Treatment Of Impacted Maxillary Canines Research Articles

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 < 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.

Gingival Health after Surgical Exposure of Impacted Maxillary Canines with Orthodontic Traction

Background: Impaction of the maxillary canines is a common clinical issue. Canine impaction may develop from a localized, systemic, or hereditary source. Interdisciplinary approaches are frequently necessary for the treatment of impacted maxillary canines. Objective: This study's objectives were to describe a surgical technique for surgically revealing a labially affected maxillary canine, elaborate on how to take care of soft tissue to promote aesthetic results, and evaluate periodontal health following the procedure. Study Design: Prospective study. Settings: CIMS institute of Medical Sciences. Duration: 24 months. Methods: A total of 53 patients who had orthodontic treatment as well as surgical exposure treatment for a unilaterally labially impacted maxillary canine were included. There was no history of periodontal disease or periodontal collapse in any of the individuals. Informed consent was gained from each patient after thorough explanations of the ambitions, potential advantages, and potential dangers of this clinical study were given to all patients. All cases' gingival health was evaluated following the conclusion of fixed orthodontic treatment. Results: There were majority 35 (66.03%) females and 18 (43.97%) males among all cases. 17 (32.1%) cases were aged between 16-20 years, 15 (28.3%) patients had age 21-25 years and 21 (39.6%) cases had age 26-30 years. On the first postoperative day, only 6 patients (13.3%) complained of minor pain, and only 2 patients complained of visible edema and inflammation in 1 patient. Four patients had gingival scars visible. In general, gingival index values were 0.39. By visual inspection or periodontal probing, significant pathologic periodontal illnesses were not found. Conclusion: We found in this study that the maintenance of dental follicles encourages soft tissue management following combined surgery and orthodontics procedures for labially impacted maxillary canines to improve periodontal health.

Radiographic Features and Treatment Strategies of Impacted Maxillary Canines

Objective: Treatment of impacted maxillary canines is essential, both aesthetically and functionally. This study aims to define the radiographic features of maxillary impacted canines, evaluate treatment options, and to detect related pathologies.Materials and Methods: In this retrospective study, orthopantomographs, treatment options, and demographic features of the patients were analyzed. Impacted maxillary canines were classified according to the study of Yamamoto et al. According to this classification, maxillary canines are evaluated under seven types according to the occlusal plane and their relative location to adjacent teeth. Moreover, the pathologies around impacted canines were detected via panoramic radiographies.Results: 323 impacted maxillary canines of 270 patients were analyzed. Two hundred fifteen of these teeth (66.6%) belonged to females, while the rest 108 (33.4%) belonged to males. It was observed that impacted maxillary canines were bilateral in 53 patients and unilateral in 217 patients. In the classification based on direction and position of impacted maxillary canines, the highest rates was Type 2 (55.42%) which was followed by Type 4 (26.93%), Type 1 (12.38%), Type 7 (2.79%), Type 3 (1.86%) and Type 5 (0.62%), respectively. Twenty-eight patients with cystic lesion related to impacted maxillary canines were detected. Impacted maxillary canines concomitant with odontoma was detected in 4 patients. In 52 of the patients, it was detected that maxilla was edentulous except for the impacted canines, and the extractions of impacted canine teeth were due to prosthetic reasons. Thirty impacted maxillary canines of 24 patients (n=30, 9.28%) were placed buttons for orthodontic maintenance, while surgical tooth extraction was preferred as a treatment option in other patients.Conclusions: Orthodontic, surgical treatments or combinations may be preferred depending on the impact level of the canine. Early diagnosis and correct orientation of the patient is essential for the success of the treatment.

Comparison of post-treatment changes with and without retention in adolescents treated for maxillary impacted canines—a randomized controlled trial

SummaryObjectiveTo evaluate whether retention is needed after orthodontic treatment of impacted maxillary canines.Trial designTwo-arm parallel group single-centre randomized controlled trial.Materials and methodsSixty-three patients, 39 girls and 24 boys, were recruited to the study. The inclusion criteria were patients with at least one impacted or unerupted maxillary canine, and moderate irregularity of the maxillary six anterior teeth according to Little’s index (LI). After gaining informed consent from the patient and their custodians, the patients were randomized to one of two groups, i.e. to a non-retention group or a retention group. The randomization process was prepared and carried out by an independent person not involved in the trial and the randomization used blocks of 20 (10 + 10). Primary outcomes were changes in single contact point discrepancy, and LI measured on digitalized three-dimensional study casts 1-year post-treatment. The study casts were anonymized before assessment and the changes were blinded for the assessor. Data were evaluated on an intention-to-treat basis. Thus, all randomized patients were incorporated into the final analysis. In the non-retention group a 10-week interim period was used to detect patients who eventually have a relapse immediately after treatment. If so, the patient got the arch-wire reinserted. Most patients in the retention group received a vacuum-formed retainer and pretreatment spacing cases got a bonded retainer.ResultsMean irregularity change was 0.4 mm in the retention and 1.3 mm in the non-retention group (P < 0.001). Maximum change was 2.5 mm in the retention and 3.2 mm in the non-retention group (P < 0.001). Most changes in the non-retention group occurred during the 10-week interim period. In the non-retention group, one patient developed contact point discrepancy of >2 mm during the interim period and was realigned.HarmsOne patient met the stopping guideline criteria. This patient had the arch wire reinserted for 2 months. After realignment, the patient received a retention appliance.LimitationsThe trial was a single-centre study and short-term changes were evaluated.ConclusionsChanges between the retention and the non-retention group were statistically but not clinically significant. Since satisfactory clinical results 1-year post-treatment were found in the non-retention group, retention does not appear to be needed. The 10-week interim period was useful in detecting patients who might have a relapse immediately after treatment.Trial registrationThe trial was not registered.

The prognosis of impacted maxillary canines and orthodontic management

Background: The orthodontic treatment of impacted maxillary canine is a major challenge for orthodontics, the treatment of which usually requires an interdisciplinary approach. If treatment is not initiated, there is always a risk of retention and also resorption of the roots of permanent incisors. Aim: The objective of this study was to assess the orthodontic treatment of impacted maxillary canines in Moroccan patients. The PIDAQ was cross-culturally adapted into Malay version by forward- and backwards-translation processes, followed by psychometric validation Methods: A cross-sectional study was conducted on 34 consecutive patients with impacted maxillary canines (23 females and 11 males) aged 9- 36 years (mean 21 years) from December 2015 to February 2016. Our analysis incorporated patients’ files, including clinical observation, X-ray imaging and iconography of good quality of patients. All the data were collected from an information collection sheet by a single operator. The assessment of the degree of difficulty of disinclusion of impacted teeth was revealed following the sector and angulation methods. Results: The circumstances in which inclusions were found were dominated (58.8%) by the reason for consultation in relation to delayed eruption or persistence of deciduous canine teeth. 61.9% of practitioners considered the difficulty of traction of the canines in this series as moderate to difficult. The assessment of the difficulty of placement of the retained teeth was revealed by 2 methods: (1) sector and (2) angulation methods. The sector technique showed that the majority of patients (52.9%) revealed canine inclusions in sector 4. The angulation method ranged from 21° to 82° with an average of 55.9°. The failure rate of placement represented 23.5%. Conclusion: The successful management of impacted canine requires close cooperation of oral surgeons and orthodontists. In this study, successful treatment was possible in approximately 76.5% of impacted canines and the sector method associated with the angulation method on the orthopantomogram could help orthodontists to assess the prognosis of included canines.

Long-term results of orthodontic treatment of impacted maxillary canines.

A total of 61 children who had 83 maxillary canines impacted were followed up for a mean of 3.5 years (range 1.1-10.9 years) after treatment to evaluate the long-term results of the treatments. In most of the children, the impacted maxillary canines had been surgically exposed and treated with fixed orthodontic appliances. In 11 cases, lateral incisors had been extracted because of extensive root resorption. The esthetic results as well as functional and periodontal conditions were evaluated. Only four of the 61 children were not satisfied with the esthetic result, whereas orthodontists judged only 56% of the results as esthetically acceptable on clinical evaluation and 57% as esthetically acceptable on color slides. The periodontal conditions and the occlusal function on sides with previously impacted canines and on sides with normally erupted canines, on the whole, were similar. Exceptions were pocket depths of the left lateral incisors and left canines, but these variables were significantly different mainly because of one patient. In lateral movements of the mandible, however, significant differences in contact pattern were found between sides with normally erupted canines and sides with impacted canines. Canine rise occurred more often on working sides with normally erupted canines than with impacted canines.

Health of periodontal tissues and resorption status after orthodontic treatment of impacted maxillary canines.

The aim of the present study was to evaluate the changes of incisor root resorption associated with impacted maxillary canines and health of periodontal tissues around maxillary canines erupted with orthodontic treatment. Twenty patients with a unilateral palatally impacted maxillary canine were included in the study. Cone-beam computed tomography images taken before and after orthodontic treatment were compared with the contralateral canines serving as control teeth. Root resorption was present in 10% of central and 40% of lateral incisors before treatment. After treatment, the incidence of resorption decreased. The thickness of the buccal bone surrounding the impacted canines was similar to that surrounding the contralateral canines, except in the apical area. Periodontal pocket depth and alveolar bone loss were greater for the impacted canine teeth than for the contralateral canines. Incisor root resorption associated with impacted canine teeth showed signs of repair after orthodontic treatment. Slight differences related to periodontal health were found between the previously impacted teeth and contralateral canine teeth.

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.

Complications associated with the occurrence and treatment of impacted maxillary canines

BackgroundThe aim of this study was to evaluate the complications associated with the occurrence and treatment of impacted maxillary canines. MethodsThis retrospective study was conducted on 533 Southern Chinese children and adolescents who attended the Paediatric Dentistry and Orthodontics Clinics and had at least one impacted maxillary canine. The study material included all the documentation files and radiographs of these patients. Complications that had been recorded in the clinical and surgical notes and that could be diagnosed from the available radiographs were noted. The data obtained were descriptively analyzed. ResultsThe most frequently reported phenomenon associated with the occurrence of impacted maxillary canine (prior to surgical treatment) was root resorption of an adjacent permanent tooth in 22 (4.1%) patients. The most frequently reported sequelae observed after any surgical procedure was swelling of the soft tissues around the operation site which often persisted for 48h as seen in 76 (18.8%) patients. Complications reported most commonly after any form of surgery included post-operative bleeding: 7(1.7%), hematoma: 7(1.7%), post-operative pain: 6(1.5%) and purulent discharge: 6(1.5%), post-operative complications in relation to surgical exposure and bonding of an attachment which included breakage of ligature wire: 5.7%; de-bonding of the attachment: 4.3% and inability to bond the attachment during surgery: 1.4% occurred rarely. ConclusionsThe frequency of root resorption of teeth adjacent to an impacted maxillary canine was low. Swelling of the soft tissue 48h post-operatively was the most commonly occurring complication after surgical intervention.

Early prediction of maxillary canine impaction from panoramic radiographs

Treatment of impacted maxillary canines frequently requires surgical intervention, which can involve substantial complications. Thus, it is desirable to identify a reliable method for the early diagnosis of canine displacement. In this study, we sought to determine whether impaction of a maxillary canine can be predicted using measurements made on a panoramic radiograph. This retrospective study was conducted at a dental hospital in Hong Kong with panoramic radiographs. Geometric measurements were made on 384 panoramic radiographs of patients with a unilaterally impacted maxillary canine (group I) to characterize its presentation and compare them with the unaffected antimere (group II). There was a clinically discernible difference of 4 mm at the age of 8 years and beyond between the mean distance of the tip of the impacted canine (group I) and that of the antimere (group II) from the occlusal plane (P <0.05). Furthermore, there was a statistically significant difference at the age of 9 years and beyond between the 2 groups according to the position in different sectors and according to the mean angle made with the midline (P <0.05). Diagnosis of maxillary canine impaction is possible at 8 years of age by using geometric measurements on panoramic radiographs.

Long-term periodontal response to orthodontic treatment of palatally impacted maxillary canines

One of the most important aspects to take into consideration when evaluating the outcome of treatment of impacted maxillary canines is the final periodontal status. The aim of the present study was to evaluate the long-term periodontal response of palatally impacted maxillary canines aligned using a codified procedure and the 'Easy Cuspid' compared with contralateral spontaneously erupted teeth. The periodontal conditions of the adjacent teeth were also considered. From an initial sample of 124 patients, 33 patients (24 females and 9 males) were selected. All patients who had undergone surgical orthodontic treatment conducted in accordance with a standardized protocol were recalled for follow-up at an average of 4.6 years after the end of treatment. The average treatment time was 29 months and the mean eruption time of the previously impacted tooth was 3.1 months. The average probing depth values showed no significant clinical differences. Probing depths recorded at the vestibular surface of the lateral incisor (P < 0.05) and at the midpalatal/midlingual aspect of the first premolar were statistically significant in comparison with the control elements. Student's t-test was used to compare the test and control group values. Coefficient of reliability was set at P < 0.05. The use of a closed-flap surgical technique in association with a codified orthodontic traction system (Easy Cuspid) allowed alignment of palatally impacted canines without damage to the periodontium.

Apical root resorption of incisors after orthodontic treatment of impacted maxillary canines: A radiographic study

The purpose of the study was to evaluate impacted maxillary canines as risk factor for orthodontic apical root resorption. The sample comprised 66 patients treated with fixed appliances. Thirty-two patients with a unilateral impacted maxillary canine, which was distanced from the roots of the incisors at a preliminary phase of treatment before bonding, formed the impaction group, and 34 patients without impactions served as the controls. Root shortening was calculated by using pretreatment and posttreatment intraoral radiographs. Inclination of the eruption path of the impacted canine relative to the midline, axis of the lateral incisor, and nasal line, root development, and the medial and vertical positions of the impacted tooth were recorded on orthopantomograms and lateral cephalometric films. The follicle/tooth ratio was evaluated by using periapical radiographs. No significant difference in apical resorption of the maxillary incisors was detected between the impaction and control groups, or between the incisors of the impacted and contralateral sides in the same subject. Likewise, no difference in the severity of root resorption was found between the incisors of impacted side alone and the incisors of the control group. Mesial and vertical inclinations of the impacted canines were negatively related to a lateral incisor's root resorption. No correlations were found between resorption and medial or vertical position of the crown of the canine. The follicle/tooth ratio was significantly related to the mesial inclination of the impacted canine, but not to root resorption. An impacted maxillary canine, after being distanced from the incisor roots, does not seem to be a risk factor for apical root resorption during orthodontic treatment.

Trattamento ortodontico-chirurgico di canini mascellari inclusi. Caso clinico

ObjectivesCombined surgical-orthodontic treatment of impacted maxillary canines has advanced significantly in recent years, regarding management of both hard and soft tissues and forces of traction. The aim of this report is to describe a combined surgical-orthodontic approach used to treat an impacted maxillary canine and to evaluate the functional and esthetic results after 5 years of follow-up. Materials and methodsA 13-year-old boy was seen in the Operative Unit of Orthodontics of Policlinico Tor Vergata in Rome. Radiographic images showed intraosseous impaction of tooth no. 2.3 in a setting of late mixed dentition, and the patient was scheduled for the combined surgical-orthodontic treatment. ResultsFive years after the combined treatment, the patient presented good occlusal stability.The maxillary canine that had been orthodontically repositioned showed keratinized mucosa of adequate width on the facial side with a margin that followed the course of the enamel-cement junction. Bleeding was absent on probing, the periodontal pocket depth was <4mm, and there was no radiographically evident bone loss. ConclusionsThe combined surgical-orthodontic technique used in this case (closed eruption towards the center of the alveolar ridge associated with conservative periodontal surgery, the acid-etch technique, and controlled orthodontic traction) simulates physiological tooth eruption and results in proper alignment with good periodontal results. It should thus be regarded as the treatment of choice for impacted teeth whose eruption is not precluded by the position of the tooth and/or the presence of ankylosis.

Analysis of failure in the treatment of impacted maxillary canines

In this study, we aimed to evaluate the reasons for failure of orthodontic treatment for impacted maxillary canines and to recommend measures to overcome them. Twenty-eight patients (ages, 17.4 +/- 4.3 years) with 37 maxillary impacted canines were referred after a failed attempt to resolve the impaction. Reasons for failure were analyzed, and corrective measures undertaken. The success rate of the revised treatments and the durations of both treatments were recorded. The mean duration of the failed treatments was 26.2 +/- 17.2 months. The failed treatments were mostly based on plane radiographs, intra-arch dental anchorage, and elastic traction directly to the labial archwire. The major reasons for failure were inadequate anchorage (48.6%), mistaken location and directional traction (40.5%), and ankylosis (32.4%). In several patients, there was more than 1 possible reason for failure. The success rate of the revised treatments was 71.4%, and the mean duration was 14.4 +/- 7.2 months. Repeat surgery was needed for 62.9% of the canines in which corrective treatment was started, mostly to redirect the ligature wires. The corrective measures included the use of 3-dimensional imaging and a change in the direction of traction. Anchorage was reinforced by dental and skeletal means. Inaccurate 3-dimensional diagnosis of location and orientation of impacted teeth and failure to appreciate anchorage demands were the major reasons for failure in the treatment of impacted canines.

Initial Vertical and Horizontal Position of Palatally Impacted Maxillary Canine and Effect on Periodontal Status Following Surgical-Orthodontic Treatment

To evaluate the impact of surgical-orthodontic treatment and the initial vertical and mesiodistal position of palatally impacted maxillary canines on the periodontal health of impacted canines and adjacent teeth. The study group consisted of 32 patients with unilateral palatally impacted maxillary canines. The initial position of the impacted canines was assessed on panoramic images. The treatment protocol of the impacted canines included surgical exposure with the closed-eruption technique and fixed orthodontic appliances. A significant increase in pocket depth was found at the canine mesiopalatal point after surgical-orthodontic treatment. Also, a correlation was found between the initial mesiodistal and vertical position of the impacted canine and the posttreatment periodontal status of the impacted canine, the adjacent lateral incisor, and the first premolar. A combined surgical-orthodontic approach in the treatment of impacted maxillary canines produces clinically acceptable periodontal conditions. The average increase in pocket depth was less than 4 mm and clinically unimportant for most patients.

Success rate and duration of orthodontic treatment for adult patients with palatally impacted maxillary canines

This study was undertaken to examine the success rate and the length of orthodontic treatment of impacted maxillary canines in adult patients. A sample of 19 adults (mean age, 28.8 ± 8.6 years; range, 20-47 years), who had been treated for a total of 23 impacted maxillary canines, was compared with a younger control group (mean age, 13.7 ± 1.3 years; range, 12-16 years). The control subjects were chosen for a similar degree of impaction difficulty by carefully matching the positions of the impacted canines in the 3 planes of space. The success rate among the adults was 69.5% compared with 100% among the younger controls. The lower success rate was due to 5 canines that had failed to erupt and 2 canines that had been partially extruded but could not be aligned in the arch. The duration of treating the overall malocclusion of the adults and young subjects did not materially differ. However, the adults showed significant increases in the duration and number of treatment visits required for resolving the canine impaction, in both the simpler and the more difficult cases. When further divided by age, all the failed canines were found in the older (over 30) adult subgroup. It was concluded that the prognosis for successful orthodontic resolution of an impacted canine in an adult is lower than that in a younger patient and that the prognosis worsens with age. Furthermore, when such treatment is undertaken, its successful completion should be expected to take considerably longer.

Surgical and orthodontic treatment of impacted maxillary canines in cases where lateral incisors are congenitally absent

Unilateral or bilateral congenitally missing maxillary lateral incisors are often accompanied by impacted canines. Planning treatment in these cases frequently involves close cooperation among the orthodontist, the oral surgeon, and the general dentist. Whether to open or close the space in the maxillary lateral incisor region depends on many factors, including age and sex of the patient, shape and shading of the canine, mesiodistal position of the canines, symmetry, mesiodistal position of the molars, mandibular arch discrepancies, and profile. Surgical exposure and the subsequent orthodontic positioning of the impacted canine often form part of the treatment. The surgical approach varies according to whether 1 canine is impacted or both. Preservation of the periodontal integrity is emphasized during the positioning of the teeth in the dental arches. The final option is a prosthetic replacement of 1 or 2 lateral incisor crowns, with either dental abutments or implants, the latter being these authors' therapy of choice. Timing of the implants, availability of bone volume, and adequate space for the placement of the lateral incisors are discussed. The article includes 69 color photographs of the procedures discussed in 5 excellently treated cases.

Correction of a superiorly displaced impacted canine due to a large dentigerous cyst

One of the more difficult situations dealt with by orthodontists is the treatment of impacted maxillary canines. This case report describes an impacted canine positioned near the floor of the orbit that was brought into a normal position. Diagnostic records revealed impacted and displaced teeth resulting from a large radiolucent lesion. The patient was referred to an oral surgeon. The lesion was diagnosed as a dentigerous cyst and marsupialized over 12 months. After decompression of the cyst, the impacted teeth were exposed and orthodontically brought into their proper position.

Transalveolar transplantation of maxillary canines. A follow-up study

This follow-up study on transalveolar transplantation includes 56 maxillary impacted canines in 47 patients, with a post-operative control period of 2-10 years (mean 4.7 years). The prognosis of the transplanted teeth is still very good; only two canines have been lost, due to poor oral hygiene or fracture of the tooth. These positive follow-up results indicate that transalveolar transplantation will offer greater flexibility in the treatment of impacted maxillary canines in adults.

Transalveolar transplantation of maxillary canines an alternative to orthodontic treatment in adult patients

Transalveolar transplantation of 31 maxillary canines in 26 patients was performed. Fixed orthodontic appliances were used for fixation for 6 to 8 weeks. All the transplanted teeth were firmly affixed in the new positions 3 to 6 months postoperatively. Complete bone regeneration and an attached gingiva with a stippled surface buccally and a normal pocket depth were observed 1 to 2 years postoperatively. These positive treatment results indicate that transalveolar transplantation is a useful alternative in the treatment of impacted maxillary canines in selected patients.