Impacted Maxillary Canines Research Articles

Two-Dimensional Radiographic Diagnosis of Maxillary Canine Impactions

Background: The primary aim of this study was to evaluate, using conventional radiographic imaging, the height, angulation, and mesiodistal position of impacted maxillary canines to determine if these variables are significantly associated with the palatal or buccal positioning of the tooth. Methods: A retrospective analysis was conducted on all patients diagnosed and treated for at least one impacted maxillary canine over a 4-year period in the Principality of Asturias. The final sample included 159 impacted canines. The variables analyzed were age, gender, associated pathology, location, angulation, height, mesiodistal position, buccopalatal position, and treatment method. Follow-up periods ranged from 12 to 50 months. Results: The mean age of the patients was 21 years (range 10–41 years), with most cases occurring in patients aged 14 to 30 years. Females accounted for 66.1% of the sample, with a female-to-male ratio of 1.95:1. The type of treatment (extraction/traction, surgical–orthodontic approach) was significantly associated with patient age. Additionally, the proximity of the impacted canine crown to the palatal or buccal cortices was significantly related to the treatment choice. However, no significant relationship was observed between the palatal/buccal position of the canine crown and its height or angulation. Conclusions: In the present work, the upper canines included by the palatal did not have a greater height or angulation than the canines included by the vestibule.

Risk of Maxillary Canine Impaction in Pediatric Patients with Maxillary Constriction: Retrospective Study on Panoramic Dental Images

The maxillary canine is the second most commonly impacted tooth after the maxillary third molar. Identifying risk factors for impaction is crucial for timely intervention; panoramic radiographs are particularly valuable for screening and identification purposes. This study aims to explore the association between transverse maxillary deficiency with bilateral crossbite, and the risk of maxillary canine impaction. A cross-sectional retrospective study was conducted on records of pediatric patients (7–13 years old) undergoing orthodontic evaluations. Panoramic radiographs were analyzed to assess the risk of canine impaction using the sectorial method, distance from the occlusal plane, and the alpha angle. Results from 48 canines of patients with transverse maxillary deficiency and bilateral crossbite were compared to canines of sex- and age-matched patients without these malocclusions. Statistical analysis was performed by the Shapiro–Wilk test, Levene’s test, or a t-test. There were no significant differences in high-risk canine impaction between groups when considering sector classification or distance from the occlusal plane. However, the control group showed a significantly higher risk according to the alpha angle (≥25°). No overall significant difference in risk was observed, suggesting that transverse maxillary deficiency with bilateral crossbite may not increase the risk of maxillary canine impaction.

Three-dimensional assessment of the skeletal characteristics accompanying unilateral maxillary canine impaction: a retrospective cone-beam computed tomography study

BackgroundEnvironmental and genetic factors associated with canine impaction have been extensively researched, whereas the bone characteristics in the impaction area have not been thoroughly studied. Accordingly, the objective of this investigation was to provide a skeletal assessment in terms of bone density, bone microstructure, bone volume, and palatal volume in subjects with unilaterally impacted maxillary canines.MethodsA retrospective design has been employed to address the aim of this study, where the initial pre-treatment cone-beam computed tomography (CBCT) scans of 30 patients with unilateral maxillary canine impaction were assessed. The obtained patients’ data were equally divided according to the location of the impaction into 2 groups, one with buccally impacted canines, and another with palatal impactions, with the contra-lateral sides in both groups serving as the controls. Skeletal measurements such as bone density (BD), bone microstructure in terms of fractal dimension (FD), maxillary bone volume (MBV), and palatal volume (PV) were evaluated from the acquired CBCTs in both groups and compared to the controls.ResultsWith buccal impactions, significantly greater BD and FD have been reported (p < 0.001), whereas non-significant differences were found regarding the PV when compared with controls (p = 0.56). MBV was significantly greater on the non-impaction side in comparison with buccal impaction sides (p < 0.001). For palatal impactions: BD, FD, and MBV were significantly greater on the impaction sides (p < 0.001), and conversely with PV which has been reported to be significantly greater on the non-impaction sides (p < 0.001).ConclusionsAs per the obtained results, buccally impacted canines are associated with greater BD and FD, and less MBV, whereas palatally impacted canines are accompanied with greater BD, FD, and MBV, in addition to less PV, when both conditions are compared with the non-impaction sides.

Prevalence and Predictors of Root Resorption Associated with Maxillary Canine Impaction in an Orthodontic Tunisian Population: An Analytical Cross-Sectional Study

The main objective of this study was to determine the occurrence of root resorption of adjacent permanent teeth associated with impacted maxillary canines and to identify a predictive model for RR by means of orthopantomographic variables, with the intention of reducing the need for additional cone beam computed tomography (CBCT) imaging. Materials and Methods: The sample consisted of 70 consecutive patients (43 females and 27 males, with a mean age of 17.03 years). A total of 90 impacted maxillary canines and adjacent teeth were analyzed using panoramic and CBCT radiographs. Univariable and multivariable analyses were respectively evaluated using chi-square test, Student's t-test, and binary logistic regression analysis. Results: The prevalence of root resorption of the permanent teeth adjacent to the impacted canine was more frequent in females than in males (ratio 1.8), but without significant association. No relationship was found between the sex, the type, the side, and the buccopalatal position of the impacted canine and root resorption. A statistically significant relationship was noted between the canines located mesial to the midline of the lateral incisor and root resorption on the maxillary incisors. Therefore, adjacent root resorption caused by impacted maxillary canines can be affirmed to exhibit a greater amount of resorption as the position proximity of the canine crown and lateral incisor root increases. In this prediction model, the patient’s age, the mesio-distal position, and the inclination of the impacted canine were the strongest predictors for RR. Conclusion: The final prediction model for RR based on the available panoramic radiographs could be a helpful tool in justifying the need of additional CBCT examination.

Longitudinal study of root resorption on incisors caused by impacted maxillary canines-a clinical and cone beam CT assessment.

To evaluate the long-term status of incisors with canine-induced root resorption (CIRR). Subjects with impacted maxillary canines (IMC) and persisting incisors with CIRR examined with cone beam computed tomography (CBCT), diagnosed ≥ 5 years earlier, were recalled. The resorption grade in the horizontal and vertical plane was assessed on CBCT images at baseline (T0) and follow-up (T1). Clinical examination was done at T1 which included probing depth, gingival retraction, mobility, ankylosis, discoloration and vitality test. In addition, patients completed a questionnaire regarding symptoms from the incisors. Forty subjects (mean age 13.7 ± 2.1 years) with 43 IMC and 47 incisors with CIRR were recruited. The IMC either spontaneously erupted, were surgically exposed or surgically removed. Thirty-four of the patients were treated with a fixed appliance and six had no orthodontic treatment. The follow-up range was 5.5-14.6 years. None of the incisors were lost or endodontically treated at T1. The horizontal resorption grade was unchanged in 38, improved in 7, and worsened in 2 teeth. The corresponding results for the vertical resorption grade were unchanged in 20 and worsened in 27 teeth. Three incisors with severe horizontal resorption at T0 were significantly more obliterated at T1 (P = .01). No significant differences were found in clinical parameters or patient-reported outcomes between incisors with CIRR and non-resorbed contralateral incisors at T1. The extent of root resorption during active orthodontic treatment was not possible to assess as only CBCT images from T0 and T1 were available. Incisors with CIRR caused by IMC have a high survival rate in a long-term perspective and do not cause more symptoms or exhibit more signs of pathology than non-resorbed contralateral incisors. Extraction of asymptomatic incisors based solely on root resorption should not be performed routinely.

Predicting the Risk of Maxillary Canine Impaction Based on Maxillary Measurements Using Supervised Machine Learning.

To predict palatally impacted maxillary canines based on maxilla measurements through supervised machine learning techniques. The maxilla images from 138 patients were analysed to investigate intermolar width, interpremolar width, interpterygoid width, maxillary length, maxillary width, nasal cavity width and nostril width, obtained through cone beam computed tomography scans. The predictive models were built using the following machine learning algorithms: Adaboost Classifier, Decision Tree, Gradient Boosting Classifier, K-Nearest Neighbours (KNN), Logistic Regression, Multilayer Perceptron Classifier (MLP), Random Forest Classifier and Support Vector Machine (SVM). A 5-fold cross-validation approach was employed to validate each model. Metrics such as area under the curve (AUC), accuracy, recall, precision and F1 Score were calculated for each model, and ROC curves were constructed. The predictive model included four variables (two dental and two skeletal measurements). The interpterygoid width and nostril width showed the largest effect sizes. The Gradient Boosting Classifier algorithm exhibited the best metrics, with AUC values ranging from 0.91 [CI95% = 0.74-0.98] for test data to 0.89 [CI95% = 0.86-0.94] for crossvalidation. The nostril width variable demonstrated the highest importance across all tested algorithms. The use of maxillary measurements, through supervised machine learning techniques, is a promising method for predicting palatally impacted maxillary canines. Among the models evaluated, both the Gradient Boosting Classifier and the Random Forest Classifier demonstrated the best performance metrics, with accuracy and AUC values exceeding 0.8, indicating strong predictive capability.

Assessment of the Trabecular Bone Microstructure Surrounding Impacted Maxillary Canines Using Fractal Analysis on Cone-Beam Computed Tomography Images.

To assess the impact of the presence or position (buccal/palatal) of impacted canines on trabecular bone density using fractal analysis (FA) on cone-beam computed tomography (CBCT) images, and to compare the results with a control group without impacted canines. This retrospective study included 41 patients with unilateral impacted canines (30 palatal, 11 buccal) and a control group of 39 patients who underwent surgically assisted rapid maxillary expansion. All patients had CBCT images recorded for diagnostic and treatment purposes. Cross-sectional CBCT images were obtained between the first and second premolars on both sides of the patients' maxilla. From these images, fractal dimension (FD) was measured in a 20 × 20 pixel region of interest in the trabecular bone using the ImageJ software. The FD values were significantly higher on the impacted side in the impacted canine group (p = 0.02). Within the impacted canine group, a significant increase in FD was observed on the impacted side in the buccal-impacted subgroup (p = 0.02), while no significant difference was observed in the palatal-impacted subgroup (p > 0.05). According to the results of our study, there is an association between the position of the impacted canine and trabecular bone density. An increased trabecular bone density may play a role in the etiology of buccally impacted canines. Clinicians should consider anchorage planning, and appropriate force level, during the forced eruption of buccally impacted canines with high surrounding bone density, to minimize undesirable movements and achieve optimal treatment outcomes.

Clinical Efficiency of Diode Lasers (810+980nm) in Exposure of Maxillary Impacted Canines

Objective: An impacted canine has no eruption following the completion of the normal growth pattern. To expose an impacted canine, a laser can be used as an additional tool in addition to a scalpel and electrocautery. To compare the effectiveness of a dual diode laser with a traditional scalpel procedure for exposing impacted canines, with the parameters of bleeding and pain as main outcomes. Methods: Thirty patients were chosen for this investigation. Each of them needed an operation for canine impaction, and they were divided into two groups at random: the study group, which were treated with a dual diode laser (980+810nm), and included fifteen patients, and the control group, which were treated with a scalpel. Data obtained prior to, during, and following surgery were compared. There were follow-ups after two hours, on the second, and third days after surgery. The Student's t and the one-way ANOVA tests were used for all comparisons. Results: Thirteen males and seventeen females were examined in this study, and their mean age was 23 years. Intraoperative bleeding score showed a significantly decrease in laser group versus the surgical blade group (0.4666 vs. 0.29333, P=0.001). The postoperative pain score was significantly decreased in the laser group compared to the surgical blade group, at two hours (4.6 vs 8.233, P = 0.001), two days (2.067 vs 4.833, P=0.001), and three days (1.066 vs 2.01, P=0.001). There were significant differences in the pain and bleeding scores (P≤ 0.05). Conclusion: When using a dual diode laser (810+910nm) as opposed to a scalpel, hemostasis can be achieved with minimal pain.

Jaw Morphology and Factors Associated with Upper Impacted Canines: Case-Controlled Trial

Introduction and aim: Orthodontic treatment of impacted maxillary canines is challenging and expensive. This study investigated factors associated with impaction risk and the need for surgical exposure. Methods: Seventy-five participants of similar age, skeletal maturity, and gender (32 impacted canines, 43 controls) were included in the case-controlled trial. Three-dimensional study models were created (Trios 3, 3Shape), and panoramic radiographs were taken. The 3D digital models were measured using software to obtain morphological characteristics of the maxilla, such as maxillary surface area (mm2) and volume (mm3). Results: The impacted canine group displayed a significantly higher prevalence of deep bite (OR = 5.01), hypoplastic lateral incisors (OR = 5.47), and rotated adjacent teeth (OR = 3.56) compared to the control group. The impacted canine group exhibited a smaller maxillary surface area and volume. Within the impacted canine group, factors associated with a greater need for surgical exposure included the presence of a persistent deciduous canine (OR = 10.15), a palatal canine position (OR = 7.50), and a steeper canine angulation (p &lt; 0.001). Conclusions: These findings suggest that several signs can serve as potential predictors of increased risk for maxillary canine impaction and the need for surgical intervention. Identifying these factors can aid in early diagnosis and treatment planning for improved patient outcomes.

Buccolingual inclination of posterior dentition in maxillary impacted canine patients using quadrant analysis - A cone-beam computed tomographic study

BackgroundTo examine the buccolingual inclination of maxillary posterior teeth, curve of Wilson, and transversal dimensions in palatally impacted maxillary canine patients, compared to controls by cone-beam computed tomography (CBCT).Materials and methodsPre-treatment images of 22 bilateral, 32 unilateral impacted maxillary canine patients and 30 controls were included. All patients had palatally impacted canines, with no posterior cross-bite. Data were reclassified in quadrants according to the presence of impaction, as the impaction quadrant (right and left quadrants of 22 bilateral impacted cases, and quadrants presenting impaction of 32 unilateral cases, n = 76), unaffected quadrant (quadrant without impaction in 32 unilateral cases, n = 32) and the control quadrant (right and left quadrants of 30 controls, n = 60) to evaluate the buccolingual inclination angle, transversal width, and arch perimeter. Additionally, comparisons were made regarding curve of Wilson and total arch perimeter among bilateral and unilateral impaction groups with the control group. Statistical analysis was performed by one-way ANOVA and Kruskal Wallis tests. Tukey or Dunn tests were used for comparisons between groups in pairs.ResultsNo significant difference was found for the buccolingual inclination of maxillary posterior teeth and curve of Wilson among groups. The buccolingual inclination of canines in the impaction quadrant was significantly lower than the other quadrants (p < 0.001). Basal bone width at the level of second premolars, and alveolar width at both premolars were significantly narrower in the impaction quadrant than in the unaffected quadrant (p < 0.05). Dental arch width at the level of first premolar was significantly decreased in the impaction quadrant compared to other quadrants (p < 0.05). Arch perimeter was significantly reduced in the impaction quadrant than in the unaffected quadrant (p < 0.05).ConclusionThe presence of bilateral or unilateral palatally impacted maxillary canines did not effect the buccolingual inclination of posterior teeth, and curve of Wilson. Transverse discrepancy was evident in the impaction quadrant even in the absence of posterior cross-bite. Quadrant analysis was particularly useful in evaluating asymmetry for basal bone and alveolar bone widths in the premolar region in patients with unilateral palatally impacted maxillary canine patients.

Clinical pearls for the management of maxillary impacted canines: Lessons learned from 14 patients

Clinical pearls for the management of maxillary impacted canines: Lessons learned from 14 patients

Treatment options for impacted maxillary canines and occurrence of ankylotic and resorptive processes: a 20-year retrospective study

BackgroundThis 20-year retrospective study aimed to evaluate the treatment methods used in patients with impacted maxillary permanent canines and to determine the occurrence of ankylotic and resorptive processes and their association with potential risk factors.MethodsThe cohort consisted of 351 consecutive Caucasian patients (120 males and 231 females, mean age 18.4 and 19.9 years, respectively) with 420 impacted maxillary permanent canines. CT and CBCT findings were subsequently confirmed during surgery. Statistical analyses were performed by the generalized linear models, Pearson x2 and Fisher exact tests using the statistical programs R and Statistica v. 14.ResultsA total of 273 (65.0%) impacted canines were aligned in the dental arch by orthodontic traction after surgical exposure, this treatment was predominant in patients under 20 years of age. Surgical extraction was performed in 115 (27.2%) impacted canines and was more common in older patients. Ankylotic changes were recorded in 61 (14.5%) impacted canines. The probability of ankylosis increased with age, particularly after the patient’s 20th year of life (p < 0.001). Patients were 1.2% likely to develop ankylosis at age 15 years, 4.3% at age 20 years, 14.1% at age 25 years, and 96.8% at age 45 years. Invasive cervical root resorption (ICRR) was found in 8 (1.9%) canines. In 4 canines (1.0%), root ankylosis in addition to ICRR was observed. In contrast to ankylosis, whose frequency of occurrence increased with age, the occurrence of ICRR resulting from PDL damage during surgery was more typical in younger patients. Canines in a high position above the root apices of the adjacent teeth, with a horizontal inclination of the longitudinal axis, with the crown located deep in the center of the alveolar bone and with labiopalatal position, should be considered critically impacted canines with a high risk to failure of orthodontic traction.ConclusionIn conclusion, the treatment of impacted canines depends mainly on the age of the patient, and the position and inclination of the longitudinal axis of the impacted tooth. To select an adequate treatment method, we recommend CBCT examination, which allows a precise analysis of the position of impacted canines.

Craniofacial morphology in patients with impacted canine: a case control-study.

The objective of this study was to evaluate the risk of maxillary canine impaction through cephalometric evaluation. One hundred and eighty-two Caucasian patients (80 males and 102 females) with a mean age of 12.4±0.5 were retrospectively enrolled in the present study. Ninety patients with impacted canines were compared with ninety-two patients with physiologically erupted canines. The following cephalometric variables were analyzed: SNA, ANB, SN-GOME, GO-ME, SP-CL, SELLA TURCICA DEPHT, A-Pt LINE, B-Pt LINE, A-Pt LINE°, B-Pt LINE°, A1s-Pt, A1i-Pt, A1s-Pt°, A1i-PT°, A-SN, B-SN and SN-U1. When applicable, a paired sample t-test was performed to investigate the difference in means between the two sample groups, while the Mann-Whitney Test was used as a non-parametric test in the case of a non-normal distribution of data. Statistical significance was set at P<0.05. The group with impacted canines showed an increase in Go-Me distance, SNA angle and A1s-Pt angle compared with the control group. In addition, the same group showed a decrease in A-SN and SP-Cl distance compared with the control group. An increase in mandibular length (GO-ME) and SNA angle associated with a reduction in A-Sn distance and interclinoid distance (SP-Cl) were observed in patients with impacted canines.

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.

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.

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.