Surgery traction canine of impacted in the maxillary: a case report / Cirurgia de tracionamento de canino impactado em maxila: relato de caso

ABSTRACT Permanent canines are essential for the preservation of the stomatognathic system, as they are part of the occlusal and aesthetic function and balance. During the normal development of occlusion, canines follow a long and complex trajectory until their eruption, that is, they are more likely to suffer disturbances during this process. Removal of the permanent canine should only be considered in extreme cases, where the canine itself is not susceptible to orthodontic traction. Orthodontic traction is the most indicated treatment due to the high morphofunctional and aesthetic value of the permanent canine. The aim of this study is to report a clinical case of traction surgery of the superior permanent canine included in the maxilla. A 13-year-old female patient attended the dental clinic at the Nilton Lins University accompanied by her guardian, referred by an orthodontistfor canine traction surgery. during the examIn the clinical analysis, tooth 13 was absent from the dental arch. The patient had a computed tomography scan, where it was possible to verify the actual position of the toothimpacted with the partially erupted crown on the alveolar ridge. After planning, surgery was performed to install an orthodontic button and adapt the ligature with a 0.30 mm wire. After the 10-month follow-up period, the presence of the tooth in arch, completely erupted, was observed, showing effectiveness in the proposed treatment. Therefore, the procedure for bonding the orthodontic device was performed satisfactorily without complications or intercurrences, making it possible to continue the orthodontic treatment. The patient remains under follow-up.

RESUMO Os caninos permanentes são essenciais para a preservação do sistema estomatognático, visto que, fazem parte da função e equilíbrio oclusal e estético. Durante o desenvolvimento normal da oclusão, os caninos seguem uma longa e complexa trajetória até seu irrompimento, ou seja, estão mais propensos a sofrerem distúrbios no decorrer desse processo. A extração do canino permanente só deve ser considerada em casos extremos, onde o próprio não se encontra suscetível à tração ortodôntica. O tracionamento ortodôntico é o tratamento mais indicado devido ao alto valor morfofuncional e estético do canino permanente. Sendo assim, o objetivo deste estudo é relatar um caso clínico de cirurgia de tracionamento de canino permanente superior incluso em maxila. Paciente de 13 anos, gênero feminino, compareceu a clínica odontológica da Universidade Nilton Lins acompanhado de seu responsável, encaminhada por um ortodontista para cirurgia de tracionamento de canino. Durante o exame clínico observou-se ausência do dente 13 na arcada dentária. A paciente apresentou a tomografia computadorizada, onde foi possível verificar o real posicionamento do dente impactado com a coroa parcialmente irrompida no rebordo alveolar. Após o planejamento, realizou-se a cirurgia destinada a instalação de botão ortodôntico e adaptação da amarrilha com fio 0,30 mm. Posteriormente ao período de acompanhamento de 10 meses, observou-se a presença do dente em arco, totalmente erupcionado, mostrando efetividade no tratamento proposto. Portando, o procedimento de colagem de dispositivo ortodôntico ocorreu de forma satisfatória sem complicações ou intercorrências, tornando possível a continuidade do tratamento ortodôntico. A paciente permanece em acompanhamento.

Tratamiento ortodóncico quirúrgico en un caso de inclusión bilateral de caninos superiores / Orthodontic surgical treatment in a patient with maxillary impacted canine teeth

RESUMEN Introducción: El tratamiento ortodóncico quirúrgico puede ser una terapia de elección para los caninos impactados, ya que estos deben conservarse en las arcadas por sus beneficios estéticos y funcionales. La inclusión bilateral de estos en el maxilar es menos frecuente y su tratamiento más complejo. Objetivo: Describir los resultados del tratamiento ortodóncico quirúrgico, en una paciente con inclusión bilateral de caninos superiores. Caso clínico: Paciente femenina de 16 años con antecedentes de salud, que acudió a consulta de Estomatología General Integral en compañía de la madre, preocupada por el aspecto de sus colmillos más blancos y pequeños. Al examen bucal, se observó una completa dentición permanente, excepto los caninos que, en su lugar, se encontraban los dientes 53 y 63. Presentó relieve anormal de la zona anterior de la mucosa palatina, con ligero aumento de volumen a la palpación. Se realizó radiografía panorámica y periapicales y se confirmó la presencia de ambos dientes impactados. Se realizó tratamiento ortodóncico quirúrgico. Conclusiones: El tratamiento ortodóncico quirúrgico devolvió a la paciente la función y la estética, mediante la correcta ubicación de ambos caninos en las arcadas.

ABSTRACT Introduction: Orthodontic surgical treatment could be a therapy of choice for the impacted canines, as they should be kept in the dental arches for their functional and aesthetic benefits. The bilateral impaction of these in the maxillary bone is less frequent and their treatment is more complex. Objective: To describe the results of the orthodontic surgical treatment in a female patient with bilateral impaction of upper canines. Case report: A 16-year-old female patient with a health history was assisted by a general dentist in the company of the mother, because she was worried about the aspect of her cupids which were whiter and littler. The oral examination showed the presence of a permanent and complete dentition with the exception of the upper canines, in their place, were teeth number 53 and 63. It was also found an abnormal relief in the anterior zone of the hard palate with a slight increase of volume at palpation. It was taken panoramic and periapical X-ray and it was confirmed the presence of both impacted teeth. It was made orthodontic surgical treatment. Conclusions: Orthodontic surgical treatment gave back the patient the function and aesthetic by means of the correct location of both teeth in the dental arches.

Manejo quirúrgico de la reabsorción radicular externa de incisivos ocasionada por un canino retenido / Surgical management of external root resorption of incisors caused by impacted canine

RESUMEN Fundamento: prevenir la pérdida prematura de dientes permanentes es el objetivo fundamental del cirujano dentista. La reabsorción externa puede ser una causa de la pérdida dentaria. Objetivo: presentar el manejo quirúrgico de un caso de reabsorción radicular externa de un incisivo central y lateral superior izquierdo, ocasionada por un canino superior retenido. Presentación del caso: paciente femenino, de 16 años de edad que acudió a consulta porque sintió movilidad de sus incisivos, al examen clínico intra bucal se apreció la ausencia en boca del canino superior izquierdo y se constata movilidad grado I de Miller de los incisivos central y lateral del mismo lado. Se hizo la evaluación radiográfica y tomográfica, se evidenció la presencia de reabsorción radicular de los dos incisivos. Se planteó la extracción quirúrgica del canino acompañado de regeneración ósea, para prevenir que la reabsorción externa siga en progreso. Se evaluó por radiografía a los seis meses post cirugía, donde se evidenció que ya no existe progresión de la reabsorción y hay una buena estabilidad de los incisivos comprometidos. Conclusiones: con la extracción del canino retenido y la regeneración ósea, el paciente pudo prevenir que la reabsorción externa siga en progreso y recuperar la estabilidad de sus incisivos.

ABSTRACT Background: preventing the premature loss of permanent teeth is the fundamental objective of the dental surgeon. External reabsorption can be a cause of tooth loss. Objective: to present the surgical management of a case of external root reabsorption of a central and left lateral incisor, caused by a retained upper canine. Case report: 16-year-old female patient who comes to the office because she feels mobility of her incisors; the intra-oral clinical examination showed the absence in the mouth of the upper left canine and Miller's degree 1 mobility of the central and lateral incisors is observed on the same side. The radiographic and tomographic evaluation is done, and the presence of root reabsorption of the incisors is evidenced. Surgical removal of the canine accompanied by bone regeneration is proposed, to prevent external reabsorption from progressing. It is evaluated radiographically at 6 months after surgery, showing that there is no progression of reabsorption and there is a good stability of the compromised incisors. Conclusions: with the removal of the impacted canine and bone regeneration, the patient was able to prevent the external reabsorption from progressing and recover the stability of his incisors.

Prosthodontic Rehabilitation of Bilateral Maxillary Lateral Incisors Agenesis: A Case Report with One-Year Follow-Up

ABSTRACT@#Globally, non-syndromic tooth agenesis is commonly seen in clinical practice. However, its management is often complex and requires a multidisciplinary team approach for the maximal outcome. While various treatment options are possible, considerations for the treatment are not only based on the dentofacial conditions but also cultural and social background and personal preference of the patient. Thus, patientcentred care approach should always be practised for an optimal outcome. In the present case, a patient with established craniofacial growth presenting with bilateral agenesis of maxillary lateral incisors and over-retained deciduous maxillary left canine sought for aesthetic improvements. The patient did not prefer any orthodontic treatment citing a prolonged treatment duration and sub-optimal motivation as a hindrance. Thus, a prosthodontic only approach was taken by providing a conventional cantilever bridge and ceramic veneers to achieve the aims of treatment. This article discusses the possible limitation of such prosthodontic only solution in managing tooth agenesis.

Pulsatile varicose veins: an uncommon presentation of a common condition / Varizes pulsáteis: uma apresentação incomum de uma condição comum

Abstract Varicose veins of the lower limbs are common. However, pulsatile varicose veins are unusual. They could be an indicator of a sinister underlying pathology, such as severe cardiac dysfunction. It is easy to miss these rare cases during clinical workup, which can result in futile treatment with potentially dangerous consequences. In this report, we describe 2 cases of pulsatile varicose veins that highlight different etiologies and management strategies for this condition.

Resumo Varizes dos membros inferiores são comuns. Entretanto, varizes pulsáteis são raras, podendo ser indicadoras de uma patologia subjacente sombria como disfunção cardíaca grave. É fácil deixar passar esses casos raros durante exames clínicos, o que pode resultar em tratamento fútil com consequências potencialmente perigosas. Neste relato, descrevemos dois casos de varizes pulsáteis que evidenciam as diferentes etiologias e estratégias de manejo para essa condição.

Does the premature loss of primary anterior teeth cause morphological, functional and psychosocial consequences?

Abstract Premature loss of primary anterior teeth in deciduous arches is a controversial topic in the literature, especially due to the lack of robust scientific evidence regarding the types and magnitudes of the consequences involved. Morphological, functional, and psychosocial problems may arise from untreated premature loss of primary incisors and canines. The morphological problems include impaction and eruption disturbances of permanent successors; inclination and/or extrusion of adjacent and antagonist teeth, respectively; midline deviation; and crowding. Functional complications, such as speech disorders, aesthetic problems, and development of non-nutritive habits may occur, resulting in psychosocial implications, including a decrease in self-esteem, and even being targeted for bullying. The current critical review aimed to present and discuss the evidence available in the literature about the etiology, characteristics, implications and interventions resulting from the premature loss of primary anterior teeth. It is of utmost importance that future studies be developed to support the clinical decisions made by dental professionals on this topic.

Effects of cone beam computed tomography measurement of maxillary anterior teeth on implant success and patient satisfaction of maxillary anterior teeth / 中国基层医药

Objective:To investigate the effects of cone beam computed tomography measurement of maxillary anterior teeth on implant success and patient satisfaction of maxillary anterior teeth.Methods:120 patients who underwent maxillary anterior teeth implantation in Hangzhou Dental Hospital from October 2017 to October 2019 were included in this study. They were randomly assigned to receive either conventional maxillary anterior teeth implantation (control group, n = 60) or cone beam computed tomography measurement of maxillary anterior teeth and maxillary anterior teeth implantation (study group, n = 60). The implant success rate was compared between the two groups. Alveolar bone thickness and ISQ value immediately, 3 and 12 months after implantation as well as patient satisfaction were compared between the two groups. Results:Implant success rate in the observation group was significantly higher than that in the control group [96.67% (58/60) vs. 85.00% (51/60), χ2 = 4.904, P < 0.05]. In the observation group, alveolar bone thickness at 3 and 12 months after implantation was (1.53 ± 0.05) mm and (1.78 ± 0.12) mm, respectively, which was significantly higher than that in the control group [(1.46 ± 0.04) mm, (1.64 ± 0.10) mm, t = 9.839, 8.066, both P < 0.001]. In the observation group, ISQ value at 3 and 12 months after implantation was (76.83 ± 5.49) and (82.91 ± 4.85), respectively, which was significantly higher than that in the control group [(67.81 ± 4.61), (74.18 ± 5.21), t = 11.324, 11.038, both P < 0.001). Total satisfaction rate in the observation group was significantly higher than that in the control group [95.00% (57/60) vs. 81.67% (49/60), χ2 = 5.175, P < 0.05]. Conclusion:Cone beam computed tomography measurement of maxillary anterior teeth can help increase implant success rate and patient satisfaction.

Prediction of the mesiodistal width of maxillary anterior teeth from nasal interalar width in peruvian subjects with facial harmony

Objective: To determine regression models to predict the mesiodistal widths of the maxillary anterior teeth from interalar width of the nose in subjects with facial harmony. Materials and Methods: A cross-sectional study was carried out in a sample of 75 subjects with facial harmony and ages ranging from 18 to 30 years (21.28±3.75 years). The mesiodistal width of the central (CI), lateral (LI) incisors, and canines (C), as well as the interalar width (IW) of each subject were measured using a digital vernier caliper. Simple linear regression analyses were used to predict the width of the maxillary anterior teeth from the nasal interalar width, from which formulas for predicting the dimensions of each anterior tooth were obtained. Results: A statistically significant relationship was found between the nasal interalar width and the mesiodistal widths of the upper central incisor (p=0.019, R2=5.23%), upper lateral incisor (p=0.019, R2=2.31%), and upper canine (p=0.016, R2=12.04%) that allowed to develop simple linear prediction models for each tooth represented by the following formulas: CI=7.04+0.04(IW); LI=6.01+0.03 (IW); C=6.19+0.05 (IW). Conclusion: The nasal interalar width is a good predictor of the mesiodistal widths of the maxillary anterior teeth.

Objectivo: Determinar modelos de regresión para predecir los anchos mesiodistales de los dientes anterosuperiores a partir del ancho interalar de la nariz en individuos con armonía facial. Materiales and Métodos: Se realizó un estudio transversal con una muestra de 75 sujetos con armonía facial entre 18 a 30 años (21.28 ± 3.75 años), se midió el ancho mesiodistal de incisivos centrales (IC), laterales (IL) y caninos (C) así como el ancho interalar (AI) de cada sujeto empleando un calibrador vernier digital. Para la predicción del ancho de los dientes anterosuperiores a partir del ancho interalar nasal se emplearon análisis de regresión lineal simple, a partir de los cuales se obtuvieron fórmulas de predicción de las dimensiones de cada pieza dentaria anterior. Resultados: Se encontró relación estadísticamente significativa entre el ancho interalar nasal y los anchos mesiodistales del incisivo central superior (p=0.019, R2 5.23%), incisivo lateral superior (=0.019, R2=2.31%) y canino superior (p=0.016, R2=12.04%) que permitieron generar modelos de predicción lineal simple para cada pieza dentaria representados mediante las siguientes fórmulas: IC=7.04+0.04(AI); IL=6.01+0.03(AI); C=6.19+0.05(AI). Conclusión:El ancho interalar nasal es un buen predictor de los anchos mesiodistales de los dientes anterosuperiores.

Extra-buccal surgical access for canine removal included in mandibular symphysis: case report / Acesso cirúrgico extra-bucal para remoção de canino incluso em sínfise mandibular: relato de caso

ABSTRACT Included teeth are all the dental elements that arrive the normal time of its eruption, remains immersed within the tissues. Usually found when missing a tooth, or on routine radiographic examinations. In the presence of included teeth, it is necessary to define the best treatment approach, whether it is surgical, through exodontia, or by orthodontic tracings. Inclusive canines, in the symphysis region and near the base of the mandible, are rare and make the use of orthodontic traction techniques contraindicated. Presence of teeth in the intraosseous ectopic position can cause injuries, such as alveolodentary ankylosis, calcium metamorphosis of the pulp and aseptic pulp necrosis, among others. Anamnesis, physical examination (intra- and extraoral) and radiographic examinations such as panoramic, periapical, computed tomography, and occlusal radiographs should be performed to make the diagnosis adequate. In general, the success of the treatment depends on the age of the patient and the position of the canines at the time of the surgical procedure. The objective of this work is the extraction of a lower canine with extra-oral access in an outpatient clinical setting under local anesthesia.

RESUMO Dentes inclusos são todos os elementos dentários que chegada a época normal de seu irrompimento, permanece imerso no interior dos tecidos. Geralmente encontrados quando se observa ausência de algum dente, ou em exames radiográficos de rotina. Na presença de dentes inclusos, deve-se definir qual a melhor abordagem de tratamento, se é cirúrgica, através de exodontias, ou por tracionamentos ortodônticos. Caninos inclusos, em região de sínfise e próximos à base da mandíbula, são raros e fazem com que o uso de técnicas do tipo tracionamento ortodôntico sejam contra-indicadas. Presença de dentes em posição ectópica intraósseos podem causar injúrias, como anquilose alveolodentária, metamorfose cálcica da polpa e necrose pulpar asséptica, dentre outros. Para que o diagnóstico seja adequado, deve-se realizar, anamnese, exame físico (intra e extraoral) e exames radiográficos como panorâmicas, periapicais, tomografias computadorizadas e radiografias oclusais. Em geral, o sucesso do tratamento depende da idade do paciente e da posição dos caninos no momento do procedimento cirúrgico. O objetivo deste trabalho relata a extração de um canino inferior com acesso extra-oral em ambiente clínico ambulatorial sob anestesia local.

Age estimation in Brazilian adults by Kvaals and Camerieres methods

Abstract The aim of this study was to verify the precision and applicability of two methods of age estimation, Kvaal's and Cameriere's methods, among Brazilian adults. A sample composed of periapical radiographs of canine teeth belonging to 320 Brazilian adults was analyzed, divided into groups according to sex (male and female) and age group (20-29 years, 30-39 years, 40-49 years and 50-59 years). Kvaal's method presented better results when compared to the results of Cameriere's method in the general evaluation of each canine tooth, except for the upper left canine (tooth 23), which presented a mean error (ME) with no statistically significant difference between the methods (Kvaal: ME = 7.43, p = 0.4991, Cameriere: ME = 7.55, p = 0.6982). In the evaluation by age groups, Kvaal's method presented a lower variation between the real age and estimated age when applied to the age groups of 20-29 years and 30-39 years compared to the results provided by Cameriere's method. With respect to the groups aged 40 to 49 years and 50 to 59 years, Cameriere's method presented better performance than the results provided by Kvaal's method. The methods of estimating age proposed by Kvaal and Cameriere are simple and nondestructive and have demonstrated reproducibility and reliability. The Kvaal method was more accurate for the age groups of 20-29 and 30-39 years, and for those over 40 years, the Cameriere method was the most accurate.

Investigation of transmigrated mandibular canines

ABSTRACT Introduction: Canine transmigration is a rare orthodontic condition and it is relevant to perform the proper diagnose at an early age. Objective: The aim of the current study was to find out the frequency of transmigrated mandibular canines (TRC) in orthodontic patients obtained from South Asian population of Pakistan origin. Methods: Panoramic radiographs of 2,550 untreated orthodontic patients (1,248 males; 1,302 females) were included, to investigate the presence, site, and type of TRC. Any permanent mandibular canine that was found to be crossing the midline in panoramic radiographs was considered as TRC. Results: The frequency of TRC was found to be 0.98%. TRC were only found unilaterally. No significance regarding gender and side was found. Nineteen TRC displayed a type 1 transmigratory pattern, while type 2 and type 5 transmigratory patterns were encountered in three patients. Conclusion: Frequency of transmigrated mandibular canines in the studied sample was 0.98%.

RESUMO Introdução: a transmigração de caninos é uma condição ortodôntica rara, e é importante realizar seu adequado diagnóstico ainda em idade precoce. Objetivo: o objetivo do presente estudo foi avaliar a frequência da transmigração de caninos inferiores (TCI) em pacientes ortodônticos de origem paquistanesa. Métodos: com o objetivo de analisar a presença, o local e o tipo de TCI, foram avaliadas 2.550 radiografias panorâmicas pré-tratamento (1.248 homens, 1.302 mulheres) de pacientes ortodônticos. Foram considerados como TCI os caninos inferiores permanentes que, na radiografia, estivessem cruzando a linha média. Resultados: a frequência de TCI foi de 0,98%. Os achados demonstraram a presença de apenas TCI unilaterais, sem diferenças significativas em relação ao sexo e ao lado da arcada. O tipo 1 de transmigração foi encontrado em 19 pacientes e os tipos 2 e 5, em três pacientes. Conclusão: na presente amostra de origem paquistanesa, a frequência da transmigração de caninos inferiores foi de 0,98%.

Tracionamento de caninos inclusos: revisão de literatura / Included canine traction: review of literature

O canino é um elemento dental com alta importância para se conseguir uma oclusão balanceada e uma estética favorável, porém existe uma grande prevalência de impactação, podendo causar consequências tanto na estética quanto na fonética do paciente. É importante tracionar os caninos sempre que possível, em função de seu valor morfofuncional e estético, especificamente, nos movimentos funcionais da mandíbula. Este estudo teve como objetivo rever a literatura sobre o tracionamento de caninos inclusos. Concluiu-se que o tracionamento ortodôntico visa trazer o dente impactado para o arco, entretanto deve começar o mais cedo possível. Optando-se pelo tracionamento, o prognóstico desta conduta deve ser definido previamente, assim como seus riscos potenciais devem ser apresentados aos pais e paciente. O resultado do controle dos efeitos colaterais e a montagem de um sistema de ancoragem eficiente, que não afete os tecidos e os dentes adjacentes, é um dos fatores que contribui para o sucesso do tracionamento de caninos inclusos. Diversas técnicas estão disponíveis para tracionar e alinhar caninos inclusos, dentre elas os aparelhos ortodônticos fixos ou removíveis, a utilização de ancoragem na mesma arcada ou na arcada oposta e a utilização de forças provindas de magnetos associados à placa removível. Em alguns casos a utilização de mini-implantes provisórios é necessária para a ancoragem dos dentes inclusos. O ortodontista deve saber que, apesar dos inconvenientes que podem ocorrer durante todo o tratamento, é preciso fazer o possível para realizar uma conduta clínica adequada e evitar extrações dos caninos permanentes, uma vez que estes são importantes para o estabelecimento e manutenção da forma e função do arco dentário.

The canine has a great importance to achieve a balanced occlusion and a favorable aesthetic, but there is a high prevalence of impaction, which can have consequences both in the aesthetics and in the phonetics of the patient. It is important to draw the canines whenever possible, depending on their morphofunctional and aesthetic value, specifically, on the functional movements of the mandible. This study aimed to review the literature on the canine traction included. It was concluded that orthodontic traction aims to bring the impacted tooth to the arch, however it should start as soon as possible. By opting for traction, the prognosis of this behavior must be defined previously, as well as its potential risks should be presented to the parents and patient. The effect of the control of side effects and the assembly of an efficient anchorage system, which does not affect adjacent tissues and teeth, is one of the factors that contributes to the successful canine traction. Various techniques are available for traction and aligning canines included, including fixed or removable orthodontic appliances, the use of anchorage in the same arch or opposite arch and the use of forces from magnets associated with the removable plate. In some cases the use of temporary mini implants is necessary for anchoring the included teeth. The orthodontist should be aware that despite the inconveniences that may occur during the entire treatment, care must be taken to conduct adequate clinical management and avoid extractions of permanent canines, since these are important for establishing and maintaining the shape and function of the canine dental arch.

Relationship between the inner intercanthal distance and the mesiodistal dimension of maxillary anterior teeth in a peruvian population with facial harmony / Relación entre la distancia intercantal interna y la dimensión mesiodistal de dientes anterosuperiores en una población peruana con armonía facial

Objective: To determine the relationship between the inner intercanthal distance and the mesiodistal dimension of the maxillary anterior teeth in a Peruvian population with facial harmony. Material and Methods: A cross-sectional study on a sample of 75 Peruvian subjects with facial harmony, with ages ranging between 18 and 30 years, was conducted. The inner intercanthal distance and the mesiodistal dimension of maxillary anterior teeth of each subject were measured with a digital vernier caliper. The relationship was evaluated by simple linear regression analysis. Results: A statistically significant direct relationship was found between the dimension of the inner intercanthal distance with the mesiodistal width of the lateral incisors (p=0.040, R2=5.65%), canines (p=0.032, R2=6.17%), and the total mesiodistal sum of the six anterior teeth (p=0.040, R2=5.63%), but not with the central incisors (p=0.273, R2=1.64%). Conclusion: The inner intercanthal distance showed a direct relationship with the total mesiodistal linear dimension of the maxillary anterior teeth, with the mesiodistal dimensions of the lateral incisors and canines in a Peruvian population with facial harmony.

Determinar la relación entre la distancia intercantal interna y la dimensión mesiodistal de los dientes anterosuperiores en individuos peruanos con armonía facial. Material y métodos: Se realizó un estudio transversal en una muestra de 75 individuos peruanos con armonía facial entre 18 a 30 años. Se midió la distancia intercantal interna y la dimensión mesiodistal de dientes anterosuperiores de cada sujeto con un calibrador vernier digital. La relación fue evaluada mediante análisis de regresión lineal simple. Resultados: Se encontró relación directa estadísticamente significativa entre la dimensión de la distancia intercantal interna con el ancho mesiodistal de los incisivos laterales (p=0.040, R2=5.65%), caninos (p=0.032, R2=6.17%) y la suma total mesiodistal de los seis dientes anteriores (p=0.040, R2=5.63%), más no con los incisivos centrales (p=0.273, R2=1.64%). Conclusión: La distancia intercantal interna mostró relación directa con la dimensión lineal mesiodistal total de los dientes anterosuperiores, con las dimensiones mesiodistales de los incisivos laterales y de caninos en individuos peruanos con armonía facial.

Fratura de mandíbula associada à transmigração de canino / Mandibular fracture associated to canine transmigration

Introdução: Apesar de ser considerado um assunto controverso, o tratamento de fraturas mandibulares, que envolvem terceiros molares inclusos, já se afigura como uma temática amplamente debatida na literatura. Por outro lado, poucos estudos discutem o manejo das fraturas em região de dentes inclusos anteriores8 . Nesse sentido, o presente estudo visa relatar um caso de fratura associada a um canino transmigrado em parassínfise mandibular. Relato de caso: Paciente A.S.S., sexo masculino, 43 anos e 6 meses de idade, apresentou-se à emergência do Hospital Geral do Estado da Bahia, com histórico de acidente motociclístico cursando com trauma em face. O exame de imagem constatou fratura em parassínfise mandibular bilateral, associada ao deslocamento de canino previamente impactado. Optou-se pela remoção do dente envolvido, redução e fixação óssea com miniplacas e Barra de Erich. O acompanhamento pósoperatório revelou estabilidade da mandíbula e regressão dos sinais e sintomas pré-traumáticos. Considerações finais: Ao tratar fraturas mandibulares que envolvem dentes inclusos, deve-se ponderar acerca da remoção ou manutenção desse dente. Para tanto, o cirurgião deve avaliar o grau de comprometimento da unidade dentária bem como sua importância para redução e fixação ósseas... (AU)

Introduction: Despite being a controversial subject, the treatment of mandibular fractures involving the included third molars is already a widely debated topic in the literature. On the other hand, few studies discuss the management of fractures in the region of anterior included teeth8. In this sense, the present study aims to report a case of fracture associated with a transmigrated canine in the mandibular parasphysis. Case report: Patient A.S.S., male, 46 years and 6 months old, presented to the emergency of the State General Hospital of Bahia, with a history of motorcycle accidents, coursing facial trauma. The image examination revealed bilateral mandibular parashymphisis fracture, associated with the displacement of a previously impacted canine. It was decided for removal of the involved tooth, reduction and bone fixation with miniplates and Erich Bar. Postoperative follow-up revealed jaw stability and regression of post-traumatic signs and symptoms. Final considarations: When treating mandibular fractures involving included teeth, consideration should be given to the removal or maintenance of this tooth. Therefore, the surgeon should assess the degree of impairment of the dental unit as well as its importance for bone reduction and fixation... (AU)

Tomografia computadorizada multidetectores de baixa dose de radiação para avaliação de canino incluso / Low-dose multidetector computed tomography for impacted canine evaluation

Objetivo: avaliar caninos inclusos em tomografias computadorizadas multidetectores (TCMD) realizadas no Hospital Universitário de Santa Maria. Materiais e mé¬todo: foi realizado um estudo observacional transversal com imagens de um banco de dados de TCMD de baixa dose de radiação, solicitadas por indicações clínicas odontológicas. Os exames em formato digital imaging and communications in medicine foram avaliados por um examinador treinado, no software Weasis Medical Viewer. A avaliação dos exames compreendeu a observação das seguintes características: impactação do canino (uni ou bilateral), localização do canino (maxila ou mandíbula), localização da coroa do canino (vesti¬bular ou lingual/palatal), eixo de erupção, espessura do folículo pericoronário, presença de lesões associadas, presença de reabsorção nos dentes adjacentes e presença de agenesias dentárias ou de supranumerários. Os resultados foram avaliados de maneira descritiva, por meio de prevalência dos achados. Resultados: foram encontrados 21 caninos inclusos em 837 tomografias avaliadas (1,9%). Foi observado um predomínio de indivíduos do sexo feminino (71,4%), e a retenção do canino foi mais frequente na maxila (71,4%) e com impactação unilateral (61,9%). Quatro caninos apre¬sentaram folículo pericoronário, com espessura maior que 2 mm; 19% dos exames apresentaram reabsorção radicular externa em algum incisivo lateral. Apenas um canino apresentava lesão associada, sugerindo esclero-se óssea. Além dos caninos inclusos, foi possível avaliar alterações relacionadas às demais regiões e estruturas dentomaxilofaciais. Conclusão: apesar da amostra limitada de imagens, o presente estudo demonstrou a aplicabilidade clínica da TCMD com protocolo de baixa dose de radiação, para a avaliação dos caninos inclusos e características relacionadas a esses dentes, bem como de dentes e regiões adjacentes. (AU)

Objective: to evaluate impacted canines by tomographic exams performed at the University Hospital of Santa Maria. Materials and method: a cross-sectional observational study was performed with selected images from a database of low dose computed tomography (CT) scans requested by several dental indications. The DICOM files were evaluated by a trained examiner, using Weasis Medical Viewer software. The evaluation of each exam included the following characteristics: canine impaction (uni or bilateral), location of the canine (maxilla or mandible), location of the canine crown (buccal or lingual / palatal), shaft of canine eruption, thickness of the pericoronal follicle, presence of associated lesions, presence of external root resorption in adjacent teeth and presence of dental agenesis or supernumerary tooth. The results were evaluated in a descriptive way, through prevalence of the findings. Results: a total of 21 impacted canines were found in 837 CT scans evaluated (1,9%). A predominance of female patients was observed (71,4%); canine impaction was more frequent in the maxilla (71,4%), and unilateral (61,9%). In 19% of the exams, external root resorption occurred in some lateral incisor. Four dental elements presented pericoronal follicles thicker than 2 mm. In the evaluated sample, only one canine presented an associated lesion, suggesting bone sclerosis. Beyond the canine-related, other dental and maxillofacial changes were also evaluated. Conclusion: in spite of the limited sample, the present study demonstrated the clinical applicability of low dose CT for the evaluation of impacted canines, and characteristics related to these teeth, as well as to the adjacent teeth and regions. (AU)

Eficiência dos tratamentos interceptivos na irrupção espontânea de caninos com desvio de irrupção / Interceptive treatments efficiency on the eruption of displaced canine

Estudos prévios relataram os benefícios da interceptação dos desvios irruptivos de caninos superiores com uso de procedimentos isolados. O objetivo dessa pesquisa foi investigar os resultados de combinações de procedimentos interceptores para tratamento de caninos desviados, como extração supervisionada de dentes decíduos (EDD), expansão rápida da maxila (ERM) e distalização de dentes posteriores superiores para ganho de espaço no arco (GE), para evitar a exposição cirúrgica e tração ortodôntica desses dentes. Avaliou-se 114 caninos com desvio de irrupção submetidos a tratamentos interceptores. Radiografias panorâmicas realizadas antes (T0) e após (T1) o tratamento foram estudadas. Em T0, caninos permanentes superiores foram considerados com desvio de irrupção quando sua inclinação em relação à linha média excedia 25°, a posição da coroa estava localizada pelo menos no setor 1 (entre o centro do longo eixo e a face distal da raiz do incisivo lateral) ou a radiografia final mostrasse impacção do canino. Em T1, a irrupção espontânea do canino foi considerada como sucesso do tratamento. Teste t para amostras independentes foi utilizado para comparação entre os grupos. Utilizou-se teste Mann-Whitney para avaliação de diferenças de setor e correlação de Spearman para relacionar setor e inclinações iniciais e finais com a taxa de sucesso. A taxa de sucesso na irrupção de caninos superiores foi de 90,4%. Apenas 11 caninos não irromperam após o tratamento. Concluiu-se que a combinação de tratamentos interceptores promoveram mudanças favoráveis na angulação e setor de caninos superiores desviados. A irrupção espontânea do canino aconteceu em grande parte da amostra (AU)

Previous investigations have reported the benefit of isolated interceptive measures in the early treatment of displaced maxillary canines. The purpose of this study was to investigate whether the combination of several clinical approaches, such as supervised primary teeth extraction (PTE), transverse maxillary arch enlargement by means of rapid maxillary expansion (RME); and distalization of maxillary posterior teeth as space gainer (SG) resulted in an improvement of permanent canine position, preventing a surgical procedure. The sample comprised 114 displaced permanent maxillary canines that underwent interceptive treatment.Panoramic radiographs taken before (T0) and after (T1) orthodontic treatment were examined. Canine was considered displaced when its inclination to a vertical line passing through the midline exceeded 25°, the crown position of the canine were located at least in sector 1 or the final radiography showed canine impaction. The full passive eruption of the previously impacted canines at T1 was considered as the success of the treatment. Independent T-test was used in the comparison between groups. Mann-Whitney test was used for evaluation of the differences of "sector" and Spearman´s correlation between the initial and final inclination and position of the permanent cuspid and the success rate. The success rate in the eruption of canines was 90.4%. Only 11 maxillary canines failed to passively erupt. Statistically significant changes in the position of impacted maxillary canines were observed after interceptive measures. Early interceptive treatment resulted in favorable changes in the maxillary canines angulation and irruptive sector. The success rate was 90,4% of this sample. (AU)

Impacted canine in orbita: case report / Inclusão de canino em órbita: relato de caso

ABSTRACT The canines are important teeth as regards function, occlusion and esthetics. Disturbances with the eruption of permanent maxillary canines are common. Ectopic eruption of a tooth germ can occur at any time after eruption. It has also been observed that upper canines are affected with eruption disorders more than the third molars. The diagnosis of retained teeth is performed through clinical and radiographic examination, or through the investigation of various complaints, such as pain or orthodontic problems. The dental surgeon should be familiar with the anatomical and functional changes of the impaction, ectopic teeth and the possible repercussions for the patient, because recommendations on the decisions to be taken in cases of canine impaction, are determined through a careful study of each case. The purpose of this paper is to report a rare case of a buried canine in the proximity of the orbital border.

RESUMO Caninos são elementos dentários importantes no que se refere a função, oclusão, estética. Distúrbios na erupção de caninos superiores permanentes são comuns. A erupção ectópica de um germe dentário pode ocorrer a qualquer momento, desde a sua erupção. Verifica-se ainda, que caninos superiores são mais acometidos com distúrbios de erupção que os terceiros molares. Diagnósticos de elementos dentários retidos são realizados por meio de exames clínicos e radiográficos, ou através de investigações de queixas diversas, como dor ou ortodônticas. O Cirurgião-Dentista deve estar familiarizado com as alterações funcionais e anatômicas referentes as impactações, ectopias dentárias e suas possíveis repercussões ao paciente, pois recomendações sobre as decisões a serem seguidas nos casos de impactações de caninos são determinadas através de minucioso estudo de cada caso. O objetivo do presente artigo é relatar um raro caso de canino incluso com proximidade da órbita.

Simplified treatment for impacted upper canines: a four-year follow-up / Tratamento simplificado para caninos superiores impactados

ABSTRACT In the literature, there are several treatment options for the correction of upper canines, from extractions to surgical procedures followed by traction. Presenting a clinical case with a new treatment proposal for the traction of impacted upper canines, aiming at simplifying the orthodontic mechanics and establishing a satisfactory result with less biological demand. 18-year old female presenting with a palatally impacted upper left canine with increased mesial inclination, bilateral Class I occlusal relationship and harmonic facial profile. The surgical traction of the canine tooth was performed with an upper fixed arch wire, modified by a TMA spring, with subsequent set up of the fixed appliance for orthodontic correction. The achieved results were satisfactory, providing suitable aesthetic and function to the case, showing good root parallelism and intercuspation, ensuring stability to treatment after four years of the appliance removal.

RESUMO Na literatura, existem várias opções de tratamento para a correção de caninos superiores impactados, desde extrações até procedimentos cirúrgicos seguidos de tracionamentos. Apresentar um caso clínico com uma nova proposta de tratamento para o tracionamento de caninos superiores impactados, visando simplificar a mecânica ortodôntica e estabelecer um resultado satisfatório com menor danos biológicos. Paciente do sexo feminino, 18 anos apresentando um canino superior esquerdo palatalmente impactado com maior inclinação mesial, relação bilateral oclusal de Classe I e perfil facial harmônico. A tração cirúrgica do dente canino foi realizada com um fio de arco superior modificado por uma mola TMA, com a instalação subseqüente do aparelho fixo para correção ortodôntica. Os resultados obtidos foram satisfatórios, proporcionando estética e função adequadas ao caso, mostrando bom paralelismo radicular e intercuspidação, garantindo estabilidade ao tratamento após quatro anos de remoção do aparelho.

Prevalência de reabsorção radicular do incisivo lateral superior associada a canino impactado ­ uma revisão sistemática / Prevalence of root resorption of maxillary lateral incisors associated with impacted canines ­ a systematic review

Este estudo teve como objetivo avaliar, por meio de uma revisão sistemática da literatura, a prevalência da reabsorção do incisivo lateral superior associada a caninos impactados, quando diagnosticada por tomografia computadorizada de feixe cônico (TCFC). A pesquisa foi realizada nas bases de dados eletrônicas MEDLINE, SCOPUS e WEB OF SCIENCE, com artigos publicados entre 01/01/2006 a 01/01/2016. As buscas resultaram em um total de 8.496 estudos. Após a eliminação de 1.860 artigos repetidos, todos os títulos e resumos foram lidos, e aqueles que não apresentavam relação com a pesquisa foram eliminados. Foram selecionados 142 artigos e os critérios de inclusão e exclusão foram aplicados. Obteve-se, assim, 17 artigos que foram lidos na íntegra. Após análise do texto completo, de acordo com os critérios de elegibilidade, restaram apenas 8 artigos, sendo 5 estudos prospectivos e 3 retrospectivos, os quais foram qualificados segundo a avaliação da qualidade metodológica. Os resultados evidenciaram haver uma correlação entre impacção de caninos e reabsorção radicular de incisivo lateral superior. Concluiu-se que a prevalência de reabsorção de incisivos laterais superiores, associada a caninos impactados e diagnosticadas por TCFC, foi bastante elevada, atingindo valores de 23 a 60%, sendo predominantemente no terço apical, de magnitude leve a moderada e mais prevalente nas impacções por palatino. Fatores de risco podem ser destacados, como uma proximidade menor que 1 mm entre o canino e o incisivo lateral e posição mésio-angular dos caninos.(AU)

The present study aimed to assess, by means of a systematic review, the prevalence of root resorption in maxillary lateral incisors associated with impacted canines as diagnosed by cone beam computed tomography (CBCT). The review was conducted through searches in the MEDLINE, SCOPUS, and WEB OF SCIENCE databases between January 1st, 2006 and January 1st, 2016, comprising a total of 8.496 articles. After exclusion of duplicated articles, all titles and abstracts were read and those considered unrelated to the review were excluded. One hundred and forty-two articles were read in full and submitted to inclusion and exclusion criteria. Seventeen articles were then selected, which were read in full. After analysis of the full texts according to the eligibility criteria, only 8 articles remained: 5 prospective and 3 retrospective studies that were classified in accordance with methodological quality assessment. The results have shown a correlation between canine impaction and root resorption on maxillary lateral incisors. Therefore, it can be concluded that there was a high prevalence of resorption of maxillary lateral incisor roots associated with impacted canines, as diagnosed by CBCT, with values ranging from 23% to 60%. It was observed that it occurs predominantly in the apical third, showing a mild to moderate magnitude whereas more prevalent in impactions palatally. Risk factors involve a distance of less than 1 mm between canine and lateral incisor, and the fact that canines are in a mesioangular position. (AU)