Computer-assisted open exposure of palatally impacted canines for orthodontic eruption: A randomized clinical trial.

OBJECTIVE: This randomized clinical trial aimed to assess the feasibility of computer-assisted open exposure of palatally impacted canines. MATERIALS AND METHODS: Patients aged 11-30 years who required orthodontic eruption for the full palatal impaction of their canines were included in this study. Exclusion criteria were psychosocial and dental contraindications of orthodontic treatment, congenital craniofacial disorders, and trauma in the patient's history in the vicinity of the surgical site. Virtual planning software was used to register the intraoral scans and cone-beam computed tomography data and to design a surgical template. In the test group, exposure of the canines was guided by a surgical template, whereas in the control group, the surgeon relied on the surgical plan to localize the impacted canine. The success of the intervention, duration of surgery, and complications, including excessive hemorrhage, damage to the canine or neighboring anatomical landmarks, and postoperative inflammation of the surgical site were assessed. Postoperative pain was reported by the patients using the visual analog pain scale (VAS). RESULTS: Surgery was deemed successful in all patients in both groups. During healing, no complications were observed. The duration of surgery decreased significantly in the test group (4 min 45.1 s ± 1 min 8.4 s) compared to that in the control group (7 min 22.3 s ± 56.02 s). No statistically significant differences were observed between the VAS scores of the two study groups. CONCLUSIONS: The application of virtual planning and static navigation is a viable approach for the open exposure of palatally impacted canines. CLINICAL TRIAL REGISTRATION NUMBER: NCT05909254. CLINICAL SIGNIFICANCE: Computer-assisted surgery is a feasible method for open exposure of palatally impacted canines, which decreases the duration of surgery compared to the freehand method.

Prevalence of canine impaction in different cities of Saudi Arabia: A systematic review.

Background: To our knowledge, no systematic review assessed and gathered information about the prevalence of impacted canines among the Saudi population. The purpose of this study was to critically assess the previously published studies about the prevalence of canine impaction according to impaction type (buccal/ palatal), gender (male/female), and location (maxillary/mandibular, right/left), are among the Saudi population. Methods: PubMed (MEDLINE), Scopus, the Web of Science, Dimensions, and Semantic Scholar databases were searched systemically for articles related to the topic of the study published between 1987 and 2022. The PRISMA statements were used to conduct a systematic review with the help of the Best Practice for Survey and the Public Opinion Research scales by the American Association for Public Opinion Research (AAPOR) to assess and evaluate the selected studies' quality. Results: The initial search of the databases yielded 221 articles. After discarding duplicates, 161 were selected for further evaluation. Eventually, 16 articles were selected for inclusion in this study. Regarding the quality of the selected articles, all articles, except one, were of high quality. Only one was of medium quality. Conclusion: It was found that the incidence of palatal canine impactions was higher than buccal impactions. Females had a higher prevalence of canine impactions as compared to males. There were more canine impactions in the maxilla than the mandible and more on the left side than the right one.

Mixed reality-based technology to visualize and facilitate treatment planning of impacted teeth: Proof of concept.

OBJECTIVE: We propose a method utilizing mixed reality (MR) goggles (HoloLens 2, Microsoft) to facilitate impacted canine alignment, as planning the traction direction and force delivery could benefit from 3D data visualization using mixed reality (MR). METHODS: Cone-beam CT scans featuring isometric resolution and low noise-to-signal ratio were semi-automatically segmented in Inobitec software. The exported 3D mesh (OBJ file) was then optimized for the HoloLens 2. Using the Unreal Engine environment, we developed an application for the HoloLens 2, implementing HoloLens SDK and UX Tools. Adjustable pointers were added for planning attachment placement, traction direction, and point of force application. The visualization was presented to participants of a course on impacted teeth treatment, followed by a 10-question survey addressing potential advantages (5-point scale: 1 = totally agree, 5 = totally disagree). RESULTS: Out of 38 respondents, 44.7% were orthodontists, 34.2% dentists, 15.8% dental students, and 5.3% dental technicians. Most respondents (44.7%) were between 35 and 44 years old, and only 1 (2.6%) respondent was 55-64 years old. Median answers for six questions were 'totally agree' (25th percentile 1, 75th percentile 2) and for four questions 'agree' (25th percentile 1, 75th percentile 2). No correlation was found between age, profession, and responses. CONCLUSION: Our method generated substantial interest among clinicians. The initial responses affirm the potential benefits, supporting the continued exploration of MR-based techniques for the treatment of impacted teeth. However, the recommendation for widespread use awaits validation through clinical trials.

Assessment of the positional and morphological differences of unilaterally impacted canines: A cross-sectional study.

INTRODUCTION: This study aimed to use cone beam computed tomography (CBCT) to evaluate the dimensional and morphological characteristics of unilaterally impacted canines, their effects on adjacent teeth, and differences with contralaterally erupted canines. MATERIALS AND METHODS: A sample of 31 patients (22 males, mean age 22.22 ± 4.82 years; 9 females, mean age 23.91 ± 5.16 years) with unilaterally impacted maxillary palatal teeth were included in the study. CBCT images were obtained using a NewTom 5 G unit in standard mode. Three-dimensional multiplanar reconstructions emulating a panoramic view and curved planar reconstructions were evaluated. Individuals were divided into two groups (low- and high-complexity) according to Ericson and Kurol's impaction complexity classification. RESULTS: The crown lengths and mesiodistal crown widths of the impacted canines were similar to the symmetric canine on the opposite arch and significantly larger than adjacent lateral and premolar teeth (p<0.05). The alpha (31.33 ± 8.32) and beta angles (39.53 ± 10.31) and the 'h' height (10.11 ± 2.02) values in the low-complexity group were significantly lower than the high-complexity group (alpha angle=57.40 ± 12.15; beta angle=71.31 ± 13.94; 'h' height=14.35 ± 3.71, and alpha angle: p<0.001; beta angle: p<0.001; 'h' height: p=0.002) CONCLUSION: The root lengths of impacted maxillary canine teeth are significantly shorter than symmetrically erupted canine teeth regarding labiolingual crown width. As the alpha and beta angles and 'h' height increase, the complexity level of the impacted canine also increases.

Periodontal outcomes of surgically exposed and orthodontically aligned buccally impacted maxillary canines: A systematic review and meta-analysis.

OBJECTIVE: This systematic review aimed to compare periodontal outcomes of surgically exposed and orthodontically aligned buccally impacted maxillary canines to spontaneously erupted maxillary canines. DATA SOURCES: An unrestricted search was carried out of indexed databases (Medline, EMBASE, Web of Science and Scopus), reference lists of included studies, and grey literature published until December 2023. DATA SELECTION: Observational and experimental studies that addressed the focused question 'Do periodontal outcomes of buccally impacted maxillary canines that were surgically exposed and subsequently extruded and aligned using orthodontic alignment differ from those of spontaneously erupted maxillary canines?' were included. DATA EXTRACTION: Study screening, selection and data extraction were performed independently by two authors, with disagreement resolved by a third reviewer. The risk of bias was assessed using the JBI Critical Appraisal Checklist and GRADE approach. RESULTS: A total of 857 citations were found and five studies were eligible for inclusion. Supragingival plaque accumulation and gingival inflammation were similar between impacted canines and their contralaterals in most studies. Meta-analyses revealed no significant differences in keratinised tissue width (prospective studies: MD = -0.28, 95% confidence interval [CI] = -1.13-0.56, I² = 78%; retrospective studies: MD = 0.61, 95% CI = -1.51-2.72, I² = 94%). However, a meta-analysis of prospective studies showed slightly greater mean probing depth for impacted canines compared to their contralateral canines (prospective studies: MD = 0.16, 95% CI = 0.04-0.28, I² = 0%). The evidence certainty for keratinised tissue width and probing depth outcomes was low. CONCLUSION: Surgically exposed and orthodontically aligned buccally impacted canines have slightly greater probing depths, potential bone loss and increased clinical crown length, compared to their counterparts. However, these small differences (<1 mm) are unlikely to be clinically significant.

Evaluation of maxillary transverse dimensions in individuals with a unilaterally impacted canine.

INTRODUCTION: The aim of this study was to investigate the maxillary width within individuals with a unilaterally impacted maxillary canine and to determine any association between the impacted canine location and some canine-related variables. METHODS: A cross-sectional analytical study using a split-mouth design included 22 CBCTs of individuals with unilaterally impacted maxillary canines (a total of 44 sides). The maxillary width was measured and compared in both impacted and non-impacted sides at various levels: basal, alveolar, and dental. The following canine-related variables were analyzed and compared with impaction location: impacted canine angulation, cusp tip distance from the occlusal plane, type of impaction (vertical or horizontal), presence of root resorption, deciduous teeth, or adjacent teeth transposition. Significance was considered at P < 0.05. RESULTS: There was a significant reduction in maxillary width on the impacted side at the following levels: maxillary first premolar alveolar crest in both coronal and axial sections, dental width measured from the central fossa of maxillary first molar to the midline, and width measured from the canine cusp tip to the midline. Moreover, the distance from the palatally impacted canine cusp tip to the occlusal plane was statistically significantly lower (7.6 ± 1.5 mm) compared to buccal (10.8 ± 3.3 mm) and mid-alveolus (12.0 ± 3.9 mm) impaction, (P values = 0.02). CONCLUSIONS: There was a significant association between canine impaction and reduction in the maxillary width at least on the dental level. The palatally impacted canine cusp tip was significantly closer to the occlusal plane compared to the buccal and mid-alveolar impaction.

The Analysis of Intermolar Width and Skeletal Base Class as a Predictor of Potential Maxillary Canine Impaction in Permanent Dentition: A Cross-Sectional Study.

Objectives. This study aimed to analyze the inter-molar width and skeletal base class to predict maxillary canine impaction in permanent dentition. Methods. This cross-sectional study was carried out between September 2021 to March 2022. Patients aged between 13 and 20 years were recruited. These patients' cone-beam computer tomography(CBCT), lateral cephalogram, and dental casts were collected and analyzed. For statistical analysis, T-test and Chi-square tests were applied. Results. A total of 92 patients were enrolled in this study. Inter-molar width was significantly decreased in patients with impacted canine(P < .001). The skeletal base classification was statistically significant when compare with intermolar width(P < .05). The location of impaction (P = .060), type of impaction(P = .435), and side of impaction(P = .239) were determined to be statistically insignificant. Conclusion. The Inter-molar width was decreased in patients with impacted canine; therefore, it may be a potential risk factor. The skeletal classification was found to affect inter-molar width in impacted canine patients.

Influence of alveolar bone thickness and bucco-palatal inclination on root resorption of lateral incisors in unilateral maxillary impacted canines: a retrospective observational study.

BACKGROUND: This study aimed to investigate the potential associations between alveolar bone thickness, bucco-palatal inclination of maxillary lateral incisors, and lateral incisor root resorption in patients with unilateral maxillary impacted canines (UMICs). METHODS: A total of three hundred and five subjects (120 males, 185 females; mean age, 16.39 years; standard deviation, 4.04) with UMICs were included. Canine position and root resorption were assessed using CBCT. UMICs were divided into palatal, buccal and mid-alveolus groups (PICs, BICs and MAICs), with 117, 137 and 51 subjects, respectively. Alveolar bone thickness and bucco-palatal inclination of lateral incisors were measured using the Dolphin software. RESULTS: The prevalence of lateral incisor root resorption was significantly lower in the BICs (13.9%) than MAICs (29.4%) and PICs (29.1%). Alveolar bone thickness of the apical area was smaller in UMICs with lateral incisor root resorption than no resorption in both PICs (8.33 ± 1.64 vs 10.53 ± 2.55 mm) and BICs (8.94 ± 1.85 vs 10.76 ± 2.28 mm). Furthermore, lateral incisors on the impacted side were more buccally inclined in PICs with lateral incisor root resorption than no resorption, while in both BICs and MAICs, there was no statistical difference between lateral incisor root resorption than no resorption. Moreover, alveolar bone thickness of the apical area, rather than bucco-palatal inclination of lateral incisors, was significantly correlated with lateral incisor root resorption both in PICs and BICs. CONCLUSIONS: Lateral incisor root resorption is less common in BICs. Thinner alveolar bone thickness at the apical area of lateral incisors can be considered as a potential risk factor for lateral incisor root resorption in UMICs.

Artificial intelligence-based automated preprocessing and classification of impacted maxillary canines in panoramic radiographs.

OBJECTIVES: Automating the digital workflow for diagnosing impacted canines using panoramic radiographs (PRs) is challenging. This study explored feature extraction, automated cropping, and classification of impacted and nonimpacted canines as a first step. METHODS: A convolutional neural network with SqueezeNet architecture was first trained to classify two groups of PRs (91with and 91without impacted canines) on the MATLAB programming platform. Based on results, the need to crop the PRs was realized. Next, artificial intelligence (AI) detectors were trained to identify specific landmarks (maxillary central incisors, lateral incisors, canines, bicuspids, nasal area, and the mandibular ramus) on the PRs. Landmarks were then explored to guide cropping of the PRs. Finally, improvements in classification of automatically cropped PRs were studied. RESULTS: Without cropping, the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for classifying impacted and nonimpacted canine was 84%. Landmark training showed that detectors could correctly identify upper central incisors and the ramus in ∼98% of PRs. The combined use of the mandibular ramus and maxillary central incisors as guides for cropping yielded the best results (∼10% incorrect cropping). When automatically cropped PRs were used, the AUC-ROC improved to 96%. CONCLUSIONS: AI algorithms can be automated to preprocess PRs and improve the identification of impacted canines.

Diagnostic accuracy of conventional orthodontic radiographic modalities and cone-beam computed tomography for localization of impacted maxillary canine teeth.

BACKGROUND: Orthodontic treatment planning for an impacted canine tooth requires accurate information about its position. The aim of this study was to compare the diagnostic accuracy of two conventional orthodontic radiographic modalities with cone-beam computed tomography (CBCT) for localization of impacted maxillary canine teeth. MATERIALS AND METHODS: Panoramic radiographs, lateral cephalograms, and CBCT scans of 30 patients with unilaterally impacted maxillary canine teeth were retrieved from the archives. Eight expert orthodontists evaluated the parameters related to the location of impacted canine teeth by using panoramic radiographs and lateral cephalograms of patients. After 4 weeks, the same parameters were evaluated on CBCT scans of patients. The diagnostic accuracy of conventional modalities and CBCT was compared with each other and also with the gold standard. RESULTS: The conventional radiographic modalities and CBCT had similar accuracy for assessment of the overall inclination (p = 0.11), apex morphology (p = 0.18), and mesiodistal position of the apex (p = 0.12). CBCT had significantly higher accuracy for determination of incisal tip location (p = 0.001), labiopalatal (p = 0.001) and vertical (p = 0.01) position of the crown tip, minimum bone thickness covering the crown (p = 0.001), and root resorption of the adjacent tooth (p = 0.001). CONCLUSION: The combination of panoramic radiographs and lateral cephalograms was sufficiently accurate to assess some diagnostic parameters such as overall inclination, apex morphology, and mesiodistal apex location of impacted canine teeth.

Optimizing the use of panoramic radiography for determining the position of impacted permanent maxillary canines.

The purpose of this research was to test the reliability of a modified magnification method for determining the position of an impacted canine from a single panoramic radiograph. This retrospective study evaluated 114 panoramic radiographs showing 136 impacted maxillary canines. The widths of the impacted canines, contralateral erupted canines, and ipsilateral maxillary incisors were measured, and ratios for the canine-incisor index (CII) and canine-canine index (CCI) were calculated. The impacted canines were also classified according to their location in the vertical plane (apical, middle, or coronal zone) relative to the contralateral central incisor. Continuous data were analyzed for normal distribution, and logistic and multivariate logistic regression models were conducted. The Benjamini-Hochberg procedure with a false discovery rate of 0.05 was used to account for multiple testing. The intrarater reliability was excellent for impacted canine, central incisor, and contralateral canine measurements (intraclass correlation coefficient > 0.9). The CII and vertical zone were strong predictors of an impacted canine position with clinically useful sensitivity and specificity values (0.69 and 0.74, respectively, based on an area under the curve concordance statistic of 0.75). A predictive range was evident for the CII of palatally (1.10-1.39) and buccally (0.90-1.19) impacted canines in the middle and coronal zones, respectively. The occurrence of palatal or buccal positioning was not significantly associated with the CCI (P = 0.2). The CII and vertical zone identified from a single panoramic radiograph can be used to determine the buccopalatal position of an impacted canine, with more reliability if the impacted canine crown is in the middle or coronal zone of the contralateral central incisor.

Redirection of palatally ectopic maxillary canines: Case report and proposition of an interceptive sequential guideline.

The eruptive deviation of the permanent maxillary canine must be identified early, at the beginning of the second transitional period of the mixed dentition. Acting at this moment is fundamental for its spontaneous redirection and eruption. The aim of the paper is to present a case where the extraction of the deciduous canines was the choice for redirecting the maxillary permanent canines with eruptive palatal deviation, as well as to suggest a sequence of procedures for diagnosis and choice of treatment. The success of deciduous canine extraction in redirecting the ectopic permanent canines is discussed in this case, as well as aspects that might lead to failure. Still, it highlights the importance of computed tomography for choosing conservative treatment or traction, including it in the sequential guideline for acting in these cases.

The effectiveness of minimally-invasive corticotomy-assisted orthodontic treatment of palatally impacted canines compared to the traditional traction method in terms of treatment duration, velocity of traction movement and the associated dentoalveolar changes: A randomized controlled trial.

Objective: To evaluate the effectiveness of a minimally-invasive corticotomy-assisted treatment of palatally impacted canines (PICs) compared with the traditional method by evaluating treatment time, the velocity of movement, and the associated dentoalveolar changes. Materials and methods: Forty-six patients with palatally or mid-alveolar upper impacted canines were recruited and distributed into two groups: the corticotomy-assisted traction group (CAT group, mean age: 20.39±2.27 years) and the traditional treatment group (TT group, mean age: 20.26±2.17 years). The closed surgical approach was used in both study groups. The velocity of traction movement, traction duration and overall treatment duration were evaluated clinically. In addition, the bone support ratios and the amount of root resorption were assessed on cone-beam computed tomography (CBCT) images. Results: At the end of treatment, significant differences were found between the two groups regarding the velocity of traction movement, traction time, and overall treatment time (P<0.05). The mean velocity of traction movement in the CAT group was greater than the TT group ( x velocity=1.15±0.35 mm/month; 0.70±0.33 mm/month, P=0.027, respectively). The duration of the active traction and the overall orthodontic treatment in the CAT group were significantly shorter than the TT group by 36% and 29%, respectively. The mean bone support ratios of the aligned canines did not differ significantly between the two groups (88% vs. 89% in the CAT and TT groups, respectively). No significant differences were found between the two groups regarding the mean amount of root resorption on the adjacent laterals ( x resorption = 1.30±1.18 mm; 1.22±1.02 mm, P=0.612, in CAT and TT groups, respectively). Conclusions: The traction movement velocity of the palatally impacted canines can be increased using minimally-invasive corticotomy-assisted orthodontic treatment. The side effects of the acceleration procedure were minimal and almost similar to those of the traditional technique.

Orthodontic Treatment of Palatally Impacted Canines in Severe Non-Syndromic Oligodontia with the Use of Mini-Implants: A Case Report.

Background: The risk of palatally displaced canines (PDCs) rises in patients with tooth agenesis. The orthodontic extrusion and alignment of PDCs require adequate anchorage to enable tooth movement and control the side effects. There is no paper presenting treatment in the case of severe oligodontia with simultaneous PDCs and the use of mini-implants (MIs) for their orthodontic extrusion. Case presentation: A 15-year-old patient presented with non-syndromic oligodontia and bilateral PDCs. Cone beam computed tomography revealed that both PDCs were in proximity to the upper incisors' roots. There was no evident external root resorption of the incisors. The "canines first" approach was chosen. MIs were used both as direct and indirect anchorage. First, the extrusive forces of cantilevers were directed both occlusally and distally. Next, the buccal directions of forces were implemented. Finally, fixed appliances were used. PDCs were extruded, aligned, and torqued. Proper alignment and occlusion were achieved to enable further prosthodontic restorations. Conclusions: The use of MIs made it possible to avoid collateral effects, reduce the risk of complications, and treat the patient effectively. MIs provide adequate anchorage in demanding cases. The use of MIs for the extrusion of PDCs made it possible to offer this treatment option to patients with severe oligodontia. The presented protocol was effective and served to circumvent treatment limitations associated with an inadequate amount of dental anchorage and a high risk of root resorption.

Comparing the Efficiency of a Newly Designed Spring With the T Loop for Buccal Canine Disimpaction: A Finite Element Study.

Disimpacting a buccally impacted canine precisely using frictionless mechanics is a challenge in orthodontics. Various mechanics can be used for aligning an impacted canine and a spring is one of the most versatile methods of accomplishing it. The present study describes a newly designed spring for canine disimpaction using the finite element method (FEM) model. In the present study, the efficiency of the newly designed spring was compared with the T loop. The FEM model of the maxilla was prepared. Harsha's Canine Disimpaction (HCD) spring and T loop with no pre-activation bends were utilized to disimpact the left maxillary canine using a 0.017 x 0.025 inch titanium molybdenum alloy wire. Efficiency of both springs in all dimensions (sagittal, vertical and transverse) was compared. Stress acting on the bone and teeth and number of activations needed for disimpaction were evaluated when the spring was activated by 3 mm. A movement/displacement of 0.8, 0.4 and 0.1 mm was seen in the sagittal (X), transverse (Y) and vertical (Z) planes, respectively, with the HCD spring, and 0.4, 0.1 and 0.1 mm seen in the X, Y and Z planes, respectively, with the T loop. A total of 12-13 and 80 activations were required as per the FEM simulation for disimpaction using the HCD spring and T loop, respectively. Stress concentration in the disto-cervical region was observed during disimpaction with both HCD spring and T loop. Within the constraints and limitations of the present study, it can be concluded that the HCD spring requires lesser activation and brings about greater control of canine disimpaction in all three dimensions when compared to the T loop.

Characteristics of Unilaterally Impacted Maxillary Canines and Effect on Environmental Tissues: A CBCT Study.

BACKGROUND: The prognosis of orthodontic treatment for a patient with impacted canine teeth can be affected by many factors and understanding some of the characteristics of impacted teeth can increase the effectiveness and reduce the duration of treatment. This study aims to explore the effects of positions and dentoalveolar morphological characteristics of impacted maxillary canines on the prognosis of orthodontic treatment. METHODS: In this study, forty-six adolescent individuals who applied for treatment of impacted teeth were divided into three groups: CC (no impacted maxillary canine group), BC (unilateral buccally positioned impacted maxillary canine group), and PC (unilateral palatally positioned impacted maxillary canine group). The impacted canine and adjacent teeth were evaluated in terms of position, angulation, inclination, mesiodistal and buccolingual widths, root length, dilaceration angle, and root resorption. RESULTS: The mean values of U3 Ang (angulation of the maxillary impacted canine) and U3/U2 angles (maxillary impacted canine and lateral incisor angle) were statistically significantly higher in the BC and PC groups (p < 0.001). The mean values of U2 RL (lateral incisor root length) and U3 RD (canine root dilaceration angle) were statistically significantly lower in the BC and PC groups. CONCLUSIONS: The results of this study suggest that shorter root lengths and increased angulation values may lead to the ectopic eruption of canines. The higher canine angulations in the PC group increase the degree of root resorption.

Treatment of Mandibular Impacted Canine in a Patient with Class II Division 1 Malocclusion with "Reverse Pin": A Case Report.

This case report presents an orthodontic treatment conducted on a 13-year-old girl with bilateral Class II malocclusion and a mandibular impacted canine. The presence of an impacted tooth necessitates careful consideration of the timing of orthodontic treatment, the appropriate surgical procedure to expose the tooth, the specific orthodontic mechanics involved, and the potential problems that may arise, all of which depend on the type and location of the canine impaction in the jaw. The treatment plan included a surgical procedure to expose the impacted tooth and orthodontic traction to guide it into position. Correction of the Class II Division 1 malocclusion utilized a specialized technique called the "reverse pin", reducing vertical side effects. The revised version maintains clarity and key information about the case report and treatment.

Revealing the Effect of Impacted Canines on the Adjacent Teeth. A Three Dimensional Study Using CBCT.

Objective: The current cross-sectional study aimed to assess the relationship between impacted maxillary canines and their effect on root resorption of neighboring teeth using cone-beam computed tomography (CBCT). Materials and Methods: The study evaluated the effect of 24 impacted maxillary canines on the adjacent tooth roots. We used a CBCT to evaluate the position and size of the dental follicle of impacted maxillary canines and the severity of root resorption on adjacent teeth. We used a t-test to compare the significant differences between the width of the dental follicle and the severity of root resorption. The inter- and intra-rater agreements were assessed. Results: A number of 12 impacted canines had resorbed the roots of adjacent teeth. Lateral incisors were most affected (83.3%), followed by central incisors (16.7%). Mild root resorption was found in 10 cases, while severe resorption was found in two cases. We found no relation between the size of the dental follicle and the degree of root resorption. The inter- and intra-rater agreements were high. Conclusion: In cases with maxillary impacted canines, special consideration should be directed to the roots of the maxillary lateral incisors. Our findings could not confirm any relationship between the size of the dental follicle width of the maxillary impacted canines and the degree of root resorption of the adjacent incisors. More studies are needed to assess the proximity and path of eruption of impacted maxillary canines and their effect on the neighboring teeth.

Maxillary Impacted Canine and Upper Lateral Incisor Agenesis Treatment with "Canine First Technique" and Clear Aligners: A Case Report.

The aim of this study was to show a case of an impacted canine in an adult patient with agenesis of the maxillary lateral incisor treated with clear aligners (CA). A 19-year-old male with a persistence of 5.3 and absence of 1.2 came to our department of the School of Orthodontics at the University of Federico II in Naples and asked for an aesthetic treatment. The Canine First approach was used to surgically expose the canine and pull it into the dental arch. In order to ensure long-term aesthetic, periodontal, and occlusal results, a treatment with CAs to close the space through the mesial placement of the canine and the enameloplasty of the tooth crown was performed. At the end of the treatment, the occlusal objectives were achieved.

Orthodontic camouflage treatment of pseudo-Class III malocclusion on skeletal class III Base complicated with canine impaction treated with temporary anchorage devices: A case report.

With conventional mechanics to protract the upper posterior teeth for correcting Class III molar relationships, such as intra-arch mechanics, face mask reverse-pull headgear protraction, and interarch Class III elastics, there are some adverse effects, including diminished patient compliance, the possibility of losing anchorage, and extrusion of upper molars and lower incisors with counterclockwise rotation of the occlusal plane. Protraction force should be directed through the center of resistance of the upper posterior teeth to prevent these side effects.