Extraction Of Primary Canines Research Articles

Do the various interceptive treatment modalities improve the position of palatally displaced permanent canines? A meta-analysis.

Removal of maxillary primary canines and other interceptive treatment modalities in the mixed dentition have been suggested as methods used to increase the rate of normal eruption of palatally displaced permanent canines (PDCs). However, the information on the overall effect on PDCs' position has been inconclusive. To assess whether this practice improves the position of PDCs and to investigate the quality of the evidence. Unrestricted searches in 7 databases and manual searching of the reference lists in relevant studies were performed up to June 2022 (Medline via PubMed, CENTRAL, Cochrane Database of Systematic Reviews, Scopus, Web of Science, ClinicalTrials.gov, ProQuest Dissertations, and Theses Global). We looked for data on the positional changes of PDCs (mesial inclination, vertical position, canine crown cusp tip to midline) from randomized controlled trials assessing the various interceptive treatment modalities. Following study retrieval and selection, relevant data were extracted, and the risk of bias was assessed using the Cochrane Risk of Bias 2 Tool. Exploratory synthesis and meta-regression were conducted using the random effects model and the overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation approach. Five studies (3 at low risk of bias) were identified, involving 238 individuals, followed for up to 18 months post-intervention with OPG (orthopantomogram) or CBCT (cone-beam computed tomography). Exploratory data synthesis showed that PDCs' position improved more in the extraction sites compared to non-extraction. Analysis of the studies at low risk confirmed the above observations (6- and 12-month). Improvements were observed in patients using headgear after extraction of primary canines compared to extraction alone, but not in patients with double extraction of primary canines and first molars. The quality of available evidence was rated at best as moderate. Interceptive treatment modalities in the mixed dentition may improve the position of PDCs. However, more studies are necessary in order to determine the clinical significance of the changes. PROSPERO (CRD42015029130).

Introducing a User-Friendly Technique for Treatment of Palatally-Impacted Canines with the Aid of Temporary Anchorage Devices.

Treatment of impacted canine teeth is a challenge for most clinicians, especially in adult patients with high risk of ankylosis. Conventionally, leveling and alignment of the teeth are first performed and after heavy arch wire placement in slot of brackets, de-impaction force is applied. However, this method has some disadvantages, such as inability to detect ankylosis of the impacted tooth until load application, risk of root resorption of incisors or necrosis of them, distortion of dental arch form, the need for early extraction of primary canines, which is esthetically unfavorable for patients, and long-term presence of fixed orthodontic appliances in the oral cavity. This study aims to introduce approach that can be easily used by busy clinicians to guide palatally impacted canines into the dental arch using a cantilever spring supported by two palatal miniscrews prior to the initiation of fixed orthodontic treatment, and report some cases treated with this technique. This technique does not have the shortcomings of the conventional technique. In addition, the total duration of treatment, and duration of presence of orthodontic appliances in the oral cavity are shorter than the conventional technique. In addition, is less technique sensitive and do not need time complex and time consuming wire bending.

Frequency, Pattern and Rationale of Tooth Extractions Among Orthodontic Patients: A 10-year Tertiary Institution Experience

Background and objectives: Tooth extractions are a vital aspect of orthodontic management that enables the orthodontist to achieve good aesthetics and function as well as long term treatment stability for the patient. Extractions may be necessary for various reasons among which are tooth size arch length discrepancy (TSALD), increased overjet and facial profile. The aim of this study was to determine the prevalence, pattern and rationale of tooth extraction among orthodontic patients attending the Orthodontic Unit of the Department of Child Dental Health, University of Port Harcourt Teaching Hospital. Methods. A retrospective study of a cohort of patients who attended one of the outpatient Orthodontic Clinics in the Department of Child Dental Health, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria between 2011 and 2021. Data was collected from the patients’ records. Results. A total of 175 patients comprising 70(40%) males and 105(60%) females were included in the study. 67(38.3%) patients had at least one extraction. Twenty-eight (41.8%) extraction cases had extraction of the first premolars. Two-unit extractions of the maxillary first premolars (13, 46.4%) was the most frequent extraction pattern. Eight (29.6%) had extraction of primary canines only. Twenty-seven (40.3%) participants had extractions due to increased overjet. Over a third of the patients had extraction of at least one tooth. Conclusion. Two-unit extractions of maxillary first premolar was the commonest extraction pattern. Increased overjet was the commonest reason for extraction.

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.

The effect of extraction of lower primary canines on the morphology of dental arch: A systematic review and meta-analysis.

The beneficial effect of the extraction of primary canines in the resolution of incisor irregularity and its side effects are controversial. To systematically review the effects of the extraction of primary canines in incisor irregularity and dental arch morphology. Controlled non-randomized (non-RCT) and randomized clinical trials (RCT) evaluating children treated with extraction of primary canines compared with those without intervention. A total of 984 articles were found, of which two RCTs and one non-RCT met the inclusion criteria. Both had a low RoB. A high level of evidence was observed through GRADE. A meta-analysis showed the extraction of primary canines produced a significant decrease in incisor irregularity (95% CI: -3.56, -2.09mm). This decrease, however, was associated with a reduction of arch length (95% CI: -1.58, -0.94mm), intermolar width (95% CI: -0.61, -0.22mm), and overjet (95% CI: -075, -018). A mild overbite increase was found (95% CI: 0.10, 0.76mm). A high level of evidence showed that the extraction of primary canines improved incisor irregularity in the mixed dentition. Side effects included reduced arch length and intermolar width. A slight reduction in overjet and a mild increase in overbite were also observed. When they are not part of the treatment goal, these occlusal changes can be prevented by installing a lingual arch.

Patterns of Maxillary Canine Impaction in Iraqi Population

Objective: To investigate the prevalence of maxillary canine impaction and whether the impacted canine cases have had a potentially good or poor prognosis if interceptive treatment was practiced at earlier ages. Material and Methods: 1755 panoramic radiographs of patients, aged 13 to 60 years, attending the University of Babylon, College of Dentistry for the period from November 2016 to July 2018 were collected and assessed for the presence of impacted maxillary canines. Subsequently, four suggested prognostic factors for each impacted canine were analyzed and recorded. Results: The prevalence of maxillary canine impaction was 119 (6.78%) with 89 unilateral impaction and 30 bilateral impaction resulting in a total of 149 impacted canines. Regarding the gender, impaction was more evident in females 70 than in males 49 with no statistical significant difference. For the side, impaction was more prevalent on the left (77) than on the right (72), also with no statistical difference (p>0.05). Following the analysis of the four prognostic factors, most of the cases, 117 (78.5%) had at least one prognostic factor to be poor. Although 82 (55%) of the cases had at least one prognostic factor to be good, only 4 had all the prognostic factors to be good. Conclusion: Although the cases that had a potentially good prognosis were little (4 cases), interceptive extraction of primary canines would mostly be beneficial for these patients as it will minimize the treatment time, cost and complications.

Extraction of primary canines for interceptive orthodontic treatment of palatally displaced permanent canines: A systematic review.

To determine whether the successful management of palatally displaced permanent canines (PDCs) can be achieved by the interceptive extraction of primary maxillary canines. Digital databases (Medline, Scopus, Web of Science, and Cochrane) were searched to retrieve articles published from 1952 to April 2016. The university librarian developed search strategies for each database. Two calibrated reviewers independently reviewed potentially related titles and abstracts. Papers meeting the inclusion and exclusion criteria were read in full. The selected articles were evaluated and scored according to methodological quality criteria. Four randomized clinical trials (RCTs) were included in the systematic review. Compared with two older studies, two more recent RCTs were found to have better study designs, were better conducted, and involved better reporting of the results. The included studies compared intervention groups (children with PDCs undergoing extraction of primary canines) with controls (subjects with PDCs but no primary canine extractions). In three of the four studies, the interceptive extraction of primary canines facilitated eruption of PDCs in more than 65% of cases. Overall, the intervention groups had a markedly higher incidence of successful eruption of PDCs (50%-69%) compared with the control groups (36%-42%). Based on the available evidence, it is reasonable to conclude that eruption of PDCs can be facilitated by extraction of primary canines. However, further high-quality, randomized clinical trials are warranted in other population groups. It is hoped that this study will help orthodontists make evidence-based decisions about clinically managing PDCs.

Effectiveness of extraction of primary canines for interceptive management of palatally displaced permanent canines: a systematic review and meta-analysis.

Although extraction of primary canines in the mixed dentition has been suggested as a measure to prevent impaction of palatally displaced permanent canines (PDCs), the relevant evidence has been inconclusive. To assess the effectiveness of this practice and investigate the quality of the evidence. Search without restrictions in 15 databases and hand searching until April 2017. Randomized clinical trials comparing extraction of primary canines in the mixed dentition to no treatment. Following study retrieval and selection, data extraction, and individual study risk of bias assessment using the Cochrane Risk of Bias Tool, the random effects method of combining treatment effects was used. The overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation approach. Finally 5 studies were identified involving 214 individuals, followed for up to 48 months post-intervention. Two studies were at low and the rest at high risk of bias. Although at the 12-month evaluation, extraction of the primary canine did not result in a statistically significant difference [risk ratio (RR): 1.537; 95% confidence interval (CI): 0.656-3.601, P = 0.323; 1 study, n = 67 individuals], beyond 12 months a benefit was noted (RR: 1.784; 95% CI: 1.376-2.314, P = 0.000; 5 studies, n = 214 individuals; I2 = 0%). Analysis of the studies at low risk of bias confirmed the above-mentioned result (RR: 1.713; 95% CI: 1.226-2.394, P = 0.002; 2 studies, n = 91 individuals; I2 = 0%; moderate quality evidence). No difference was observed regarding root resorption of adjacent permanent teeth (RR: 0.602; 95% CI: 0.277-1.308, P = 0.200; 1 study; n = 67 individuals; moderate quality evidence). Extraction of primary canines in the mixed dentition may increase the chance of subsequent successful eruption of PDC in the long term. However, better study standardization is necessary.

Interceptive Approach to Treatment of Impacted Maxillary Canines

Impaction of maxillary canines can be prevented by early intervention in the mixed dentition phase after the correct diagnosis of malocclusion, reducing the complexity of the treatment. This article reports the case of a 10-year-old patient who possessed impacted maxillary canines and, after early extraction of primary canines, had reestablished favorable permanent successors' eruption axis. This 5-year radiographic follow-up study with panoramic radiography shows that this can be used in practice and that an effective control strategy ensures the accuracy in the inclination of the impacted canines. Treatment success is related to early diagnosis and strategic interceptive treatment choice.

Pain, discomfort, and use of analgesics following the extraction of primary canines in children with palatally displaced canines

BACKGROUND. Pain following the extraction of the primary canine in children with palatally displaced canines (PDC) as an interceptive treatment has not been investigated. AIMS. To describe pain, discomfort, dental anxiety, and use of analgesics following the extraction of primary canines in children with PDC. DESIGN. Forty-four children, aged 10-13 with PDC, were included. Pain intensity, discomfort, and analgesic consumption were rated the first evening and 1 week after the extraction of the primary canine. Dental anxiety was assessed pre-extraction, using the dental anxiety scale (DAS). A matched reference group also completed the DAS. RESULTS. No significant differences were found between the study and the reference group regarding the pre-extraction assessments. Post-extraction pain and discomfort was low. The experience of the injection was graded worse than the extraction, and more pain was rated at the evening post-extraction than during the extraction. Analgesics were used only the first evening. High correlation was detected between DAS and pain during injection and extraction. CONCLUSIONS. The experience of pain and discomfort during and after extraction of the primary canines is low, despite that 42% of the children used analgesics. Therefore, appropriate analgesics and recommendation doses pre- and post-extraction should be prescribed.

The early treatment of unusual sever ectopic eruption of the bilateral maxillary canines in a young Japanese girl: A case report

The purpose of this report was to describe an unusual severe ectopic eruption of the bilateral maxillary canines in a young patient aged 7 years and 8 months and to discuss the effects of early intervention such as extraction of the predecessors and fenestration of the affected canines. The patient was referred to the author's clinic for a consultation regarding bilateral ectopically erupting maxillary canines with an ectopic maxillary right first molar. After improvement of the first molar, the affected canines were fully erupted and aligned in occlusion 3 years and 7 months after the extraction of primary canines. Before treatment, the findings on the orthopantomogram were as follows, there was no direct cause, both canine tooth germs were situated in very high positions, and the cusp tips of both canines were not overlapped with the roots of the adjacent lateral incisors (Sector 1). The maxillary left canine impacted horizontally in a mesio-distal direction (axial angulation: 90 degrees) could be successfully guided to eruption by early intervention such as the extraction of predecessors and three fenestrations. Even in severe ectopic cases, therefore, it is considered that traction may be postponed until no effect of fenestration can be detected in cases of early discovery and intervention when the crown top is situated in Sector 1.

A rational approach to the treatment of the mixed dentition

1. 1. There is anthropologic proof that malocclusion is a part of deep-rooted evolutionary elements tending toward a reduction of facial structure. 2. 2. There are extensive hereditary factors working on the formation of the dentofacial complex. 3. 3. The interrelationship of hereditary and environmental factors creates the individual, but the hereditary factors take precedence over the environmental factors. 4. 4. Through the experimental evidence compiled on rats and through observations of primitive peoples, we can be sure that function plays a large part in the growth and development of the jaws. 5. 5. Early treatment of the mixed dentition, which tends to create the conditions for normal function, is useful in procuring a beneficial effect upon the growth and development of the patient's dentofacial complex. 6. 6. In those cases which, through measurements, show a definite deficiency of basal bone beyond the scope of present-day techniques to remedy, early serial extraction of primary canines and first primary molars followed by extraction of the permanent first premolars upon their eruption can abort the production of a severe malocclusion. 7. 7. Even when treatment must be reinstated in the permanent dentition, the early re-creation of normal function has a beneficial effect in terms of better balance of the facial structures. 8. 8. An awareness of the limitations imposed upon treatment by heredity, environment, nurture, and present-day techniques will result in more effective and efficient treatment.