Gingival recession in canines orthodontically aligned: a narrative review / Recessão gengival em caninos ortodonticamente alinhados: uma revisão narrativa

Background: The orthodontic traction of impacted canines represents a great challenge for Orthodontics. Surgical exposure of the impacted canine and the complex orthodontic mechanics applied to align the tooth back to the arch can lead to complications involving supporting tissues inducing gingival recession when the teeth are moved out of the alveolar bone. Aim: The aim of this study is to present an updated bibliographic review of the main periodontal results found in the literature after the clinical management of impacted canines and the prevalence of gingival recession. Materials and methods: Research in electronic databases PubMed, PMC, and MedLine until June 2020 and reference lists of relevant publications were used to identify studies that assessed the periodontal status of impacted and orthodontically tractioned canines. Controlled and randomized clinical trials, literature reviews, systematic reviews, studies in humans, meta- analyzes and text that had at least one occurrence relating to gingival recession, periodontal outcomes and impacted canines tractioned orthodontically, whether by buccal or palatal, superior and / or lower as the eligibility criteria. Results: 691 articles were found in a free search. After applying the eligibility criteria, 7 relevant articles were subtracted, and these results were more frequent for upper canines. Conclusion: Currently, there is no clear evidence to determine which surgical technique procedure is better to discover canines in terms of periodontal outcomes. The results found stated that clinically the evidence were insignificant when compared to teeth normally erupted.

Introdução: O tracionamento ortodôntico de caninos inclusos representa um grande desafio para a Ortodontia. A exposição cirúrgica do canino impactado e a complexa mecânica ortodôntica aplicada para alinhar o dente de volta ao arco podem levar a complicações envolvendo os tecidos de suporte, induzindo recessão gengival quando os dentes são movimentados para fora do osso alveolar. Objetivo: O objetivo deste estudo foi apresentar uma revisão bibliográfica atualizada dos principais resultados periodontais encontrados na literatura após o manejo clínico de caninos impactados e a prevalência de recessão gengival. Materiais e métodos: Foram feitas pesquisas eletrônicas no PubMed, PMC e MedLine até junho de 2020 e uma listas de referência de publicações relevantes foram usadas para identificar estudos que avaliaram o estado periodontal de caninos impactados e tracionados ortodonticamente. Ensaios clínicos controlados e randomizados, revisões de literatura, revisões sistemáticas, estudos em humanos, metanálises e textos que tiveram pelo menos uma ocorrência relacionada a recessão gengival, desfechos periodontais e caninos impactados tracionados ortodonticamente, seja por vestibular ou palatino, foram os critérios de elegibilidade. Resultados: Foram encontrados 691 artigos em busca livre. Após a aplicação dos critérios de elegibilidade, 7 artigos relevantes foram subtraídos, sendo esses resultados mais frequentes para caninos superiores. Conclusão: Atualmente, não há evidências claras para determinar qual técnica cirúrgica é melhor para descobrir caninos em termos de resultados periodontais. Os resultados encontrados afirmaram que clinicamente as evidências foram insignificantes quando comparadas a dentes normalmente

Surgical Management and Traction of Impacted Maxillary Canine in a Patient with Mixed Dentition: A Case Series.

Introduction: Maxillary canines are crucial for the smile and facial esthetics, its impaction is a commonly seen condition which is always challenging to bring the tooth to the normal position. Case report: We present two case reports of a 13-year-old girl and a 12-year old boy with impacted left maxillary canine teeth. Thorough clinical examination and investigation was made with panoramic radiograph and CBCT, then surgical and orthodontic treatment was performed to correct impacted teeth and to achieve good aesthetic and functional results. Conclusion: The management of impacted canine requires skilful handling and careful observation. If any tooth is absent in the dental arch after the normal time of eruption has lapsed, the dentist must investigate and intervene as early as possible.

Root Resorption On Adjacent Teeth Associated With Included Permanent Canines: A Study With Computerized Tomography

Introduction: The most common complication that an impacted canine can generate is root resorption in neighboring pieces. The objective of this study is to describe the prevalence and location of root resorption in teeth adjacent, diagnosed with computed tomography. The database of the diagnoses of all the patients evaluated during theMethod: years 2020 and 2021 between 15 and 22 years of age was reviewed. All the pieces with the diagnosis of included canine were included in the study. Those pieces with incorrect diagnosis and those that did not have an image or its report were excluded. The variables: affected teeth, damaged root third and compromised root canal were analyzed. Of theResults: total of 62 patients, 14 presented root resorption associated with included canines. Of these 14 patients, all were female. The frequency of root resorption generated in neighboring teeth was 25.37%. The most affected pieces were lateral incisors (58.82%). Our results reported a similar frequency of root resorption compared to internationalConclusion: studies on the subject, following a similar pattern in terms of their affected surface in the root thirds.

Frequency Of Included Canines, Their Location And Direction Through Computerized Tomography, In Santiago, Chile.

Introduction: Dentomaxillofacial anomalies are frequent, among which we find the inclusion of definitive canines. The diagnosis of included canine becomes important when planning an orthodontic treatment. The objective of this study is to determine the frequency of included canines, their location and position in the arch through the analysis of computed tomography, in patients undergoing orthodontic evaluation in Santiago, Chile. The database of the diagnosesMethod: of all the patients evaluated during the years 2020 and 2021 between 15 and 22 years of age was reviewed. All the pieces with the diagnosis of canines included in the study were included. Those pieces with incorrect diagnosis and those that did not have an image associated with the diagnosis or its report were excluded. The computed tomography scans of each piece were analyzed, evaluating the variables piece included, position in the vertical axis, direction and position in the mesiodistal direction. 67 included canines from 63 patients were analyzed. Of these 63 patients, 68.7% wereResults: women. A frequency of 0.36% of included canines was determined. 6.34% were bilateral. The piece with the highest frequency was the upper left canine. This is the Chilean study with the largest sample size on the subject toConclusion: date.The frequency found was lower than the average of similar studies, possibly due to the age range analyzed.

Impactación Canina Maxilar y Reabsorción Radicular de Dientes Adyacentes: Un Análisis a Través de Tomografía Computarizada Cone-Beam / Canine Maxillary Impaction and Root Resorption of Adjacent Teeth: An Analysis through Cone-Beam Computed Tomography Analysis

RESUMEN: Uno de los problemas con mayores consecuencias tanto estéticas como funcionales en ortodoncia es la impactación de caninos maxilares (ICM) siendo principal motivo de reabsorciones radiculares de dientes adyacentes. Actualmente se carece de estudios que describan la reabsorción radicular por ICM a través de tomografía computarizada conebeam (TCCB) en la población chilena. El objetivo del estudio fue describir a pacientes entre 8 a 18 años, que presentan ICM (o riesgo de ella), tanto en las características de la impactación canina como en la reabsorción radicular presentada en incisivos laterales (IL) y en otros dientes adyacentes. En este estudio retrospectivo, 135 datos de TCCB fueron seleccionados por conveniencia, de los cuales 181 caninos presentaron ICM. Fueron analizadas las variables edad, sexo, tipo de ICM (unilateral o bilateral), localización bucolingual (vestibular o palatino), lado de impactación (derecho o izquierdo), reabsorción radicular en el incisivo lateral y registro de el o los dientes anexos afectados por reabsorción radicular (incisivo central y/o premolares). Además en el caso de reabsorción de IL fue analizada la reabsorción tridimensionalmente a través de la ThreeDimensional Leeds Orthodontic Root Resorption Target Scale (3D-LORTS). La ICM en la muestra seleccionada tuvo una edad promedio de 12 años, una relación por sexo mujeres:hombres de 1,5:1, frecuentemente de tipo unilateral, en el lado derecho y una localización bucolingual palatina (64,1 %) por sobre la vestibular (35,9 %). La reabsorción radicular alcanzó un 35,9 %, de la cual un 27,6 % involucró a IL y un 8,3 % en dientes anexos adyacentes. En cuanto a la distribución tridimensional de la reabsorción radicular, la más frecuente involucró el tercio apical (60 %), con compromiso pulpar o severo (40 %), involucrando solo una cara, la palatina (54 %). Ninguna de las variables anteriores consideradas, demostró diferencias estadísticas con la reabsorción radicular de incisivos laterales.

ABSTRACT: One of the problems with greatest aesthetic and functional consequences in orthodontics is the Impaction of Maxillary Canines (ICM) being the main reason for root resorption of the adjacent teeth. Currently there are no studies describing root resorption by ICM through cone beam computed tomography (CBCT) in the Chilean population. The main objective of the study was to describe patients between 8 and 18 years old, who presented with ICM (or risk thereof), with the characteristics of canine impaction as well as root resorption presented in lateral incisors (IL) and in other adjacent teeth. In this retrospective study, 135 CBCT subjects were selected for convenience, of which 181 canines presented ICM. The variables were analyzed: age, sex, type of ICM (unilateral or bilateral), buccolingual location (vestibular or palatal), side of impaction (right or left), root resorption in the lateral incisor and registration of adjacent teeth affected by resorption radicular (central incisor and/or premolars). In addition, when reabsorption of IL was observed, three-dimensional analysis was made using the Three-Dimensional Leeds Orthodontic Root Resorption Target Scale (3D-LORTS). The ICM in the selected sample had an average age of 12 years, a ratio by sex of women:men of 1.5:1, frequently of unilateral type, on the right side and with palatine buccolingual location (64.1 %) above the vestibular (35.9 %). Root resorption reached 35.9 %, of which 27.6 % presented in the IL and 8.3 % in adjacent teeth. Regarding the three-dimensional distribution of root resorption, the most frequent involved the apical third (60 %), with pulpal or severe damage (40 %), in only one location, the palatine (54 %). None of the above variables considered showed statistical differences with the root resorption of lateral incisors.

Displacement and periodontal stress analysis on palatally impacted canine - A finite element analysis

Objective: The aim of the study was to analyze the displacement and stress pattern in periodontal ligament (PDL) of palatally impacted canines (PIC) lateral incisors (LI) and first premolars (FP) adjacent to the impacted teeth when different magnitudes of orthodontic extrusion forces were applied along with variation in the inclination of the impacted teeth. Methodology: A three-dimensional finite element model of a maxilla containing a palatally impacted canine was made with three different inclinations of the palatally impacted canine (model one, model two, and model three). Forces of 50, 70, and 100 g were loaded on the impacted tooth. Results: There was steady increase in the initial rate of displacement in the three teeth when the magnitude of the force that was applied on to the PIC increased. The initial rate of displacement was more in the FP tooth as compared to LI and the impacted teeth. The von Mises stress on the PDL varied along with the variation in the inclination of the impacted canine. Conclusion: The study showed that there was variation in the displacement and the stress distribution in the impacted canine when it was placed in different angulations. The rate of displacement of the impacted teeth reduced when the crown of the palatally impacted canines (PIC) was inclined more mesial. The use of minimal forces is ideal to extrude the impacted canines as observed from the study that the PDL stress increases with increase in the magnitude of force.

The Importance of CBCT as Investigation for Impacted Canine: Case Reports

@#Panoramic radiograph is a routine investigation tool in orthodontic diagnosis and treatment planning however the limitation of two-dimensional image in assessing the position of impacted canine and surrounding tissues had cause unnecessary treatment options and complications during treatment. This report highlights the differences in investigation outcome and orthodontic treatment planning of two similar cases of patients with impacted upper canine, in which one only had panoramic radiograph and another case supplemented with Cone Beam Computed Tomography (CBCT). The case supported only by panoramic radiograph had changes in treatment planning during canine removal surgery as prevention from oro-antral fistula. This event could have been prevented if CBCT was taken where the canine can be assessed for proximity towards maxillary sinus. It is recommended for CBCT in orthodontic assessment for canine impaction especially for cases where canine is positioned higher than root apex of adjacent teeth and when root resorption is suspected.

Tracción de canino maxilar izquierdo impactado con botón bondeable, ligadura metálica y cadena elastomérica / Traction of left maxillary impacted canine with bondeable button, metal ligature and elastomeric chain

Se presenta una paciente con 13 años y 7 meses de edad, el motivo de consulta fue "un colmillo en el paladar"; es clase I molar bilateral, clase I canina derecha con el canino infantil 53, clase II canina derecha, clase I canina izquierda, clase I esquelética, normodivergente, tiene apiñamiento dental moderado superior e inferior leve, mordida cruzada anterior de canino superior derecho, diente 23 impactado, acortamiento radicular en los incisivos centrales y segundos premolares inferiores. El tratamiento consistió en la extracción de dientes temporales 53 y 63, alineación nivelación, tracción quirúrgica del diente 23, cierre de espacios, detallado, retención. La retención se llevó a cabo mediante retenedores "Hawley" superior con "Fingers" en los dientes 23 y 13 e inferior. El tiempo de tratamiento activo fue 1 años 2 meses.

Patient with 13 years and 7 months old, the reason for visit "a fang on the palate" presenting molar class I bilateral, right canine class I with OD 53, right class II canine with 13, left canine Class I, is a class I skeletal, normodivergent, with the adequate overbite and overjet, superior moderate crowding and lower light, cross bite between teeth: canine13 and 43, 23 impacted upper right canine, root shortening 11, 21, 35, 45. Treatment consisted of extraction of primary teeth 53-63, alignment, leveling, surgical traction 23, space closure, detailed, and retention. Retention by upper and lower Hawley retainers with fingers in canine 13 23. The active treatment time was 1 years 2 months.

The effect of canine disimpaction performed with temporary anchorage devices (TADs) before comprehensive orthodontic treatment to avoid root resorption of adjacent teeth

ABSTRACT Objective: The aim of this study was to evaluate the movement of impacted canines away from the roots of neighboring teeth before full-mouth bracket placement, performed by means of TADs to decrease undesired side effects on adjacent teeth. Methods: The study sample consisted of 34 palatally impacted canines, being 19 in the experimental group and 15 in the control group. In the experimental group, before placement of brackets, the impacted canine was erupted by means of miniscrews. In the control group, after initiation of comprehensive orthodontics, canine disimpaction was performed by means of a cantilever spring soldered to a palatal bar. At the end of treatment, volume of lateral incisors and canine root resorption were measured and compared by means of a CBCT-derived tridimensional model. Visual Analogue Scale (VAS) score, bleeding on probing (BOP) and gingival index (GI) were recorded. Clinical success rate was also calculated. Results: The volume of root resorption of lateral teeth in the control group was significantly greater than in the experimental group (p < 0.001). At the end of treatment, VAS score, GI and BOP were not significantly different between the two groups. Conclusion: Based on our results, it seems that disimpaction of canines and moving them to the arch can be done successfully carried out with minimal side effects by means of skeletal anchorage.

RESUMO Objetivo: o objetivo do presente estudo foi avaliar o uso de dispositivos de ancoragem temporária (DATs) para a movimentação de caninos impactados, afastando-os das raízes dos dentes vizinhos, antes da colagem dos braquetes em todos os dentes, com o objetivo de minimizar os efeitos colaterais indesejáveis nesses dentes adjacentes. Métodos: a amostra consistiu de 34 caninos impactados por palatino, sendo 19 no grupo experimental e 15 no grupo controle. No grupo experimental, antes da colagem dos braquetes, os caninos impactados foram tracionados utilizando-se mini-implantes. No grupo controle, após o início do tratamento ortodôntico, a desimpacção dos caninos foi realizada com uma mola em cantiléver soldada a uma barra transpalatina. Ao fim do tratamento, os valores referentes à reabsorção radicular nos incisivos laterais e caninos foram medidos e comparados por meio de modelos tridimensionais reconstruídos a partir de TCFCs. Foram também registrados os escores relativos à dor sentida pelos pacientes, usando uma escala visual analógica (VAS); além do Índice de Sangramento à Sondagem (ISS) e do Índice Gengival (IG). O índice de sucesso clínico também foi calculado. Resultados: o volume de reabsorção radicular nos incisivos laterais no grupo controle foi significativamente maior do que no grupo experimental (p < 0,001). Ao fim do tratamento, não houve diferença significativa entre os dois grupos quanto aos escores relativos à VAS, ao IG e ISS. Conclusão: esses resultados sugerem que a desimpacção de caninos e a movimentação deles para a arcada dentária podem ser realizadas, com sucesso e com mínimos efeitos colaterais, por meio da ancoragem esquelética.

Micro-implant anchorage for orthodontic intervention of buccal impacted maxillary canine / 实用口腔医学杂志

Micro-implant anchorage was used for orthodontic intervention of 3 patients with buccal impacted maxillary canine,good clinical outcome was obtained.The micro-implant anchorage may provided a new approach for the treatment of this kind of teeth.

Diagnosis and treatment of upper impacted canines / 实用口腔医学杂志

This paper focuses on the diagnosis and treatment of upper impacted canines.Radiograph diagnosis is the most important tool in-cluding panoramic,CT and CBCT.Preventive and interceptive treatment,tooth extraction,self tooth transplantation and orthodontic traction can be used in the treatment.

A Long-term Follow-Up Case of Enucleation of Dentigerous Cyst in the Maxilla: Case Report

Palatally impacted canine: diagnosis and treatment options: [review]

Canines contribute significantly to the esthetic and chewing functions. Orthodontists should diagnose canine ectopic eruption early, trying to prevent retention of these teeth. Its multifactorial etiology involves general and local factors and the correct diagnosis depends on clinic, radiographic and/or tomographic exams. Several therapeutic procedures depend on factors such as relationship between canine and adjacent structures, possibility of orthodontic movement and patient age. Orthodontic and surgical treatment with canine traction is very much effective, with time of treatment being shorter than in patients under the age of 25.

Localization of impacted permanent maxillary canine using single panoramic radiograph.

Background and Objectives : The objective in localization is selection of a suitable technique which has minimal radiation dose, cost and maximum details. Panoramic radiograph, being a screening radiograph, can satisfy the above needs. Taking this into consideration, the present study was done to evaluate the reliability of panoramic radiograph in localization of impacted permanent maxillary canines by applying the criteria suggested by Chaushu et al. and by comparing it with Clark's rule. Materials and Methods : The study comprised of 114 subjects in the age group of 13-30 years of both the genders with 150 impacted canines visiting Department of Oral Medicine and Radiology during the study period. The study subjects were examined for clinically missing canine, and then confirmed with intra-oral peri-apical radiograph (IOPAR). Panoramic radiographs (for application of Chaushu et al. criteria) and IOPAR's (for application of Clark's rule) of the subjects were made and interpreted for parameters pertaining to the impacted canines. The data obtained was tabulated and subjected to statistical analysis using the statistical package for social sciences (SPSS) software. Results : Determination of the bucco-palatal position from panoramic radiographs, by applying Chaushu, et al. criteria, showed that localization in bucco-palatal position was possible for 96 of the 102 impacted canines placed in the middle and coronal zones. The remaining six impacted canines, three each in the middle and coronal zones, could not be localized as they showed overlapping in their range. By excluding them, the overall agreement worked out to be 94.11%. Localization was not possible for 48 impacted canines that lied in the apical zone. Conclusion : A single panoramic radiograph can serve as a reliable indicator for determining the bucco-palatal position of the impacted canines when they lie in the middle and coronal zones. When they lie in the apical zone it is recommended to explore their presence with other conventional or advanced imaging modalities.

Evaluation of potency of panoramic radiography for estimating the position of maxillary impacted canines using 3D CT / 대한치과교정학회지

OBJECTIVE: The aim of this study was to evaluate the potency of panoramic radiography for the detection of maxillary impacted canines. METHODS: Twenty-five patients were selected, comprised of 7 males (mean age: 10.9 years, range: 8.5 - 14.5 years) and 18 females (mean age: 10.9 years, range: 8.2 - 15.7 years). In total, thirty-five maxillary impacted canines were estimated. The position of the canine and root resorption of adjacent teeth were evaluated on panoramic radiography and 3D CT. RESULTS: Except for angulation to the occlusal plane, the other parameters, such as tooth length, crown width, vertical distance and lateral shift showed larger values on panoramic radiography compared to 3D CT. In palatally impacted cases, the angulation of canine was smaller, and the vertical distance to the occlusal place was larger on panoramic radiography than 3D CT. For labially impacted canines, tooth length, crown width, and angulation to the occlusal plane were similar for the two methods. The sensitivity for detecting root resorption on panoramic radiography was calculated as being 33.3% of 3D CT. CONCLUSIONS: The position of labially impacted canines can be effectively estimated using panoramic radiography, but palatally impacted canines need further investigation such as 3D CT for proper diagnosis.

Factors that influence treatment duration for patients with palatally impacted maxillary canines / 대한치과교정학회지

OBJECTIVE: The aim of this study was to determine the relationship between the status of a unilateral palatally impacted maxillary canine (as seen on the panoramic radiograph) and the orthodontic treatment duration. METHODS: A total of 36 subjects were chosen (8 males and 28 females, 13.7 +/- 2.5 years). All patients had undergone orthodontic traction of the impacted canine after a closed flap surgery. The position of impacted canine on the panoramic radiograph was traced and calculated with regard to the treatment duration. RESULTS: The canine overlap over the lateral incisor (COGr) had significant statistical difference between the short-term and the long-term treatment duration groups (divided by average treatment time of 21 months) (p < 0.05). Multiple regression indicated that the variables of significance (with treatment duration as the dependent variable) were the canine vertical height from the occlusal plane (HCV, r(2) = 0.115; p < 0.05) and the mandibular anterior width (MnDW, r(2) = 0.142; p < 0.05). The treatment duration, the canine angle to the incisor midline (CA), and HCV decreased from primary dentition (under 12 yrs) to permanent dentition (15 yrs). Howerer, these increased again at the adolescent ages (over 16 yrs). CONCLUSION: These findings suggested that orthodontic treatment of a palatally impacted canine would show good prognosis at an age of early permanent dentition with the canine showing smaller CA and HCV.

C-activator treatment for distalization of maxillary molars in Class II anterior deep bite malocclusion / 대한치과교정학회지

A modified removable appliance for molar distalization called C-activator was used in a 10-year old male patient with a Class II anterior deep bite malocclusion with upper arch discrepancy. The treatment plan involved correcting the Class II relationship, distalizing both upper first molars, and regaining space for the erupting canines. The C-activator, which was used for 6 months, consisted of a labial framework formed from .036-in stainless steel wire and an acrylic monobloc. Both the closed helices of the labial framework were compressed for reactivation during the C-activator treatment period. C-activator mechanics simultaneously achieved distalization of the upper first molars into their proper positions and repositioning of the mandible. After 21 months of treatment, the correct overbite and overjet was obtained and contributed to an improvement in facial balance. The treatment results were stable 6 months after debonding. Fabrication and placement of the new appliance and clinical procedures are detailed, and the treatment sequence and results of this case are presented as follows.

Orthodontic treatment of palatally impacted canine / 대한치과교정학회지

Upper canine is described as 'cornerstone' of maxilla, and its importance is implicated by long root and good alveolar support, The incidence of impaction of upper canine is the second most frequent next to the third molar because it takes a long period of time to develop, and has a complicated path of eruption, and erupts lately. Generally, the patient who has a palatally impacted canine visit the clinic primarily due to a missing of canine after 12-13 years old. Palatally impacted canine is different from labially impacted canine in its cause and treatment process, It is due to malposition or anomalous lateral incisor rather than arch length deficiency. Once the impaction is identified, the first stage of the treatment is to localize the lesion by radiographic examinations or others and according to severity, orthodontic traction, or transplantation should be considered, and comprehensive diagnosis and treatment plan of malocclusion should be established, Properly managed impacted canine can provide funtion and esthetic through proper diagnosis and treatment of extraction of canine is not indicated.