Palatal Canine Impaction Research Articles

Skeletal and Dentoalveolar Bilateral Dimensions in Unilateral Palatally Impacted Canine using Cone Beam Computed Tomography

Skeletal and Dentoalveolar Bilateral Dimensions in Unilateral Palatally Impacted Canine using Cone Beam Computed Tomography

Open or closed exposure for palatally impacted maxillary canines? A review

Palatally impacted canines (PICs) can be surgically exposed using one of the two exposure methods: open or closed. There is generally lack of consensus with regards to the preferred exposure method, hence the choice of operative technique remains open to discussion. The two techniques are compared and the choice of surgical technique is assessed in terms of patient factors, orthodontic/surgical and radiographic factors. Taking all possible determinant factors into account, a flowchart for the selection of the surgical exposure technique is presented. CPD/Clinical Relevance: As there are no clinical guidelines currently in the literature for the selection of surgical exposure method of PICs, carrying out this review article might help orthodontists and oral surgeons (especially juniors) in the selection process by following the proposed flowchart presented in this article, based on the available evidence in the literature.

Sella turcica bridging and dental anomalies: is there an association?

Sella turcica bridging (STB), or calcification of the interclinoid ligament of sella turcica, has been reported to be associated with some dental anomalies (palatal canine impaction and transposition). The aim of the study was to find any association between canine impaction, hyperdontia or hypodontia and sellar dimensions or bridging. Lateral cephalometric radiographs from 78 patients with impacted canines, 68 with dental agenesis and 17 with hyperdontia were collected. Linear dimensions of sella turcica were calculated and compared to those of a control group (47 individuals). A standardize scoring scale was used to quantify the extent of STB from each radiographs. The frequency of partial and complete calcifications of sella in patients with dental anomalies is increased when compared to controls. STB can influence the interclinoid distance but does not affect other linear dimensions of sella. No statistically significant difference has been found in sellar dimensions and STB expression when evaluating radiographs at different ages. STB is frequently found in patients with dental abnormalities.

Skeletal and dentoalveolar bilateral dimensions in unilateral palatally impacted canine using cone beam computed tomography

BackgroundThe aim of this investigation was to compare skeletal and dentoalveolar measurements of subject with unilateral palatally impacted canine versus the unaffected contralateral side on cone beam computed tomography (CBCT).MethodsA cross-sectional study (split mouth design) that included 28 CBCTs (i.e., 56 sides) with unilaterally impacted maxillary canines was performed. After conducting a pilot test to gauge the researcher, heights and widths of skeletal and dentoalveolar variables obtained in the maxilla were measured using coronal and axial views. The angulations of incisors were also measured, and the side with impaction and the unaffected side were compared. Paired sample t test and Wilcoxon signed-rank test were used.ResultsSignificant statistical differences (2 mm, p < 0.001) were found between the impacted and non-impacted side measurements from the mid-palatine raphe to the first premolar (proximal alveolar bone crest between the canine (deciduous or permanent) and first premolar); the distance were significantly lower (12.72 ± 2.25 mm) than in the side without impaction (14.67 ± 2.00 mm). Also, the central and lateral incisor angulations showed significant reductions; presenting disto-angulated incisors on the impacted canine side (86.14 ± 7.70° and 74.75 ± 12.67°, respectively) and mesial-angulated incisors on the non-impacted side (91.63 ± 6.79° and 81.21 ± 8.56° respectively). The other skeletal and dentoalveolar measurements showed no significant differences.ConclusionsThe width from the median raphe to the first premolar is lower in the side of maxillary palatal impacted canines than in the side without impaction. Lateral angulations of incisors were disto-angulated on the side of impacted canines. Both conditions have clinical implications in the orthodontic treatment.

Periodontally Accelerated Osteogenic Orthodontics (PAOO) Assisted Management of Palatally Impacted Canine with Five Years Follow Up

Periodontally Accelerated Osteogenic Orthodontics (PAOO) Assisted Management of Palatally Impacted Canine with Five Years Follow Up

What Are the Histologic Effects of Surgical and Orthodontic Treatment on the Gingiva of Palatal Impacted Canines?

To histologically evaluate changes in the marginal gingiva of palatal impacted maxillary canines after surgical exposure and orthodontic treatment. A prospective case-and-control study was conducted of 10 patients presenting with bilateral palatal impaction of the maxillary canines. All patients underwent surgical exposure of the impacted canines with an open-window technique, which was followed by orthodontic treatment to achieve proper arch alignment. Once the treatment was finalized, 4 samples of marginal gingival tissue from each patient were taken for histologic study. The 4 samples consisted of 1 from each of the repositioned maxillary canines (case teeth) and 1 from each of their respective adjacent first premolars (control teeth). Histologic examination of the case teeth tissue samples showed microscopic changes mainly in the nonkeratinized epithelium and connective tissue, whereas changes in the keratinized epithelium remained minimal. The control teeth showed a greater inflammatory reaction in the nonkeratinized epithelium. Orthodontic treatment of impacted maxillary canines used in conjunction with an open-window surgical technique results in predictable orthodontic eruption with few periodontal discrepancies of the marginal gingiva compared with their adjacent first premolars.

The Relationship between Palatal Displacement of Upper Canines and Incisors Widths in a Syrian Sample of Patients with Uncrowded Arches.

The aim of this study investigates mesiodistal crown size of the maxillary and mandibular incisors of patients with palatally impacted canines (PDC). Pretreatment dental casts of orthodontic patients with PDC of one or both maxillary canines (N: 33) were collected. This PDC sample was matched according to age and sex with pretreatment dental casts from unaffected orthodontic patients. For the PDC and matched control samples, maximum mesiodistal crown diameters were recorded for the four incisors on the right side only. The results showed that, on average, the mesiodistal crown diameters for the maxillary and mandibular incisors measured smaller in the PDC sample than in the control sample. These findings of statistically significant tooth-size reductions associated with PDC occurrence indicate a generalized pattern of reduced tooth size as a characteristic associated with the PDC anomaly. Further, the presence of generalized tooth-size reduction in cases with palatally displaced canines help explain why most orthodontic treatment plans for PDC patients are of the nonextraction type.

Different manifestations of class II division 2 incisor retroclination and their association with dental anomalies

To investigate whether there is an association between dental developmental anomalies (DDAs) and different manifestations of class II division 2 (CII/2) malocclusion incisor retroclination. Retrospective comparative study. Private orthodontic practice in the regions of Lisbon and Porto, Portugal. The sample comprised 115 CII/2 malocclusions distributed into two groups on the basis of incisor retroclination: Group I composed of 48 CII/2 with retroclination exclusively of both maxillary central incisors; Group II composed of 67 CII/2 with retroclination of all four maxillary incisors. Using the initial orthodontic records, it was determined for each patient the presence of the following DDAs: tooth impaction, tooth agenesis, maxillary lateral incisor microdontia, tooth transpositions and supernumerary teeth. Fifty-five per cent of patients were diagnosed with at least one of the DDAs studied. In the total sample the prevalence rates were: 20.0% of palatal maxillary canine impaction, 27.4% of third molar agenesis, and 15.7% of maxillary lateral incisor microdontia. No patient exhibited any transposition or supernumerary teeth. The distribution of the DDAs studied by groups revealed a strong association of palatal canine impaction, tooth agenesis and maxillary lateral incisor microdontia with Group II but not with Group I. The association of DDAs with CII/2 malocclusion is not common to all types of maxillary incisor retroclination, suggesting different etiologic factors among the different manifestations of CII/2 incisor retroclination.

Dental anomalies associated with buccally‐ and palatally‐impacted maxillary canines

The aim of the present study was to determine the association of both buccally- and palatally-impacted canines with other dental anomalies. This retrospective study was conducted on a population of 533 southern Chinese children and adolescents who had impacted maxillary canines that had been treated in the Paediatric Dentistry and Orthodontics Clinic, Prince Philip Dental Hospital, The University of Hong Kong, Hong Kong. Descriptions of the impacted canine and other associated anomalies were obtained from the case notes and radiographs. Clinical photographs and study casts were used, where available. A total of 253 (47.5%) patients with impacted maxillary canines were diagnosed with other dental anomalies. Microdontia was the most frequently-occurring anomaly reported in these patients, with the maxillary lateral incisor the most commonly affected tooth. Other odontogenic anomalies that were associated with both buccally- and palatally-impacted canines included hypodontia, supernumerary teeth, transposition of other teeth, enamel hypoplasia, other impacted teeth, and dens invaginatus. Both buccally- and palatally-impacted canines were found to be associated with other odontogenic anomalies.

Residents' journal review

Residents' journal review

Impacted maxillary canines: A clinical perspective

As impacted permanent maxillary canine occurs in 1-2% of the population, the clinician should know th e signs and symptoms of this condition and the interceptive treatment. Features of palatal canine impaction include lack of canine bulges in the buccal sulcus indicating a lingual eruption path and possible impaction; lack of symmetry between the exfoliation and eruption of canine that may indicate palatal or lingual impaction; and abnormal mesio-distal location and angulation of the developing maxillary permanent canine on radiographs. Diagnosis of impacted canine teeth at age 8-10 years can significantly reduce serious ramifications, including surgical exposure and orthodontic alignment as well as root resorption of the lateral incisors. In specific cases, extraction of the primary maxillary canine can prevent impaction of the permanent maxillary canine and additional sequelae. This article discusses the etiology, diagnosis, and clinical management of impacted maxillary canine teeth.

Maxillary palatal canine impaction displacement in subjects with congenitally missing maxillary lateral incisors

The aims of this research were to study the prevalence of palatally displaced maxillary canines (PDCs) in subjects with congenitally missing maxillary lateral incisor (MxI2) teeth and to assess the dental and occlusal features associated with this displacement in these subjects. The material for this study consisted of the pretreatment orthodontic casts of 246 subjects (78 male, 168 female) with missing MxI2 teeth. These were divided into 2 groups: subjects with PDC (displacement group) and subjects with no PDC (nondisplacement group). A nondisplacement comparison group was selected by matching the displacement group according to age, sex, type of malocclusion, and unilateral or bilateral absence of the MxI2 teeth. Of 246 subjects, 31 (12.6%) were found to have PDC. Sex distribution and type of congenital absence of MxI2 teeth were not different in the displacement and the nondisplacement groups. There was no significant difference between the dental and occlusal features in the displacement and the comparison groups. There was a strong association between PDC and missing MxI2; this supports the guidance theory. In subjects with MxI2 agenesis, no other dental or occlusal features were found to play a role in PDC.

Incidence and effects of genetic factors on canine impaction in an isolated Jewish population

The etiology of palatal canine impaction is multifactorial and includes a genetic contribution. The aim of this study was to find the incidence and effects of genetic factors on palatally impacted canines in a genetically isolated community of ultraorthodox Hassidic Jews of Ashkenazi decent. For this study, we retrospectively evaluated 1000 charts of Hassidic Jewish patients. Their distribution was 58% female and 42% male, with a mean age of 14 years. From those patients, 49 (4.9%) were determined to have canine impaction. Of these 49, 69.4% had unilateral palatal impaction, 26.5% had bilateral palatal impaction, and 4.1% had unilateral labial impaction. The z-test of proportion showed that female patients have a greater percentage than males for unilateral palatal impaction (P<0.01) with left-side dominance (P<0.01). Our results imply that genetics plays a significant role in maxillary canine palatal impaction. A genetically isolated Hassidic Jewish community can be a useful group to study the effects of genetic factors on various dental anomalies, including palatally displaced canines.

The Pattern of Maxillary Canine Impaction in Relation to Anomalous Lateral Incisors

To investigate the probability and pattern of maxillary canine impaction in relation to anomalous adjacent lateral incisors. A total 66 patients (M=24, F=42) in the age range of 12 to 18 years who had at least one impacted maxillary canine were included for the study. The maxillary lateral incisor anomalies and nature of canine impactions were diagnosed from the radiographs and study models. Maxillary lateral incisors were classified as normal, peg shaped, impacted and congenitally missing. The maxillary canine impactions were classified as buccal and palatal impaction. Each affected maxillary side was considered separately. This resulted total 88 cases for which the probabilities of different canine positions adjacent to the different categories of lateral incisor anomalies were evaluated statistically. : The occurrence of palatal canine impaction was almost 1.6 times more than the buccal canine impaction. Total 11.76% of the bucally impacted canines and 38.89% of the palatally impacted canines were associated with anomalous lateral incisors. There was no positive association between anomalous lateral incisors and maxillary canines. In relation to anomalous lateral incisor, the probability of palatal canine impaction was more than the buccal canine impaction. There was no positive association between lateral incisor anomalies and maxillary canine impaction. However, there was a high probability of palatal canine impaction when adjacent lateral incisors were anomalous.

Risk Indicators and Interceptive Treatment Alternatives for Palatally Displaced Canines

The present article reviews diagnostic, prognostic, and therapeutic aspects related to palatal displaced canines (PDCs) and their possible evolution to palatally impacted canines (PICs). Through the analysis of the relevant literature, a series of dental anomalies can be identified that present with a significant clinical association with PDC. Because these tooth disturbances may appear before PDC, they represent risk indicators for the occurrence of the eruption anomaly of the maxillary permanent canine. The second part of this work describes comparatively the effectiveness of several interceptive treatment approaches to PDC to avoid the evolution from PDC to PIC. In particular, the extraction of the deciduous canine, alone or in combination with orthodontic forces aimed to prevent the physiological mesial movement of the upper permanent molar, appears to be able to increase by 2 to 3 times the rate of eruption of PDCs (diagnosed on a panoramic radiograph) with respect to that which occurs in untreated subjects with PDC (spontaneous eruption in about one third of the cases). Rapid maxillary expansion in the early developmental stages may represent a valid alternative for the interceptive treatment of PDCs (diagnosed on a posteroanterior cephalogram). Although genetic factors are known to play a fundamental role in the etiology of PDC (and subsequent PIC), it appears that environmental local factors can be affected by orthodontic/orthopedic approaches during the pathogenetic evolution process leading from PDC to final PIC.

Periodontal Healing of Marginal Flap Versus Paramarginal Flap in Palatally Impacted Canine Surgery: A Prospective Study

The aim of the present study was to compare the influence of 2 mucoperiosteal flaps, marginal and paramarginal, on the periodontal healing of adjacent maxillary teeth after extraction of palatally impacted canines. Marginal (15 patients) and paramarginal (16 patients) techniques were used to remove palatally impacted canines. The periodontal examination of the adjacent teeth included evaluation of the plaque index, gingival index, probing depth, and clinical crown length preoperatively and at the first, third, and sixth months postoperatively using an individual acrylic stent. No significant differences between the marginal and paramarginal flaps were found with respect to plaque index, gingival index, labial and palatal probing depth, and labial and palatal clinical crown length at all follow-up points. The results of our study have shown that the paramarginal flap design is a good alternative to the marginal flap design.

Palatally impacted canines and the modified index of orthodontic treatment need

The aim of this study was to assess the severity of any underlying malocclusion in subjects presenting for treatment of a palatally impacted canine (PIC) using a modification of the Dental Health Component (DHC) of the Index of Treatment Need (MIOTN), which does not factor in the impacted canine. The pre-treatment study models of 54 subjects who had previously undergone surgical exposure of a PIC, followed by fixed appliance orthodontic alignment, were scored independently by two examiners on two occasions using the MIOTN system. Unweighted kappa statistics revealed good intraoperator agreement for the two examiners and a moderate level of interexaminer agreement. Forty-six and 41 per cent of the sample still scored either an MIOTN grade 4 or 5 (i.e. a great or very great need of orthodontic treatment). However, 20 and 25 per cent of the subjects were graded with a MIOTN score of 1 or 2, indicating little or no need for treatment when the PIC was not taken into consideration. This finding emphasizes the importance of early diagnosis of an impacted canine and the need to institute interceptive measures where necessary, as up to 25 per cent of patients might otherwise require no other orthodontic treatment.

Poster 088: Periodontal Healing of Marginal Flap Versus Paramarginal Flap in Palatally Impacted Canine Surgery: A Prospective Study

Poster 088: Periodontal Healing of Marginal Flap Versus Paramarginal Flap in Palatally Impacted Canine Surgery: A Prospective Study

Caninos permanentes retidos por palatino: diagnóstico e terapêutica: uma sugestão técnica de tratamento

Os dentes seguem uma seqüência de erupção favorável no desenvolvimento da oclusão normal, mas algum distúrbio desse mecanismo, nesse período de transição da dentadura mista para a permanente, pode levar a alterações na seqüência ou mesmo no trajeto de erupção, levando a impactação de dentes. Os caninos superiores permanentes, depois dos terceiros molares, apresentam maior ocorrência de impactação, especialmente na região palatina, mesmo na presença de espaço suficiente para o seu alinhamento na arcada dentária. Na impossibilidade do diagnóstico precoce, esforços serão empregados para reposicionar o dente no arco dentário evitando sua extração, dada a sua importância no equilíbrio, harmonia e função do arco dentário. Nos casos não diagnosticados ou tratados inadequadamente podem ocorrer perturbações mecânicas, infecciosas ou neoplásicas. O prognóstico depende da posição do canino em relação às estruturas adjacentes e à possibilidade de movimentação ortodôntica. O presente trabalho aborda os principais fatores a serem considerados nos casos de caninos superiores permanentes impactados, tais como processo de erupção, etiologia, diagnóstico e uma forma de tração proposta para caninos impactados. Também será apresentado um caso clínico em que se optou pelo tratamento ortodôntico-cirúrgico, cuja técnica de tração tem-se mostrado bastante eficiente nos casos de impactação de caninos no palato.

Palatal displacement of canines and maxillary skeletal width

The purpose of this study was to determine whether a clinically significant association exists between maxillary skeletal width and palatal canine impaction, also known as palatally displaced canine (PDC). Seventy-nine patients with PDC were matched for age, sex, and malocclusion to 79 controls. Maxillary and mandibular skeletal widths and nasal cavity widths were measured on posteroanterior cephalograms; maxillary and mandibular intermolar widths were measured on dental casts; and maxillary interalveolar arch widths at 3 levels (canine, premolar, and first molar) were measured on occlusograms. Only maxillary alveolar arch width at the canine level was significantly different between the 2 groups. However, further analysis showed that the presence of erupted deciduous or permanent canines, rather than their absence in the canine area (whether due to extraction, exfoliation, impaction, or not yet having erupted), was strongly associated with maxillary intercanine alveolar arch width. The additional finding in this study that the eruptive status of canines significantly affects maxillary alveolar arch width in this area suggests that maxillary intercanine alveolar arch width as measured in this or other studies is not a good predictor of PDC.