children’s cohort from an orthodontic clinic

PurposeTo investigate the significance of association between maxillary impacted canines and various dental anomalies.MethodsFiles of 874 orthodontic patients were evaluated for the presence of maxillary impacted canines. From this sample, a group of 97 patients (39 males and 58 females) with at least 1 impacted maxillary canine consisted the study group. This group was compared to a control group of 97 patients (42 males and 55 females) that was created by random selection from the initial sample without maxillary canine impaction. The impaction diagnosis was made from the panoramic radiographs. Chi-square test was used to perform the analysis for significant associations. Stepwise discriminant analysis, binary logistic regression and classification tree were used to identify best combinations.ResultsStatistically significant difference was found for peg-shaped maxillary lateral incisors and infraoccluded deciduous molars. The presence of peg-shaped upper lateral incisors arises the probability of impacted canine to 83.3%, a distal displaced unerupted second premolar to 63.16% and the impaction of any other teeth to 80% as showed by the classification tree.ConclusionsThe presence of peg-shaped maxillary lateral incisors and infraocclusion of deciduous molars can be considered major valuable early risk indicators for maxillary canine impaction, because they manifest before the maxillary canine eruption. Special consideration should be given on distal displaced unerupted second premolar and the impaction of any other teeth. Patients with these dental anomalies are candidates for future interceptive treatment for canine eruption.

Does interceptive extraction of multiple primary teeth increase the chances of spontaneous eruption of permanent maxillary canines positioned palatally or centrally in the alveolar crest? A Systematic review

Extraction of primary maxillary canines in the mixed dentition has been suggested to increase the rate of normal eruption of displaced permanent canines (DPCs). In this study we assessed whether extracting multiple primary teeth increases the rate of normal eruption of DPCs positioned palatally or centrally in the alveolar crest. Unrestricted searches in 8 databases were performed up to March 2021. We looked for data on the prevalence of physiologic eruption of DPCs and the changes in their position from randomized controlled trials. The risk of bias was assessed using the Cochrane Risk of Bias 2 Tool. Exploratory synthesis was carried out using the random effects model. Three studies (at low risk of bias) were identified, involving 128 individuals, followed for up to 48 months. The double extraction did not result in a benefit regarding successful eruption at 24 months follow-up, nor the change in position after 14.8 months. However, after 48 months the double extraction was beneficial (Risk Ratio: 1.17; 95% Confidence Interval: 1.05 to 1.30, P=0.005). Moreover, after 18 months, the DPCs' position improved more in the double extraction sites. While the extraction of the deciduous canine and first molar does not increase the chance of normal eruption nor improves the position of DPCs in shorter follow-ups, it might confer a benefit after a longer period of observation. Further studies are warranted in order to clarify the magnitude and clinical significance of any potential benefit and provide guidance to clinical decisions.

The effects of rapid maxillary expansion and face-mask application on mesio-distal axial inclination and apex flexion of maxillary canine tooth

Background: The aim of this study was to investigate the effects of rapid maxillary expansion (RME) and face-mask application (FMA) on the mesio-distal axial inclination and apex flexion of maxillary canine tooth in mixed dentition. Methods: In this study, panoramic radiographs of 38 patients were used. In the study group, there were 19 patients who treated with RME and FMA. The control group comprised 19 patients who did not applied treatment. In the study group, radiographs were separated at the before (T0) and after (T1) RME and FMA. Radiographs for the control group were separated before (T0) and after (T1) maxillary canine eruption. The inclination and flexion of maxillary canine were measured on these radiographs. A Shapiro Wilk test was used to test the data for a normal distribution. A Wilcoxon test was used for intra-group comparisons of T0 and T1 measurements and a Mann Whitney U test was used for inter-group comparisons of T1-T0 differences and flexion values. The significance level was considered to be p < 0.05. Results: There was no statistically significant difference (p = 0.748) between the T0 and T1 measurements in the study group but a statistically significant decrease was found in the control group (p = 0.031). There were no statistically significant differences between the groups for T1-T0 (p = 0.271) and flexion (p = 0.583) measurements. Conclusion: RME and FMA does not have a significant effects on mesio-distal axial inclination and the apex flexion of maxillary canine tooth in mixed dentition.

Impactação dentária de caninos permanentes - consequências e relação com ortopedia funcional dos maxilares

Clinical experience and knowledge of normal growth and development of children, as well as radiographic studies of the dental eruption evolution, are important to supervise the maxillary permanent canine eruption. Clinical observations of signs and symptons such as digital palpation of the permanent canine bulges above the primary canine apex, on children of about nine years old, is a very important step for the diagnosis of ectopic eruption. Dentist may find more help with the early diagnosis, to avoid complications that are not so frequent to happen, but are still a burden such as traction and adjacent root tooth resorption.

The efficacy of rapid palatal expansion on the eruption of impacted maxillary canine: a systematic review

Abstract Objective The purpose of this study was to assess the current literature on the effectiveness of rapid palatal expansion (RPE) in assisting the spontaneous eruption of impacted maxillary canines. Materials and methods Four electronic databases were searched (Pubmed, Scopus, Web of Science, Embase) by applying appropriate Medical Subject Headings (MeSH). Two authors independently and systematically reviewed the literature. Randomised controlled trials (RCTs) and prospective controlled clinical trials (pCCTs) were identified and selected. The Cochrane Collaboration’s risk of bias tool and the risk of bias in non-randomised studies of interventions (ROBINS-I) were used to assess the quality of the obtained articles. Spontaneous canine eruption was used as a primary outcome. Results Three RCTs and two pCCTs met the inclusion criteria. One study was assessed at a high risk of bias in the RCT group, while the remainder were at an unclear risk of bias. Both pCCTs were classified as a moderate risk of bias based on the ROBINS-I tool. The success rate of canine eruption following RPE, with or without additional treatment, ranged from 65.7 to 85.7%, which was statistically significantly different from the control group. Conclusion RPE appears to improve the position of displaced maxillary canines and increase the likelihood of spontaneous eruption. However, there is a shortage of high-quality evidence to conclude that RPE can be an effective treatment option for impacted maxillary canines.

Validation of a novel method for canine eruption assessment in unilateral cleft lip and palate patients.

ObjectiveThe aim of this study was to propose and validate a three‐dimensional (3D) methodology for the assessment of canine eruption in patients born with unilateral cleft lip and palate (UCLP) following secondary alveolar bone graft (SABG).Methods and MaterialsA total of 10 patients (four females, six males; mean age: 8.8 years) with UCLP who underwent SABG were recruited. Pre‐ and 6‐month post‐operative cone‐beam computed tomography (CBCT) was acquired for all patients. Post‐operative data was registered onto pre‐operative data utilizing voxel‐based registration. Following superimposition, a segmentation process was applied to segment maxillary canine on both cleft and non‐cleft side. Thereafter, translational and rotational changes in canine position were assessed for both cleft and non‐cleft side by two observers.ResultsThe intra‐class correlation coefficient (ICC) indicated excellent reliability (≥0.90) with inter and intra‐observer error of less than 0.05 mm. The overall ICC was found to be high for assessing both translational and rotational changes. The mean absolute inter‐ and intra‐observer difference for translational and rotational changes was found to be less than 1 mm and 3°.ConclusionThe present method was found to be reliable proving to be clinically applicable for assessing maxillary canine eruption changes in both cleft and non‐cleft bone.

Frequency of Additional Congenital Dental Anomalies in Children with Cleft Lip, Alveolar and Palate.

The aim of the study was to assess the risk of incidence of additional congenital dental anomalies in children with nonsyndromic cleft lip, alveolar and/without palate (CL/P). Hypodontia, hyperdontia and canines impaction was recognized. From patients with CL/P treated at the Clinic of Congenital Facial Deformities in Chair and Department of Jaw Orthopedics Medical University of Lublin, 56 subjects were randomly selected. On the panoramic radiographs taken at the age of 8–12 years, the angle of upper unerupted canines was measured using Westerlund’s recommendations. The supernumerary teeth and hypodontia were checked. The procedures: maxillary expansion, secondary alveolar bone graft (SABG) and extraction of primary canines were noted. The frequency of canines impaction was 5.36%. Hypodontia was found in 37.5% of patients; hyperdontia was present in 23.21% of patients. No influence of procedures (expansion of the maxilla, SABG, deciduous canines extraction) on permanent maxillary canine eruption was proved. Patients with CL/P are exposed to the unfavorable position of unerupted maxillary canines most frequently in the cleft area of complete cleft. Maxillary lateral incisor on the cleft side is most frequently affected with congenital anomaly. Hypodontia and hyperdontia do not influence maxillary canine impaction. Good clinical result was achieved with an applied approach, which should be widely introduced.

Frequency and association of maxillary ectopic canine with incisor root resorption and dental agenesis.

To assess the frequency of maxillary ectopic canine both buccally and palatally displaced with incisor root resorption and dental agenesis. The cross-sectional study was conducted from April 8 to June 29, 2019, at the Department of Orthodontics, Dr. Ishrat Ul Ebad Khan Institute of Oral Health Sciences, and Dow Dental College, Dow University Of Health Sciences, Karachi, and comprised orthodontic patients diagnosed with maxillary ectopic canine eruption. Root resorption and agenesis were diagnosed on panoramic films. Root resorption was further confirmed by periapical radiographs. Data was analysed using SPSS 21. Of the 98 subjects, 86(87.8%) had buccally displaced canines of which 38(44.2%) were associated with root resorption, while 12(12.2%) patients had palatally displaced canines of which 10(83.3%) had root resorption (p=0.011). Overall, 30(30.6%) lateral incisors were resorbed, 7(7.1%) both central and lateral incisors, 5(5.1%) premolars, and 6(6.1%) both lateral incisors and premolars were resorbed. Agenesis was detected in 10 (10.2%) subjects (p=0.62). There was found to be no association of maxillary ectopic canines with incisor root resorption and dental agenesis.

Changes in canine inclination after rapid and slow maxillary expansion compared to untreated controls.

Palatally displaced canines (PDC) might represent condition causing several clinical problems, such as roots resorption and malocclusion, and can develop palatal canine impaction. Some interceptive treatments such as rapid maxillary expansion were suggested in order to foster maxillary canine eruption. Among expansion protocols, no data are available about differences between rapid and slow maxillary expansion on maxillary canine eruption. The aim of this study was therefore to evaluate α-angle changes in palatally displaced canines using rapid and slow maxillary expansion compared to untreated control patients. The final sample comprised 19 patients treated with rapid maxillary expansion (RME group), 17 treated with slow maxillary expansion (SME group) and 22 control patients (Control group). α-angle was measured on panoramic films to detect canine inclination at the beginning, and at the end of maxillary expansion treatment or observation, time and changes over time were compared. In the comparisons among groups, RME group was the only group showing a decrease in α-angle measurements that was statistically significant also when compared to the other groups, except for the left side when compared to SME group. RME treatment significantly and positively affected canine position when compared to SME treatment and control group.

Upper canine response to rapid maxillary expander anchored to deciduous vs. permanent molars.

To understand whether two different designs of Haas-type rapid maxillary expander (H‑RME) might have adifferent influence on canine eruption. In all, 108 subjects seeking orthodontic treatment were selected and divided into two groups-H‑RME with bands on the upper second deciduous molars (GrE), H‑RME with bands on the upper first permanent molars (Gr6)-and were also compared to an historical untreated control group (CG) of 29subjects. Panoramic x‑rays (OPG) were performed before and after RME (T0-T1: 16 ± 7months) and the upper canine angulation to the midline ("α"angle) was measured on both pre- and posttreatment OPG. Asignificant improvement of the canine position (decrease of the αangle) following RME in subjects with mixed dentition was reported in both treated groups, although the different design of the RME did not significantly affect canine angulation. Canine angulation in untreated subjects with transversal discrepancy did not improve significantly. Using RME in the early mixed dentition appears to be an effective procedure to increase the rate of eruption of maxillary canines, but the position of the bands on the upper second deciduous molars or on the upper first permanent molars and the significant different expansion of the upper dental arch at the canine level does not significantly influence the canine angulation following early treatment therapy.

Correlation between skeletal development and maxillary canine eruption.

The aim of this study was to find a correlation between the permanent maxillary canine eruption and the cervical vertebral maturation index (CVMI). 145 subjects (73 male and 72 female) in the age of 7-14 years were examined radiographically with lateral cephalographs and orthopantomographs. The CVM patterns were evaluated on the lateral cephalograph using the classification of Hassel and Farman. The stage of the permanent maxillary canine eruption has been investigated on the orthopantomographs depending on its vertical height in relation to the adjacent incisor. Descriptive statistics were obtained for both CVMI stages and canine eruption grading. Spearman rank correlation test was used to determine the correlation between both methods. The minimum level of significance was considered less than 0.05 (P < 0.05). Results showed a strong correlation between CVMI and the grading of the maxillary canine eruption in both female and male and the (r) value estimated was 0.862 and 0.758, respectively. Over 90% of deceleration stage of CVMI in both genders show canine eruption (pubertal growth spurt) about 91.66% for female and 95.65% for male and a small percentage of delay eruption 8.33% and 4.35% in female and male gender, respectively, with a predilection to the female gender. A significant correlation between the permanent maxillary canine eruption stages and skeletal maturity was found. The eruption of maxillary canine occurs before the end of pubertal growth. Any delay in the eruption of maxillary canine after the deceleration stage of CVMI, suggesting a chance of impaction.

Residents' journal review

Residents' journal review

Early Eruption of Maxillary Permanent Canines : Report of 2 Cases

Early Eruption of Maxillary Permanent Canines : Report of 2 Cases

Impacted canines – interceptive treatment

Canines, especially upper canines, are the second most frequently impacted permanent teeth, after third molars. Orthodontic extrusion of ectopic impacted canines is often complex, long-lasting and may lead to iatrogenic complications. In children, implementation of interceptive treatment helps to normalise the canine position in the alveolar process and its spontaneous eruption. &lt;b&gt;Aim.&lt;/b&gt; The aim of the study was to review the literature regarding the methods of interceptive treatment for impacted maxillary and mandibular canines supported by relevant clinical examples. &lt;b&gt;Material and methods.&lt;/b&gt; A review of literature on interceptive treatment of impacted canines has been performed for the period 1961–2018. The medical databases PubMed and Medline were used. &lt;b&gt;Results.&lt;/b&gt; Extraction of deciduous maxillary canines and maxillary first deciduous molars, maxillary expansion with rapid maxillary expanders and transpalatal arches, also in combination with extraoral traction and space opening the dental arch with fixed appliances are effective methods of interceptive treatment in patients at the developmental age with impacted upper canines. There is no effective protocol for interceptive treatment for impacted mandibular canines described in the literature. &lt;b&gt;Conclusions.&lt;/b&gt; The use of interceptive treatment in growing patients positively influences spontaneous eruption of ectopic impacted maxillary canines. Early clinical and radiological diagnosis of ectopic canine position is very important for success. &lt;b&gt;(Abramczyk J, Zadurska M, Czochrowska E. Impacted canines – interceptive treatment. Orthod Forum 2018; 14: 224-36).&lt;/b&gt;

The Optimal Timing of Secondary Alveolar Bone Grafting: A Literature Review

Secondary alveolar bone grafting (SABG) during the period of mixed dentition is currently the standard of care for patients with alveolar clefts in most centers. However, early SABG at the age of 4-7 years old before the eruption of lateral incisors versus late SABG at the age of 8-12 years before the eruption of maxillary permanent canines is still debated.

Whole exome sequencing in an Italian family with isolated maxillary canine agenesis and canine eruption anomalies

ObjectiveThe aim of this study was the clinical and molecular characterization of a family segregating a trait consisting of a phenotype specifically involving the maxillary canines, including agenesis, impaction and ectopic eruption, characterized by incomplete penetrance and variable expressivity. DesignClinical standardized assessment of 14 family members and a whole-exome sequencing (WES) of three affected subjects were performed. WES data analyses (sequence alignment, variant calling, annotation and prioritization) were carried out using an in-house implemented pipeline. Variant filtering retained coding and splice-site high quality private and rare variants. Variant prioritization was performed taking into account both the disruptive impact and the biological relevance of individual variants and genes. Sanger sequencing was performed to validate the variants of interest and to carry out segregation analysis. ResultsPrioritization of variants “by function” allowed the identification of multiple variants contributing to the trait, including two concomitant heterozygous variants in EDARADD (c.308C>T, p.Ser103Phe) and COL5A1 (c.1588G>A, p.Gly530Ser), specifically associated with a more severe phenotype (i.e. canine agenesis). Differently, heterozygous variants in genes encoding proteins with a role in the WNT pathway were shared by subjects showing a phenotype of impacted/ectopic erupted canines. ConclusionsThis study characterized the genetic contribution underlying a complex trait consisting of isolated canine anomalies in a medium-sized family, highlighting the role of WNT and EDA cell signaling pathways in tooth development.