Bazargani F, Magnuson A, Dolati A, Lennartsson B (2013) Palatally displaced maxillary canines: factors influencing duration and cost of treatment. Short-and long-term periodontal evaluation of impacted canines treated with a closed surgical-orthodontic approach. if the tube and the canine move in the same direction, then the tooth is likely lingually positioned. Restorative alternatives for the treatment of an impacted canine: surgical and prosthetic considerations. alternatives such as expanders, distalization appliances should be used only in cases where it is indicated, preferably under the supervision of an Extraction of the deciduous tooth may be considered when the maxillary permanent canine is not palpable in its normal position and the radiographic examination confirms the presence of an impacted canine. The following results were found: patients in group 1 had 27% of PDCs erupted, while group 2 had 62.5 % erupted, 79.2% in group 3 No difference in surgical outcomes between open and closed exposure of palatally displaced maxillary canines. Cookies eruption in comparison to older patients (11-12 years of age). Figure 5: Angulation (Alpha Angle): Angle Between The Long Axis of The In 2-3% of Caucasian populations, maxillary canines become impacted in ectopic position and fail to erupt into the oral cavity. Jacobs SG (1999) Radiographic localization of unerupted maxillary anterior teeth using the vertical tube shift technique: the history and application of the method with some case reports. also be determined by magnification technique, based on comparison between the impacted canine width with the adjacent teeth or with the contralateral canine This technique may be used in cases where there is enough space for the canine to erupt, and where the root formation is incomplete. [5] that two patients showed labial positioning . This technique is preferred for teeth that are in an unfavourable position, and which are likely to cause problems in the future. Commonly implicated factors include familial factors, missing/diminutive/malformedlateral incisors (guidance theory) and late developing dentitions, The most serious potential complication of an ectopic canine is root resorption of adjacent teeth. (2013) Pre-surgical treatment planning of maxillary canine impactions using panoramic vs cone beam CT imaging. Address reprint requests to Dr. Park at Arizona School of Dentistry & Oral Health, A.T. Impacted canines that are malpositioned, but have a favourable root pattern (without hooks or sharp curves) may be considered for autotransplantation into the dental arch. Other treatment alternatives may also be used in combination with the extraction of primary canines as expansion, distalization Aust Orthod J 25: 59-62. Am J Orthod Dentofacial Orthop115: 314-322. Parallax refers to the apparent movement of an object based on the position of the beam. 2008;105:918. 4 mm in the maxilla. This allows localisation of the canine. Class IV: Impacted canine located within the alveolar processusually vertically between the incisor and first premolar. Prog Orthod 18: 37. Dewel B. 1995;179:416. (c) Drill holes placed in the cortical plate overlying the crown so as to expose the crown, after the full exposure of the crown, elevator is applied beneath the crown to mobilize the tooth, (d) If the tooth is resistant to elevation, the crown is sectioned using bur and it is removed, (e) Cavity created following removal of crown, (f) The root is moved into the space created by the removal of the crown and it is then removed. Adjacent teeth may undergo internal or external resorption. This is the most appropriate approach for an impacted canine. 1. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in When costs and degree of treatment Orthodontic considerations in the treatment of maxillary impacted canines. Bjerklin K, Guitirokh CH (2011) Maxillary incisor root resorption induced by ectopic canines. SLOB: Same lingual opposite buccal TADs: Temporary anchorage devices With early detection, timely interception, and well-managed surgical and orthodontic treatment, impacted maxillary canines can be allowed to erupt and be guided to an appropriate location in the dental arch. Copyright and Licensing BY Authers: This is an Open Access Journal Article Published Under Attribution-Share Alike CC BY-SA: Creative Commons Attribution-Share Alike 4.0 International License. Angle Orthod. 6 mm distance or less from the canine cusp tip to Surgical extraction and radiographic monitoring were suggested for transmigrant mandibular canines: The authors proposed a decision tree in order to guide practitioners through the treatment plan of impacted mandibular canines [26]. CT of the same patient showing the relationship of the inverted 13 (yellow circle) to adjacent structures such as maxillary antrum, nasal floor and nearby teeth. Sufficient time is given for the flap to undergo initial healing. impacted canine can be properly managed with proper diagnosis and technique. and the other [2]. [10]). The impacted maxillary canine may be managed by several different techniques. Impacted teeth: surgical and orthodontic considerations. (a) Impacted maxillary canine. The SLOB (same-lingual, opposite-buccal) rule is similar to image shift but the film/sensor must be positioned to the lingual of the teeth to use this method. diagnosis of impacted maxillary canines, as well as the most recent studies regarding Close interaction with the paedodontist and orthodontist is required to get an optimal outcome. The final factor that influences the eruption of PDC after interceptive treatment is the space available at the PDC area before extraction. Class II: Impacted canines located on the labial surface. Dental radiographs are taken in all patients to evaluate the status of root and tooth when the tooth is missing or partly erupted. Other risks include cyst formation, Horizontal parallax this could either be 2 periapical radiographs, or a periapical and an upper standard occlusal, Vertical parallax an upper standard occlusal and OPT or a periapical and an OPT, This is only suitable if the permanent canine is minimally displaced, It must be done before the age of 13, ideally before the age of 11, Close radiographic follow-up is needed to monitor the movement of the permanent canine if no movement 12 months post-extraction, then alternative options must be considered, Patients must be well motivated to undergo surgical and orthodontic treatment, including wearing fixed appliances, Cases where interceptive treatment is not feasible, Canine is not so grossly displaced that it is unlikely to move sufficiently, The patient may not want intensive orthodontic management or may not be co-operative to wearing fixed appliances, Root resorption may be identified of adjacent teeth, Patient has declined active orthodontic treatment, Sufficient room within the arch to accept the canine, Essential: Remember your cookie permission setting, Essential: Gather information you input into a contact forms newsletter and other forms across all pages, Essential: Keep track of what you input in a shopping cart, Essential: Authenticate that you are logged into your user account, Essential: Remember language version you selected, Functionality: Remember social media settings, Functionality: Remember selected region and country, Analytics: Keep track of your visited pages and interaction taken, Analytics: Keep track about your location and region based on your IP number, Analytics: Keep track of the time spent on each page, Analytics: Increase the data quality of the statistics functions, Advertising: Tailor information and advertising to your interests based on e.g. degrees indicates need for surgical exposure (Figure Eur J Orthod 21: 551-560. When patients reach 10 years of age, dentists shall be alert since 29% of the population has non-palpable canines unilaterally or bilaterally, while 71% of 1Department of Orthodontics, Al-Jahra Specialty Dental Center, Ministry of Health, Kuwait, 2Department of orthodontics, Bneid Algar Speciality Dental Center, Ministry of Health, Kuwait, 3General Dental Practitioner, Ministry of Health, Kuwait, 4Department of Orthodontics,The Institute for Postgraduate Dental Education, Jonkoping, Sweden, *Corresponding author: Salem Abdulraheem, Department of Orthodontics, Al-Jahra Specialty Dental Center, Ministry of Health, Kuwait. With this license readers can share, distribute, download, even commercially, as long as the original source is properly cited. In the opposite direction i.e. The same guidelines are applicable in the 12-year-old patient group [2]. Another RCT was published by the same group of diagnoses of impacted maxillary canines, as well as the interceptive treatment (including In such a case, it may be better to use an apically repositioned flap. suggested a technique that used a horizontal line that extended from the mesiobuccal cusp tip of the right and left maxillary first molars, along the long axis of the impacted canines. Proc R Soc Med. Multiple RCTs concluded If the root is >75% formed, the likelihood of requiring root canal treatment increases. 1997;26:23641. In 2-3% of Caucasian populations, maxillary canines become impacted in ectopic position and fail to erupt into the oral cavity [2,3]. However, since CT exposes the patient to a high dose of radiation, the unfavourable relationship between cost and benefit to the patient determines its use only in particular cases, such as in the presence of craniofacial deformities. Archer WH. On the other hand, if the canine moves to the opposite The tooth may be elevated in toto, or may require sectioning if resistance is met (Figs. rule" should be used to determine the location of an impacted tooth. Relation Between Canine Cusp Tip and Parallax is the key to effective evaluation with radiographs. Peck S, Peck L, Kataja M (1994) The palatally displaced canine as a dental anomaly of genetic origin. However, this can result in some functions no longer being available. A three-year periodontal follow-up. She now is in private practice, Tucson, Ariz. 2 Dr. Park is an associate professor and the chair, Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Then a horizontal incision is made that links the two vertical incisions. An elevator is being used to dislodge the root, (d) Empty socket after removal of the root. problems may arise such as root resorption of maxillary lateral and central incisors, high cost and long treatment time, and migration of adjacent teeth with greater successful eruption in comparison to sector 3 and 4. The impacted maxillary canine: a proposed classification for surgical exposure. Chaushu S, Becker A, Zeltser R, Branski S, Vasker N, Chaushu G. Patients perception of recovery after exposure of impacted teeth: a comparison of closed-versus open-eruption techniques. The VP technique requires panoramic and anterior occlusal radiographs [15,16]. The overlying soft tissue is simply excised to expose the crown. There are 2 types of parallax that could be used: Radiographs can also be used to assess features such as root resorption, cyst development and presence of other abnormalities. Angle Orthod 81: 370-374. in 2017 opined that the most common treatment strategies for the treatment of mandibular canine impactions are surgical extraction and orthodontic traction. Drawback of this technique is that the tooth cannot be inspected directly once the flap has been sutured (Fig. An ideal management protocol for impacted permanent maxillary canines should involve an interdisciplinary approach linking the specialties of oral and maxillofacial surgery, periodontology and orthodontics. Thilander B, Jakobsson SO (1968) Local factors in impaction of maxillary canines. Eur J Orthod 37: 219-229. Gingivectomy and exposure of crown/ surgical window. If the impacted canine moves in the same direction as the cone, it is lingually positioned. of the patients in this study had exfoliated maxillary deciduous second molars [10]. Chapokas AR, Almas K, Schincaglia GP. Results. - It is an area which has been extensively studied with regard to the various imaging modalities and their advantages. . Serrant PS, McIntyre GT, Thomson DJ (2014) Localization of ectopic maxillary canines -- is CBCT more accurate than conventional horizontal or vertical parallax? 17 of the impacted maxillary canines were located on the right side (Tooth 13) and 22 on the left side (Tooth 23). than 30 degrees has a better prognosis than PDC with an alpha angle more than 30 degrees. Impacted canines can be detected at an early age, and clinicians might be able to (a) Frontal view, (b) Occlusal view, (c) OPG showing impacted canines (yellow circle). Early diagnosis and interception of potential maxillary canine impaction. Digital palpation of the canine bulge to ascertain the status of permanent maxillary canines is best carried out Eur J Orthod 2017 Apr 1;39(2):161169. - the content you have visited before. that interceptive treatment can be done to patients with age less than 12 years old even by general dentists, while patients at 12 years old and above will grade 1 and 2, which does not cause any change in the treatment plan. Size and shape of the canine, and its root pattern. Alexander Katsnelson A, Flic WG, Susarla S, Tartakovsky JV, Miloro M. Use of panoramic X-ray to determine position of impacted maxillary canines. Home. 1994 Jan;105(1):6172. Saline irrigation is used to clear out bone debris. Two major theories are It is also not uncommon to have the likelihood of creating a communication between the oral cavity and antrum, which may lead to post-operative nasal bleeding. (al) show the clinical and radiographic images of the steps in removing a labially impacted canine by odontectomy. Labiopalatal position of the canine relative to the erupted teetheither labial, palatal or directly above the teeth. resorption, cystic changes. mesial or distal movements of the x-ray beams will lead to a change of canine sector position as what happens in horizontal parallax techniques. Orthodontic reasons, such as the need to move an adjacent tooth into the area of impaction. (ad) Schematic diagram showing steps in the surgical removal of palatally positioned impacted maxillary canine (a) Reflection of the flap, (b) Removal of bone to expose the crown, (c) Sectioning of the crown, (d) Removal of the root. impacted canine but periapical radiograph is a 2D image which gives minimal information. Related data were The SLOB (same-lingual, opposite-buccal) rule is similar to image shift but the film/sensor must be positioned to the lingual of the teeth to use this method. An orthodontic bracket may be bonded to the crown and to the bracket, a traction wire is affixed. As in the case of maxillary canine in the labial position, bone removal is done with bur. Opposite Buccal What . There are multiple management options including extraction of the deciduous or permanent canine, surgical exposures, transplantation and monitoring. The degree of inclination of the canine as compared to the midline is recorded.