Closed-eruption surgical technique for impacted maxillary incisors: a postorthodontic periodontal evaluation

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

OBJECTIVE

To compare the 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.

Effectiveness and side effects of orthodontic traction of impacted maxillary incisors in a labially inverted position: A systematic review

INTRODUCTION

Treatment of impacted upper incisors in a labially inverted position is challenging for orthodontists, and its prognosis has not been established in the literature. Thus, this systematic review aimed to determine the effectiveness and side effects of orthodontic traction of impacted maxillary incisors in a labially inverted position.

METHODS

A comprehensive search was conducted in multiple databases, including MEDLINE (via PubMed), Scopus, Embase, Science Direct, and LILACS, up to June 30, 2024. Initially, 1640 articles were identified, and after applying specific selection criteria, 11 articles were selected for full-text evaluation. Following the review, only six studies were deemed relevant, comprising one before-and-after study, two longitudinal retrospective studies, and three cross-sectional studies. Newcastle-Ottawa and Risk of Bias (ROB-2) tools were used to assess the risk of bias in the selected studies.

RESULTS

The average duration of traction for maxillary labially inverted impacted central incisors ranged from 8.60±1.26months to 18±6.0months, with all cases being successfully treated. Following traction, the clinical crown height of the incisors was significantly higher compared to the control group (P<0.01). Similarly, the root length of the impacted incisors after traction was shorter in the impaction group (approximately 2mm) compared to the control group. Likewise, the thickness of the alveolar bone varied among different studies. Some authors noted that the treatment group had a smaller thickness (about 0.5mm) compared to the control group (P<0.05), while other authors found similar thickness after treatment.

CONCLUSIONS

Although there are few reported studies with a low risk of bias, it is clear that it is possible to successfully treat labially inverted impacted maxillary central incisors with apparently few side effects. Following traction, the clinical crown height of these incisors increased, while the root length was shorter than their normally erupted contralateral teeth.

Radiographic assessment and management of two deeply and horizontally impacted maxillary central incisors: A clinical case report

This case report describes the treatment of a 9-year-old boy with impacted maxillary central incisors due to 2 supernumerary teeth. A sequential approach comprising of surgical removal of the supernumerary teeth and 2 stages of surgical exposure and orthodontic traction of the impacted teeth resulted in correct repositioning of incisors. Close monitoring and multidisciplinary cooperation during various stages of treatment led to a successful esthetic outcome, with optimal periodontal health and functional occlusion.

Unconventional Dental Implant Placement Through an Impacted Maxillary Central Incisor in Stable Contact With Enamel and Dentin: A Case Report

When edentulism is accompanied by an impacted tooth, conventional treatment usually involves traumatic tooth extraction, which would inevitably destroy the surrounding alveolar bone and cause unfavorable esthetics, especially for anterior teeth. Recently, implant placement through the impacted tooth or residual root has been proposed as an alternative to invasive extraction. A particular type of integration has been observed between dentin/cementum and titanium implant, while enamel-implant contact has not been reported. In this article, an implant was placed through the impacted maxillary central incisor, thereby avoiding an invasive extraction surgery. The buccal section of the tooth, including crown enamel, was retained in situ for buccal alveolar ridge preservation. The follow-up results were satisfactory, and a stable enamel-implant contact was observed. Combining with previous similar studies, this technique opens intriguing possibilities and brings fresh insight for the concept of dentointegration. More histological and clinical studies with long-term follow-up are warranted before endorsing this technique in routine application.

Morphometric evaluation of alveolar bone after orthodontic treatment of multiple impacted teeth in the unilateral maxillary anterior region

INTRODUCTION

This study aimed to investigate the height and thickness of alveolar bone by cone-beam computed tomography imaging after orthodontic treatment in the unilateral maxillary anterior region and speculate on reasons for the difference in alveolar bone morphology.

METHODS

This study selected 11 patients (3 males and 8 females; mean age, 9.42 ± 1.45 years). Cone-beam computed tomography was performed for these 11 patients before and after treatment using Dolphin Imaging software (Dolphin Imaging and Management Solutions, Chatsworth, Calif). Labial and palatal alveolar bone thickness (BT) at root apices and different levels along the roots and loss of alveolar bone height was measured for each impacted tooth and its contralateral homonymous tooth.

RESULTS

After orthodontic therapy, all 3 impacted anterior teeth had different degrees of loss of labial alveolar bone height compared with the normal side (central incisor: -1.5 mm, P <0.005; lateral incisor: -1.06 mm, P <0.01; canine: -0.59 mm, P < 0.01). The lateral incisors also showed palatal alveolar bone height loss compared with the unaffected side (-0.8 mm, P <0.005). Alveolar BT at root apices of impacted canines was 1.14 mm thicker than the normal side (P <0.005). Central and lateral incisors were similar to the normal side. The thickness of the alveolar bone at 8, 10, and 12 mm of the impacted canine position was still larger than that on the healthy side, whereas the difference in average thickness between the healthy and affected side had been significantly reduced compared with pretreatment measurements.

CONCLUSIONS

There is satisfactory retention of alveolar bone height in canines after orthodontic treatment; however, alveolar bone loss is slightly worse at central and lateral incisors. Retention of alveolar BT was normal for impacted anterior teeth, whereas excess apical alveolar BT at the canines, although still present, was substantially less significant than had been observed before treatment.

Retrospective evaluation of traction time for impacted dilacerated maxillary central incisors in mixed dentition

PURPOSES

This study aimed to contribute to understanding the factors affecting the time of traction treatment of impacted dilacerated maxillary central incisors.

METHODS

This retrospective study included children aged 8 - 11 years with a history of trauma, who applied to the pediatric dentistry clinics of Marmara University, School of Dentistry, between December 2013 and December 2019, and were treated for unilateral impacted dilacerated maxillary upper central incisors. Children's age, sex, digital panoramic radiographs, cone-beam computed tomography, and intraoral photographs were retrieved from electronic dental health records. The effects of children's age, sex, the direction of impacted teeth, distance of the teeth to the top of the alveolar crest, and root dilaceration level on traction time were analyzed by Mann-Whitney U test and Spearman's rank correlation coefficient test.

RESULTS

The inverse position of the incisors significantly increased the traction time (P = 0.012). However, the traction time did not differ according to the sex of the children (P = 0.707) or the level of root dilaceration (P = 0.429). No correlation was observed between the traction time and the age of children (P = 0.644) or the distance of the incisors from the top of the alveolar crest (P = 0.397).

CONCLUSIONS

In cases of the forced eruption of for the impacted dilacerated maxillary central incisors, the direction of the teeth should be evaluated when deciding on the treatment plan, as it may affect the treatment time.

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.

Comparison of spontaneous eruption and modified closed eruption technique with palatal traction in alignment of impacted maxillary central incisor teeth

BACKGROUND

Central incisor impaction is a rare condition with potentially severe clinical and psychological implications for the patient. Treatment techniques vary according to the pretreatment situation and individual factors. The aim of this study was to compare the esthetic outcomes and treatment times between two different approaches.

MATERIALS AND METHODS

In this retrospective study, thirty-one consecutive patients (13 boys, 18 girls; average age 9.5 ± 2.3 years) with a total of 34 impacted permanent upper central incisors were included in the study. Patients were divided into two groups according to method of treatment. Group A comprised patients in whom spontaneous eruption occurred after space opening (n = 12), and Group B comprised patients in whom teeth showed no eruption and required treatment with a modified closed eruption method with palatally oriented traction (n = 19). Treatment time and esthetic outcomes were assessed and compared between groups.

RESULTS

The mean treatment time was 22.0 ± 6.7 months, and all teeth were successfully aligned. No statistically significant difference in average treatment time was found between groups in baseline characteristics (p > 0.05). The amount of attached gingiva was significantly smaller when compared to contralateral reference teeth in the closed eruption group (Group B; p = 0.03). However, no difference in amount of attached gingiva was found between both groups (p = 0.26). Additionally, no difference in the clinical crown length was found between groups (p = 0.27).

CONCLUSION

The closed eruption method with palatal traction directed at the peak of the alveolar crest provided results comparable to the physiologic tooth eruption.

Interventions to facilitate the successful eruption of impacted maxillary incisor teeth due to the presence of a supernumerary: A systematic review and meta-analysis

INTRODUCTION

A failure of maxillary incisor eruption is commonly attributed to the presence of a supernumerary tooth. This systematic review aimed to assess the percentage of impacted maxillary incisors that successfully erupt after surgical removal of supernumerary teeth with or without other interventions.

METHODS

Systematic literature searches without restrictions were undertaken in 8 databases for studies reporting any intervention aimed at facilitating incisor eruption, including surgical removal of the supernumerary alone or in conjunction with additional interventions published up to September 2022. After duplicate study selection, data extraction, and risk of bias assessment according to the risk of bias in nonrandomized studies of interventions and Newcastle-Ottawa scale, random-effects meta-analyses of aggregate data were conducted.

RESULTS

Fifteen studies (14 retrospective and 1 prospective) were included with 1058 participants (68.9% male; mean age, 9.1 years). The pooled eruption prevalence for removal of the supernumerary tooth with space creation or removal of the supernumerary tooth with orthodontic traction was significantly higher at 82.4% (95% confidence interval [CI], 65.5-93.2) and 96.9% (95% CI, 83.8-99.9) respectively, compared with removal of an associated supernumerary only (57.6%; 95% CI, 47.8-67.0). The odds of successful eruption of an impacted maxillary incisor after removal of a supernumerary were more favorable if the obstruction was removed in the deciduous dentition (odds ratio [OR], 0.42; 95% CI, 0.20-0.90; P = 0.02); if the supernumeraries were conical (OR, 2.91; 95% CI, 1.98-4.28; P <0.001); if the incisor was in the correct position (OR, 2.19; 95% CI, 1.14-4.20; P = 0.02), at the level of the gingival third (OR 0.07; 95% CI, <0.01-0.97; P = 0.04) and had incomplete root formation (OR, 9.02; 95% CI, 2.04-39.78; P = 0.004). Delaying removal of the supernumerary tooth 12 months after the expected eruption time of the maxillary incisor (OR, 0.33; 95% CI, 0.10-1.03; P = 0.05) and waiting >6 months for spontaneous eruption after removal of the obstacle (OR, 0.13; 95% CI, 0.03-0.50; P = 0.003) was associated with worse odds for eruption.

CONCLUSIONS

Limited evidence indicated that the adjunctive use of orthodontic measures and removal of supernumerary teeth might be associated with greater odds of successfull impacted incisor eruption than removal of the supernumerary tooth alone. Certain characteristics related to supernumerary type and the position or developmental stage of the incisor may also influence successful eruption after removal of the supernumerary. However, these findings should be viewed with caution as our certainty is very low to low because of bias and heterogeneity. Further well-conducted and reported studies are required. The results of this systematic review have been used to inform and justify the iMAC Trial.

Orthodontic management of a horizontally impacted maxillary incisor in an adolescent patient

Horizontal maxillary incisor impaction is not common, but it affects facial esthetics, phonetics, and the patient's self-esteem. Therefore, it is necessary to manage this problem as early as possible. This case report presents a patient with an unerupted maxillary left central incisor combined with anterior and left posterior crossbite, edge-to-edge overbite on the right and left anterior open bite, low smile line, and mild skeletal Class III discrepancy. The treatment consisted of 3 stages: (1) maxillary expansion and sufficient space creation for the impacted tooth; (2) surgical exposure by closed-eruption technique; and (3) induced eruption of impaction. The treatment outcome was highly favorable. Maxillary impaction erupted in the proper position with a normal clinical crown height and consonant gingival line with the adjacent teeth. Maxillary and mandibular teeth had normal and stable occlusion. The 3-year follow-up demonstrated an esthetically functional outcome after orthodontically induced tooth eruption. This treatment required a good treatment plan by the orthodontist to obtain satisfactory results.

Periodontal status of maxillary central incisors after orthodontic traction: a longitudinal follow-up

BACKGROUND

The aim of this study was to evaluate the clinical and radiographic periodontal status of impacted permanent maxillary central incisors (Mx.1) after a long term of orthodontic traction.

METHODOLOGY

This split-mouth study evaluated a sample of 11 patients (five females, six males) treated with Mx.1 unilateral traction one to 28 years after the removal of orthodontic appliances. The traction Group (TG) consisted of 11 Mx.1 and the Comparison Group (CG) comprised 11 spontaneously erupted contralateral Mx.1. High-resolution CBCT exams of central incisors were performed using Accuitomo (J. Morita, Kyoto, Japan). Cross-section imagens passing through the center of maxillary central incisors were used to measure buccal and lingual alveolar bone level. Presence of fenestration, root dilacerations, root coverage, and position of the root apex were also assessed in the same images. Clinical parameters included periodontal probing depth, attachment level, gingival bleeding index, plaque index, degree of gingival recession, amount of gingival mucosa, and evaluation of interproximal papilla and black triangle. Digital model analysis included an assessment of clinical crown height and width. Intergroup comparisons were performed using paired t-, McNemar's, and Wilcoxon tests (p<0.05).

RESULTS

Compared to CG, we found a significantly thinner labial bone plate thickness in TG at the middle (p=0.000) and apical (p=0.009) root level. We also observed an apical displaced labial bone crest level in TG (p=0.000). The Traction Group showed a greater frequency of root dilacerations and gingival recessions, a decreased amount of keratinized mucosa, and a decreased clinical attachment level at the labial aspect compared to contralateral teeth.

CONCLUSIONS

A decreased thickness and height of labial alveolar bone and gingival recessions were found in maxillary central incisors 15 years after orthodontic traction. Though incisor traction might cause some periodontal impact, differences are acceptable under a clinical point of view considering the cost-benefit ratio.

Impacted Central Incisors in the Upper Jaw in an Adolescent Patient: Orthodontic-Surgical Treatment—A Case Report

The inclusion of both maxillary permanent central incisors is uncommon. This condition compromises face aesthetics, phonation and masticatory function. Therefore, early diagnosis is essential to avoid complications and failures. There are various reasons for inclusion, but supernumerary teeth are the leading cause. Early causes of removal and rapid expansion of the palate determine a high probability of success with the spontaneous eruption of the impacted elements. However, it is often necessary to proceed with a surgical–orthodontic treatment. The inclination of teeth in relation to the midline and the root maturation degree determine prognosis and therapeutic timing. In this case report, the orthopantomogram (OPG) X-ray of a 9-year-old boy revealed two impacted supernumerary teeth in the anterior maxillary region, preventing the eruption of the permanent upper central incisors. The impacted supernumerary teeth were surgically removed at different times. A straight wire multibrackets technique associated with a fixed palatal appliance was used. The palatal appliance featured an osteomucous resin support at the level of the retroincisal papilla. Subsequently, surgical exposure was carried out using the closed eruption technique and elastic traction, bringing 11 and 21 back into the arch.

Treatment of impacted canines with aligners: An alternative and viable option

To recover impacted canines without esthetic issues, the aligners can be a resolutive tool allowing by pontics the camouflage of absent canines during orthodontic treatment. Knowledge of biomechanics, correct staging of dental movements, and surgery planification are strategic to achieve a good result.

The VISTA Approach in Canine Disimpaction

Canine disimpaction is always a challenging orthodontic treatment overall, even when the impacted permanent canine is in a high position, especially when in tight relation with the upper incisors’ roots. Conventional treatment methods are usually not capable of performing the correct force direction, consisting of the contemporary movement in the distal and vestibular directions of the canine crown, often provoking, as side effects, the presence of decubitus on the mucous of the lips and cheeks or a poor final appearance of the periodontal support of the disimpacted canine. Among the different approaches, the vertical incision subperiosteal tunnel access (VISTA) technique shows good performance with regard to the direction of the forces and the canine’s periodontal conditions when erupted; it is usually realized through an elastic chain connected to a temporary anchorage device (TAD) in the posterior area. In this paper, a different protocol for the VISTA method is also presented, to be resorted to in cases of difficult miniscrew positioning due to the anatomic conditions or stage of dentitions. The new protocol also considers the use of nickel–titanium coil springs in order to avoid the need of frequent reactivation of the device and consequent patient discomfort, highlighting its advantages and indications with respect to the traditional approach.

Post-Treatment Status of Impacted Maxillary Central Incisors following Surgical-Orthodontic Treatment: A Systematic Review

Background and Objectives: The aim of this systematic review was to summarize currently available data of published articles that have investigated the post-treatment status of impacted maxillary central incisors (ICI) treated by the surgical-orthodontic approach. Materials and Methods: MEDLINE, Scopus, Cochrane Oral Health Group’s Trials Register, and ScienceDirect electronic databases were systematically searched with no publication date restrictions up to January 2021. Data assessing the status of ICI after combined surgical-orthodontic treatment and forced eruption duration were extracted, and the quality of the studies was evaluated. Results: In total, 7074 studies were identified, of which 42 articles were assessed for eligibility through full-text evaluation. Seven included studies (five retrospective studies, one randomized clinical trial, and one prospective clinical trial) met the inclusion criteria, representing 211 patients with unilaterally impacted maxillary incisors. The risk of bias ranged from moderate to high. The results show that the root length of immature ICIs increased significantly but remained shorter than that of homonym teeth at post-treatment. Periodontal parameters of treated ICIs were in a clinically acceptable range. Measurements of the alveolar bone showed a reduction of bone thickness and support. The average forced eruption duration ranged from 8.0 ± 4.5 to 14.41 ± 4.03 months. Conclusions: Based on existing evidence, it is reasonable to conclude that the surgical-orthodontic treatment affected the post-treatment status of ICI; however, the current literature is insufficient to draw concrete conclusions. Further well-conducted multi-center randomized studies with a large sample are needed to confirm this statement.

Periodontal implications of surgical-orthodontic treatment of an impacted dilacerated maxillary incisor: A case report with a 2-year follow-up

The treatment of an 8-year-old girl with a dilacerated maxillary incisor began in the mixed dentition; a modified palatal arch attached to the molars served as anchorage for the forced eruption of the dilacerated tooth to prevent the intrusion of the adjacent teeth and reduce the risk of root resorption. Two surgical sessions were planned: the first to permit the closed eruption; the second was an apically positioned flap to add attached gingiva to the labial side of the erupting tooth. The result was an optimal periodontal outcome; moreover, the roots of the adjacent teeth did not show any sign of resorption at the end of the forced eruption. The tooth was vital at the end of the treatment, and the apex covered by alveolar mucosa. The root developed normally throughout the treatment, and the periodontium was healthy and esthetically acceptable at the 2-year follow-up. Further study is needed to assess the advantages of the combined surgical-orthodontic treatment.

National clinical guidelines for the management of unerupted maxillary incisors in children

This article summarises recently updated guidelines produced by the Clinical Governance Directorate of the British Orthodontic Society through the Clinical Standards Committee of the Faculty of Dental Surgery, Royal College of Surgeons of England (FDSRCS) on the management of unerupted maxillary incisor teeth in children. The maxillary incisor teeth usually erupt in the early mixed dentition but eruption disturbances can occur and are often attributable to local factors. A failure of eruption will affect the developing occlusion and potentially influence psychological development of the child. The general principles of management for delayed eruption or impaction of these teeth is to ensure that adequate space exists in the dental arch and to remove any obstruction to eruption. Consideration should also be given to further promoting eruption through surgical exposure of the incisor, with or without subsequent orthodontic traction. A number of factors influence the decision-making process, including patient age, medical history, potential compliance, aetiology and position of the unerupted incisor. Treatment planning should be complemented by careful clinical assessment and the use of appropriate special investigations. To optimise the treatment outcome a multidisciplinary specialist approach is recommended.

Alveolar Bone and Epithelial Attachment Status following Two Different Closed-eruption Surgical Techniques for Impacted Maxillary Central Incisors

Aim

Two eruption surgical techniques are commonly described for the treatment of upper impacted central incisors (ICIs): Open and closed. Currently, the closed-eruption surgical technique (CEST) is the most commonly used, as it allows for the best esthetic and periodontal results.

The aim of this study was to determine the effect of traction discontinuation on maxillary central incisor sulcal depth and alveolar bone ridge levels compared with contralateral incisors, when CEST is used.

Materials and methods

Our study involved 28 unilateral impacted maxillary central incisors treated by CEST. Thirteen teeth were subjected to traction interruption for a month at the time of emergence of the crown, while 15 teeth underwent continuous traction. One year after treatment, periapical digital X-rays, anterosuperior cone beam computerized tomography (CBCT) scanning, and periodontal probing of the ICIs and contralateral central incisors (CCIs) were performed. Student’s t-test was used to study whether a statistically significant difference between continuous and interrupted tractions takes place while using the CCI measurements as reference.

Results

There was a statistically significant difference between the two techniques only for the following measurements: Mesial probing (p-value 0.039352), labial bone level (p-value 2.58E-08), and palatal bone level (p-value 2.56E-06).

Limitations

A larger sample size and longer term follow-up are needed to draw more robust conclusions.

Conclusion

A temporary discontinuation during traction of the tooth appears to positively impact treatment outcome on ICIs.

Clinical significance

• The CEST leads to the best periodontal status for ICIs.

• The discontinuation of traction at the emergence of the tooth allows the supracrestal fibers to insert into the cement in a proper way.

How to cite this article: Sfeir E, Gholmieh M, Skaf Z, Mourad A. Alveolar Bone and Epithelial Attachment Status following Two Different Closed-eruption Surgical Techniques for Impacted Maxillary Central Incisors. Int J Clin Pediatr Dent 2018;11(4):317-322.

Does muscular activity related to vertical facial divergence influence the time needed for orthodontic extrusion of palatally impacted maxillary canines? A retrospective study

Background

The aim of the present study was to evaluate if the different muscular activity correlated to different degrees of facial divergence has an effect on the time needed to extrude a palatally impacted maxillary canine.

Material and Methods

Twenty-six patients were retrospectively selected, all treated with a specific cantilever appliance that allows extrusion of the impacted canine applying a physiologic amount of force below 0.6 N in a predictable way. For all the patients, pre-treatment cephalometric tracings were used to evaluate facial divergence through the FMA angle, the angle between the maxillary and mandibular plane, and the angles between the occlusal plane and either the maxillary and mandibular plane. Linear bivariate regression was calculated to evaluate if facial divergence can predict the time needed for canine extrusion.

Results

The linear regression model was not able to predict extrusion time from variables explaining the facial divergence.

Conclusions

Palatally impacted maxillary canines can be treated with the application of physiologic extrusion force regardless of patients’ facial divergence and muscular activity.

Key words:Impacted canines, cantilever, facial divergence, muscular activity.

Retrospective evaluation of treatment time and efficiency of a predictable cantilever system for orthodontic extrusion of impacted maxillary canines

INTRODUCTION

Orthodontic extrusion of impacted maxillary canines requires careful biomechanical planning and the use of physiologic force. The aim of this study was to evaluate the time needed for orthodontic extrusion of impactions of different severities, using a device that can predictably apply forces under 0.6 N.

METHODS

Twenty-two patients who were consecutively treated were selected retrospectively, and a total of 30 impacted canines were studied. Indexes of impaction were used to measure severity on pretreatment panoramic radiographs. Statistical analysis was used to detect interactions between treatment time, complexity of impaction, age, and sex.

RESULTS

Treatment time was highly dependent on the patient's age; the shortest treatment time was observed in 11- to 12-year old patients. On the other hand, the severity of impaction had no effect on treatment time.

CONCLUSIONS

Applying physiologic force with the proposed device resulted in a short treatment time, which depended on the patient's age more than the impaction complexity. Few complications were associated with use of this device. Future prospective studies are needed to replicate these findings and confirm the recommended use of this device.

Review of Dilaceration of Maxillary Central Incisor: A Mutidisciplinary Challenge

Traumatic injuries to primary dentition may interfere with the development of permanent dentition. Among the many malformations, dilaceration is particularly important to the clinician. Management of dilacerated maxillary central incisor requires a multidisciplinary approach. The main purpose of this review is to present the etiological factors, the mechanism, clinical features, radiographic features and treatment of dilaceration of the maxillary central incisors. How to cite this article: Walia PS, Rohilla AK, Choudhary S, Kaur R. Review of Dilaceration of Maxillary Central Incisor: A Multidisciplinary Challenge. Int J Clin Pediatr Dent 2016;9(1):90-98.

What Are the Histologic Effects of Surgical and Orthodontic Treatment on the Gingiva of Palatal Impacted Canines?

PURPOSE

To histologically evaluate changes in the marginal gingiva of palatal impacted maxillary canines after surgical exposure and orthodontic treatment.

MATERIALS AND METHODS

A prospective case-and-control study was conducted of 10 patients presenting with bilateral palatal impaction of the maxillary canines. All patients underwent surgical exposure of the impacted canines with an open-window technique, which was followed by orthodontic treatment to achieve proper arch alignment. Once the treatment was finalized, 4 samples of marginal gingival tissue from each patient were taken for histologic study. The 4 samples consisted of 1 from each of the repositioned maxillary canines (case teeth) and 1 from each of their respective adjacent first premolars (control teeth).

RESULTS

Histologic examination of the case teeth tissue samples showed microscopic changes mainly in the nonkeratinized epithelium and connective tissue, whereas changes in the keratinized epithelium remained minimal. The control teeth showed a greater inflammatory reaction in the nonkeratinized epithelium.

CONCLUSION

Orthodontic treatment of impacted maxillary canines used in conjunction with an open-window surgical technique results in predictable orthodontic eruption with few periodontal discrepancies of the marginal gingiva compared with their adjacent first premolars.

Εvaluation of a treatment protocol for unerupted maxillary central incisors: retrospective clinical study of 46 children

AIM

To evaluate the clinical outcome of a treatment protocol performed in children with unerupted permanent maxillary central incisors, including surgical removal of any related obstruction and traction initiation in one stage, under fully repositioned flap, combined with pre- and post-operative orthodontics for space creation and final alignment.

METHODS

Forty-six patients aged 7.3-12.7 years (mean = 9.44 ± 1.36) having 54 impacted maxillary central incisors were reviewed. The study group included 37 patients fully treated by us and nine referrals with eruption failure of impacted incisors following previous surgical removal of various obstructions. Detailed patient's clinical and radiographic data were recorded.

RESULTS

Aetiology of unerupted incisors included 9 patients with odontomas, 24 with supernumerary teeth, 1 with skeletal lack of space, 1 with a dentigerous cyst, 4 with dilaceration, 1 with severe incisor MIH, 5 with luxation injuries to primary predecessors and 1 with coexisting dilaceration and odontoma. The total treatment time following the standardised protocol ranged from 5 to 21 months (mean 9.88 ± 3.10), while the time needed using different approaches (no pre-operative orthodontics or obstruction removal and then to wait over an assessment period) ranged from 12 to 18 months (mean 15 ± 2.12) and 17 to 30 months (mean 23.73 ± 5.14), respectively (p < 0.05). The time needed for full alignment depended on the inclination, the height of the impacted tooth (p = 0.001) and the patient's age (p = 0.002). Additionally, the absence of pre-operative orthodontics for space creation dramatically increased treatment time (p = 0.018). In contrast, the maturity of the impacted tooth and the developmental stage of the anterior teeth did not affect treatment time. Finally, when the location of the impacted tooth and the space availability allowed waiting for spontaneous eruption, treatment time was not statistically different from that of the main treatment protocol (p = 0.545).

CONCLUSIONS

The studied treatment protocol appears ideal for successful results and minimum treatment time. Space creation followed by surgical removal of any obstruction together with orthodontic traction initiation produces excellent results, while waiting for spontaneous eruption is indicated only in cases of favourable patient's age and tooth location. Treatment initiation with operation in the absence of the required eruption space is not recommended, whereas in unfavourable cases obstruction removal without simultaneous orthodontic traction increases dramatically the total treatment time and requires an unnecessary second operation for traction.

Orthodontic traction in a patient with cleidocranial dysplasia: 3 years of follow-up

This case report describes the treatment and long-term follow-up care of a patient diagnosed with cleidocranial dysplasia who had multiple impacted permanent and supernumerary teeth. The aim of the treatment was to provide an adequate esthetic and functional reconstruction of the occlusion with good periodontal care. The patient was treated with a multidisciplinary therapeutic protocol including orthodontic and surgical procedures, and traction of 11 permanent teeth. The proposed objectives of good occlusion, normal function, healthy periodontium, and balanced profile were achieved, and the 3-year follow-up records showed stable results.

Clinical recommendations for management of mesiodens and unerupted permanent maxillary central incisors

BACKGROUND

Un-erupted maxillary incisors may result secondary to supernumerary teeth. Despite the removal of such mesiodentes, orthodontic traction of a permanent un-erupted maxillary incisor may be required.

REVIEW

The literature regarding the impacted maxillary central incisor(s) was reviewed and all pertinent publications on the subject assessed. The review specifically relative to mesiodentes, surgical exposure and orthodontic management was interpreted together with the clinical experience of a number of the authors' cases. From this analysis a set of recommendations was developed.

RECOMMENDATIONS

(1) A sufficient arch space has to be ensured or orthodontically created for permanent maxillary central incisor(s). (2) Early surgical extraction of a mesiodens or mesiodentes (ideally before 7 years of age), with simultaneous closed surgical exposure of the permanent impacted maxillary incisor with bonding of an attachment with gold chain. (3) Re-evaluation after 2-3 months to assess for any natural eruption of the maxillary central incisor. (4) Application of orthodontic traction in the event of non-eruption.

CONCLUSION

Early diagnosis of the presence of mesiodentes is imperative. Appropriate surgical and/or orthodontic traction is often indicated with regular post-surgical follow-up assessments.

Radiographic assessment of maxillary incisor position after rapid maxillary expansion in children with clinical signs of eruption disorder

BACKGROUND AND OBJECTIVE

In this study we assessed the influence of rapid maxillary expansion (RME) on the intraosseous vertical position and inclination of the impacted incisors diagnosed at an early developmental stage on panoramic radiographs and subsequently treated by surgical removal of the obstacle.

MATERIALS AND METHODS

Following surgical removal of the obstacles to incisor eruption (T1), a group of 34 subjects (mean age 8 years 11 months ± 11 months) underwent RME, while a group of 28 subjects (mean age 9 years 1 month ± 1 year) was monitored after surgery without further treatment. At T2 (on average 10 months after T1), the prevalence rate of subjects with erupted incisors was recorded. The measurements were taken on the panoramic radiographs at T1 and T2 to assess the vertical position and angulation of delayed unerupted incisors.

RESULTS

At T2, impacted incisors erupted in 82.4% of the patients in the RME group versus 39.3% of those in the monitored group (χ(2) =8.45, p<0.001). All the patients treated with RME showed an improvement in the vertical and angular position of the unerupted teeth. Logistic regression revealed RME therapy as the only significant predictive variable (p<0.001) for successful eruption of the delayed incisors at T2.

CONCLUSION

RME in early mixed dentition appears to be an effective procedure to increase the prevalence rate of impacted maxillary incisor eruption.

Correction of bilateral impacted mandibular canines with a lip bumper for anchorage reinforcement

Multiple treatment options are available to patients with impacted manibular canines in addition to a retained deciduous canine. This article describes the treatment of a prepubertal girl, aged 10 years 6 months, with a skeletal Class I, dental Class II Division 1 malocclusion, retrognathic mandible, deep overbite, proclined maxillary incisors, midline diastema, and bilateral mandibular canine impaction. The orthodontic treatment plan included extraction of the deciduous canine and forced eruption of the impacted canines. A modified lip bumper appliance was used both for forced eruption and to reinforce anchorage. Through the collaborative efforts of an orthodontist and an oral surgeon, an excellent esthetic and functional outcome was achieved.

Multiple supernumerary teeth associated with an impacted maxillary central incisor: Surgical and orthodontic management

Various anomalies in the size, shape, number, structure and eruption of the teeth are often observed clinical conditions. Supernumerary teeth can be found in almost any region of the dental arch, and most of the times they are asymptomatic, and are routinely found during radiographic evaluation. The most common cause of impacted maxillary incisors is the presence of the supernumerary teeth. This paper describes a case of multiple supernumerary teeth associated with an impacted permanent maxillary central incisor in an 11-year old child along with its surgical and orthodontic management.

Strategies for treating an impacted maxillary central incisor

Impaction of a central maxillary incisor is relatively rare and, consequently, poses all the more problems to the diagnosing practitioner. The etiology, when known, can implicate the presence of an obstacle hindering eruption or a trauma to the temporary dentition. Central incisor impaction is revealed during routine examination or following concern on the part of parents who have noticed that a tooth is missing on the arch. When confronted with this anomaly, the practitioner should determine the precise position of the unerupted tooth and offer a customized treatment protocol. Whenever possible, orthodontic-surgical placement on the arch is the solution of choice. In all cases, the esthetic and functional issues at stake will oblige the various specialists to choose their treatment with caution and to follow the treatment plan very strictly. These different requirements must form part of a customized multidisciplinary treatment strategy.

Treatment of a horizontally impacted mandibular canine in a girl with a Class II Division 1 malocclusion

When a patient has an impacted tooth, the timing of orthodontic treatment, the type of surgical procedure to expose the tooth, the orthodontic mechanics, and the potential problems vary depending on which tooth is impacted and its position in the jaw. This case report describes the successful treatment of a patient with a horizontally impacted mandibular canine. The impacted tooth was surgically exposed and then moved into its normal position in the dental arch, combined with correction of a Class II Division 1 malocclusion.

Impacted maxillary central incisor, canine, and second molar with 2 supernumerary teeth and an odontoma

This report describes the orthodontic treatment of a 14-year-old boy who had 3 impacted maxillary teeth (right canine, left central incisor, and left second molar), 2 supernumerary teeth, and an odontoma. The treatment protocol involved surgical intervention followed by sequential traction of the 3 impacted teeth. The patient's smile dramatically improved after orthodontic treatment. Good posterior occlusion was achieved. However, long-term monitoring of the stability and periodontal health is critical.