Changes in alveolar bone morphology after traction of buccally vs palatally unilateral maxillary impacted canines: A cone-beam computed tomography study

Conservative Treatment of Bilateral Impacted Mandibular Canines Traction

The objectives of the treatment of impacted canines differ according to the characteristics of dental malocclusion. Traction of the tooth is a conservative and viable alternative, which allows for maintaining stability and occlusal function. The following case report describes the treatment of an 11.6-year-old female patient, who presented bilateral impaction of mandibular canines in contact with the midline, mixed dentition in the inter-transitional period, class I angle malocclusion, with light crowding teeth. The treatment comprised three phases. The first phase, verticalization of the mandibular canines in mixed dentition, was performed to pull the impacted bilateral mandibular canines towards the dental arch to achieve their verticalization, maintaining the molar relationship, and the position of the upper and lower incisors. In the second phase, osteogenic rest was planned to relieve post-traction stress while awaiting the replacement of the mixed dentition. Finally, the third phase in permanent dentition was to align and level canines within the arch after extraction of the deciduous canines. For the viability of the permanent mandibular canines in the dental arch, orthosurgical traction was implemented, with a traction system with closed nickel-titanium coil springs with a transitory rigid dental-mucous-supported anchorage device, which allowed control and protection of the adjacent teeth and movements with helical forces of a controlled three-dimensional range. The results of the treatment were adequate, achieving consolidated molar and canine relationships, overjet, overbite, and optimal facial balance.

Three-dimensional orthodontic anchorage management of impacted maxillary canines: A systematic review

Objectives:

Our work aims to provide scientific evidence by conducting a serious systematic review of the efficacy of three-dimensional (3D) anchorage devices for orthodontic traction of impacted maxillary canines.

Material and Methods:

An electronic search extending from 2012 to 2022, targeting mainly clinical trials was performed on the following databases PUBMED (MEDLINE), The Cochrane Library, SCIENCE DIRECT, EBSCO HOST DATABASES, and GOOGLE SCHOLAR. The search was established on a well-defined research question following the PICO principle: population, intervention, comparator, and outcome. Search evaluation and the assessment of the risk of bias (RoB) were undertaken in each study following its type and design.

Results:

Thirteen studies were included for qualitative analysis, with a low to moderate RoB. Ten studies used only heavy conventional palatal anchorage such as a fixed trans palatal arch (TPA), while one study used skeletal anchorage to manage the orthodontic traction of impacted maxillary canines. Two studies compared trans palatal arch and mini-screws efficiency to treat impacted maxillary canines.

Conclusion:

Studies proved that the trans palatal arch (TPA) presents a particular anchorage unpredictability in the sagittal, transversal, and vertical dimensions. Whereas, anchorage management using mini-screws proved to be very beneficial clinically; however, further studies must be implemented to evaluate the 3D efficacy of skeletal anchorage to place an impacted maxillary canine to its rightful position into the arch.

Investigation of the relationship between maxillary dimensions and labial and palatal maxillary impacted canines using cone beam computed tomography

OBJECTIVES

To compare the maxillary dimensions of individuals with labial and palatal bilateral maxillary canine impaction and a control group of individuals with no impaction using CBCT.

METHODS

45 patients were included in the study with age range of 13 to 18 and consisted of 22 females and 23 males. The sample included three groups of 15 patients as the control, labial and palatal group. The measurements made on the axial and coronal planes were made on the levels of the 1st premolar and the 1st molar. Also nasal cavity and anteroposterior depth were measured.

RESULTS

The maxillary anteroposterior depth, basal first molar width, alveolar first molar and premolar width and first molar palatal vault depth of the control group were significantly higher than labial and palatal groups (p<0.05).The basal first premolar width of the control group was significantly higher than palatal group (p<0.05). The first premolar palatal vault depth and nasal cavity width of the palatal group were significantly lower than other groups (p<0.05).

CONCLUSIONS

The basal and alveolar widths associated with the molars and the palatal depths were lower in the impacted group than control group. The anatomical structures in the female patients were affected by the position of impaction to a higher extent in comparison to the anatomical structures in the male patients.

Multiple eruptive delay as a variant of primary eruption failure. A preliminary case report

Primary failure of eruption (PFE) is an autosomal disease that occurs in approximately 0.06% of the population and is defined as the malfunction of dental eruptive mechanisms with delay and absence of these processes in a non-ankylosed tooth. Treatment options for patients with eruptive delays range from prosthetic to surgical interventions. Although this condition is relatively rare, the occurrence of eruptive disorders in clinical dental practice is becoming more frequent. Correct diagnosis of this eruptive anomaly plays an essential role in treatment planning. The aim of this case report was to describe the treatment of a case of multiple PFE with a biomechanical approach to extrusive traction using NiTi closed coil springs and a customized rigid anchorage. In conclusion, complex orthodontic cases with eruptive delay and variants of PFE can be successfully intervened to make morphologically and functionally compromised dental organs viable, if diagnosed and treated in a timely and preventive manner by a multidisciplinary approach using alternative biomechanics for efficient osteogenic traction.

Three-dimensional changes in root angulation of buccal versus palatal maxillary impacted canines after orthodontic traction: A retrospective before and after study

INTRODUCTION

The aim of this study was to three-dimensionally compare the root angulation changes after orthodontic traction of buccally versus palatally maxillary impacted canines (MICs).

MATERIAL AND METHODS

This retrospective study included patients from a private dental office of both sexes, older than 12 years, with at least one unilateral or bilateral buccal or palatal MIC, no loss of permanent teeth, with complete apical closure at the beginning of traction, and with CBCTs taken at pretreatment (T₀) and after orthodontic traction (T₁). The sample was divided in two groups according to their impaction site: buccal versus palatal. In all the scans, the MIC was segmented and the root angulation changes after traction were evaluated. The assessment included the sigma angle (projected on the XZ plane or coronal tomographic view), the delta angle (projected on the XY plane or axial view) and the epsilon angle (projected on the YZ plane, or sagittal view). Intragroup comparisons were performed with Wilcoxon signed-rank tests. Intergroup comparisons were performed with t-tests or Mann-Whitney U tests. Finally, the influence of MIC characteristics on the measured angles were evaluated with multiple linear regression analyses (α=0.05).

RESULTS

Thirty-three patients (16 men, mean age: 20.38; 17 women, mean age 18.37) with forty-five orthodontically treated MIC (19 buccal versus 26 palatal) were finally included. The palatal MICs showed greater mediolateral uprighting than the buccal MICs, root displacement towards the midsagittal plane, as demonstrated by the sigma angle (palatal group: 37.58±15.08°; buccal group: 29.17±31.15°; P=0.164) and delta (palatal group: -76.90±26.55°; buccal group: -30.56±41.67°; P<0.001)angle changes. The buccal MICs showed greater anteroposterior uprighting, anterior root displacement, as demonstrated by the epsilon angle (palatal group: -4.63±12.37°; buccal group: -25.96±17.79°; P<0.001).

CONCLUSIONS

Mediolateral and anteroposterior root angulation show significant differences after traction between buccal and palatal MICs. Palatal MICs showed greater medial root displacement while buccal MICs showed greater anterior root displacement. This condition should be considered for better planning of traction and orthodontic finishing.