Maxillary incisor root resorption induced by ectopic canines

Interdisciplinary management of maxillary incisors with root resorption caused by impacted canines: A case report

The aetiology of impacted canines is multi-factorial. Several theories have been proposed, such as lack of space, genetic predisposition, physical barriers like supernumerary teeth, odontomas and other conditions that interfere with the eruption pathway. One of the main complications that can be generated by impacted canines is the resorption of the root of the adjacent teeth. This case report examines the importance of interdisciplinary management of maxillary incisors with root resorption caused by impacted canines in a 13-year-old male patient. Careful traction of impacted canines and proper tissue management followed by space closure and retroclination of anterior incisors with orthodontic treatment. Finally, functional and aesthetic results using dental veneers for oral rehabilitation allowed the patient to obtain favourable results.

The effect of optimum, indication-specific imaging fields on the radiation exposure from CBCT examinations of impacted maxillary canines and mandibular third molars

OBJECTIVE

Indication-specific optimum field-of-views (FOVs) have been assessed for CBCT scans of impacted maxillary canines and mandibular third molars, as 40∅ × 35 mm and 35∅ × 35 mm, respectively. The objective was to investigate possible changes in absorbed organs and effective doses, for these two imaging indications, performing CBCT examinations with optimum FOV sizes instead of commonly used FOVs. Additionally, radiation exposure-induced cancer risk was calculated for both imaging indications with optimum FOVs.

METHODS

An adult female head phantom (ATOM 702-D, CIRS, Norfolk, VA, USA) was scanned using Planmeca Viso G7 CBCT-device (Planmeca, Helsinki, Finland). Scanning factors, different FOV sizes, dose-area product (DAP) values and anatomical FOV locations were used for Monte Carlo PCXMC-simulation and ImpactMC software. In the PCXMC- simulation, 10-year-old child and 30-year-old adult phantoms were used to estimating effective and absorbed organ doses.

RESULTS

The effective dose varied from 58 µSv to 284 µSv for impacted maxillary canines, and from 38 µSv to 122 µSv for mandibular third molars, the lowest dose value for each corresponding to optimum FOV. Effective dose reduction between the optimum FOV and the smallest common FOV of 50∅ × 50 mm, maintaining other scanning factors constant, was 33% for impacted maxillary canines, and 45% for mandibular third molars. At all examinations, the highest absorbed organ doses were in salivary glands or in oral mucosa.

CONCLUSIONS

Optimum FOVs, 40∅ × 35 mm for impacted maxillary canine and 35∅ × 35 mm for mandibular third molar, could decrease effective doses received by young patients, and improve radiation safety in these common CBCT imaging procedures.

Radiographic assessment of unerupted permanent maxillary canines and their relationship to the phases of dentition in mixed dentition Spanish children: a retrospective cross-sectional study

PURPOSE

Evaluate if there is a significant association between the position and inclination of the unerupted maxillary canine measured on a panoramic radiograph, and their relationship to gender, age of the patient and stage of dentition.

METHODS

138 panoramic radiographs were examined for this retrospective cross-sectional investigation. Only patients living in Madrid, Spain with mixed dentition were included. These measurements were performed on radiographs, considering the inclination and position of the maxillary canines with regards to the midline, and height with respect to the occlusal plane. Spearman's correlation coefficient was used to analyze the relation among the canine angle and height. p < 0.05 was considered to be significant.

RESULTS

The prevalence of patients with an altered canine angle was 10%, while 43.5% had an apparently abnormal position (overlapping at least half of the adjacent lateral incisor root). No statistically significant association was found between these two variables. In 5% of the patients, the maxillary canine was with an anomalous angle and position. Significant differences were obtained when comparing canine height between children with ectopic canines and normal canines (p = 0.032).

CONCLUSION

No significant association was found between the position and inclination of the unerupted maxillary canine in our sample. Ectopic maxillary canines had a higher incidence in girls, although we did not find statistically significant differences between genders. We observed a higher prevalence of abnormal position and inclination of the permanent maxillary canine in early mixed dentition. Maxillary canines were significantly elevated, further from the occlusal plane, in children with ectopic canines.

Root Resorptions on Adjacent Teeth Associated with Impacted Maxillary Canines

Aim: Through the use of CBCT images, many unidentified features of impacted canines can be easily resolved. The potential collision of impacted maxillary canines and adjacent teeth could lead to root resorption (RR). The aim of this study is to examine the prevalence, location and severity of RR on adjacent teeth caused by impacted maxillary canines and the association between the adjacent teeth and the features of maxillary impacted canines on CBCT. Methods: This study examined 89 subjects with 108 maxillary impacted canines, having had no previous orthodontic treatment (mean age: 18.3 ± 4.1 years). The following impacted-canine-related parameters were analyzed on the CBCT images: location; RR levels on adjacent teeth; occlusal line and midline distances of impacted canines; and the angulations of impacted canines to the midline, lateral incisor and occlusal line. Logistic regression was used to evaluate the association between RR and the measured parameters on CBCT. Results: In this study, we found that the majority of our patients with impacted maxillary canines were female (62.5%). Of the total 108 maxillary impacted canines, 60.2% resorbed the adjacent teeth of the affected quadrants. Lateral incisors were the most affected (34.3%). The mean age of subjects with RR was 16.7 ± 3.5 years. The frequency of RR was statistically significantly higher in female subjects (40.4%). Slight RR was the most frequent (30.5%) and the highest incidence noted at the apical third of the root (29.6%). Regarding the impacted maxillary canine angulation to the midline and adjacent tooth, higher values of angulation caused severe forms of RR (p < 0.05). Conclusion: The sensitivity of CBCT allows for the accurate diagnosis of the location and the degree of RR, alongside the angulation and distance of impacted canines to adjacent teeth. The association between the linear and angular features of the impacted maxillary canines and RR was confirmed.

Root Resorption of Adjacent Teeth Associated with Maxillary Canine Impaction in the Saudi Arabian Population: A Cross-Sectional Cone-Beam Computed Tomography Study

This study aimed to identify the location of root resorption in relation to an impacted maxillary canine and grade its severity using cone-beam computed tomography (CBCT) in the Saudi Arabian population. Materials and Methods: CBCT scans of 169 patients with maxillary canine impaction were evaluated. The location and the severity of root resorption of the affected tooth in relation to the impacted maxillary canine were recorded for each patient. Results: a total 204 impacted maxillary canines caused root resorption in 218 adjacent teeth. Maximum root resorption was present in 63.3% of the apical one-third of the root and 37.6% of the palatal surfaces. There was mild root resorption in 55%, moderate in 10% and severe in 35%. There was no statistically significant difference between the gender, age, type of impaction, side of impaction, and the number, location, or degree of root resorption. Multiple logistic regression models showed significant association (p = 0.024) between gender, type of impaction, and root resorption. A significant correlation was found between the level and the surface of the root resorption (p = 0.018). Conclusion: In the Saudi population, apical one-third root levels and palatal surfaces were primarily involved in root resorption caused by impacted canines. The females with bilateral canine impaction were more likely affected by root resorption.

Location and severity of root resorption related to impacted maxillary canines: a cone beam computed tomography (CBCT) evaluation

Background

The present investigation was designed to determine the location and severity of root resorption associated with impacted maxillary canine teeth using cone beam computed tomography (CBCT). A secondary aim was to identify possible influencing factors.

Methods

The radiological reports of 183 patients, radiographed with a small-volume CBCT focussed on the impacted maxillary canine teeth, were assessed. Eighty-five patients had resorption associated with the impaction. The CBCT image datasets were viewed to determine the location and severity of the lesions.

Results

A total of 110 impacted maxillary canine teeth resorbed 120 adjacent teeth, including 14 premolars and one permanent molar. The apical third and palatal surface were commonly involved. Fifty per cent of the resorptive lesions were mild, 20% moderate and 30% severe. There was no significant relation between age or gender on the number, location or severity of resorption. There was a statistically significant correlation between the number of impacted canine teeth and the number of teeth resorbed, as well as the tooth type and the surface involved in the resorption.

Conclusions

All root levels and surfaces of teeth associated with impacted maxillary canine teeth can be resorbed to different levels of severity. Neither age nor gender influences the number, location or severity of the resorption.

Orthodontic management of impacted maxillary canines

The prevalence of impacted maxillary canines is 2–3%. In Caucasian populations, it is reported to be more palatally displaced than buccally, with the opposite trend seen in Asian populations. At the ages of 9–11 years, the position of the canine germ should be diagnosed, for most children through clinical supervision. In 7–10% of children, the clinical investigation must be supplemented with radiographic investigation, in most cases with intraoral radiographs. About 50% of impacted canines cause root resorption of the adjacent teeth. To detect the severity of resorption, cone-beam computed tomography is necessary. Root resorptions on incisor roots occur most often at 11–12 years of age. Early diagnosis of ectopically positioned maxillary canines is very important. In cases with palatally displaced canines and no root resorptions, extraction of the primary canines has been found in different studies to give good results. If the permanent canine has not started to normalize its position within 12 months, orthodontic treatment must be taken in consideration. Often, this is done by surgical exposure and orthodontic traction of the canine out into the dental arch.

To what extent are impacted canines associated with root resorption of the adjacent tooth?: A systematic review with meta-analysis

BACKGROUND

The authors' aim in this systematic review was to evaluate to what extent impacted canines are associated with root resorption (RR) of the adjacent tooth by using cone-beam computed tomography.

METHODS

The authors performed an open-ended electronic search of the Cochrane Library, Latin American and Caribbean Health Sciences Literature, PubMed (MEDLINE), Scopus, and Web of Science and a partial gray literature search by using Google Scholar, Open Grey, and ProQuest. The authors included studies in people (adolescents, adults, and older adult) with impacted maxillary permanent canines in which the investigators assessed the incidence of RR in adjacent teeth. The investigators detected RR by using cone-beam computed tomography. Two reviewers independently performed the study selection, data extraction, and risk of bias assessment with no language restrictions. The selection criteria included observational studies.

RESULTS

From the 953 studies recorded in databases, the authors included 18 studies. The meta-analysis results revealed that the most frequent position of impacted canines was 56.99% palatal (95% confidence interval [CI], 47.032% to 66.673%); the apical one-third was the most prevalent one-third for RR (56.87%; 95% CI, 38.880% to 73.628%). The intensity of RR was slight (43.2%; 95% CI, 35.229% to 51.352%), although 30.9% (95% CI, 19.007% to 44.261%) of RR was severe. Although the studies had different sample sizes, the main methodological problem was the absence of a control group and follow-up.

CONCLUSIONS

RR in maxillary incisors was correlated with their contact with maxillary canines during eruption. Delayed eruption or treatment of impacted canines may lead to resorption of the adjacent lateral and central incisors. All root levels and surfaces of teeth associated with impacted maxillary canines can be resorbed to different levels of severity, but the apical one-third with slight resorption is the most common.

PRACTICAL IMPLICATIONS

Knowing to what extent impacted canines are associated with root resorption of the adjacent tooth before starting any intervention, and being able to share this information with the patient, caregivers, or caregivers and patient, allows the choice of the most appropriate treatment.

External root resorption of second molars caused by impacted third molars: an observational study in panoramic radiographs

Abstract Objective This research investigate the presence of external root resorption (ERR) in second molars caused by impacted third molars in panoramic radiographs, relating to the position of third molars according to classification of Winter, Pell and Gregory. Material and method A cross-sectional, retrospective study using panoramic radiographs obtained from January 2014 to December 2015. The inclusion criterion was the presence of a second molar adjacent to an impacted third molar. Data were analyzed using descriptive and inferential statistics. Pearson's Chi-Square Test and Fisher's Exact Test (p≤0.05) were performed. Result The sample consisted of 584 panoramic radiographs, 356 (60.95%) of women, and 228 (39.05%) of men, the mean age was 25.31 years. The prevalence of ERR was 12.5%, and the group of 14-24 year olds was the most affected (p = 0.46). The presence of ERR was statistically higher in the mandible (42.1%) with p=0.01. The ERR located in the cervical (57.1%) and medium (58.8%) thirds was proportionally higher in the teeth with B2 (p=0.02) and mesio-angular positions (p=0.26). Conclusion The prevalence of ERR in second molars, caused by impacted third molars, was shown to be similar to results found in the literature, with no gender preference, this affects young patients, occurring frequently in mandible teeth, and presents greater severity in the cervical and middle thirds. The B2 and mesio-angular positions were more prone to ERR.

Three-dimensional evaluation of angular, linear, and resorption features of maxillary impacted canines on cone-beam computed tomography

OBJECTIVES

The aim of this study was to evaluate the localization, angulation, and resorption features of maxillary impacted canines on cone-beam computed tomography (CBCT).

METHODS

This retrospective study examined the CBCT scans of 140 maxillary impacted canines in 102 patients (43 males, 59 females; mean age: 16.25 ± 6.31 years). The following impacted canine-related parameters were analyzed on the CBCT images: impaction side; location; root resorption levels of adjacent teeth; occlusal plane and midline distances of impacted canines; and angulations of impacted canines to midline, lateral incisor, and occlusal plane.

RESULTS

Bilateral canine impaction was found in 38 subjects, and unilateral canine impaction was present in 64 subjects. Severe resorption was found in 14 canines. There were no significant differences between the occlusal plane and midline distances to the impacted canine cusp tip and root apex (p > 0.05). The midline angulation of right maxillary impacted canines was significantly higher than that of left maxillary impacted canines (p < 0.05), while the occlusal plane angulation of left maxillary impacted canines was significantly higher than that of right maxillary impacted canines (p < 0.05).

CONCLUSIONS

Maxillary canine impaction was more frequently seen in female subjects than in male subjects. Lateral incisors were more frequently affected than first premolars, and slight resorption was more frequently seen in adjacent teeth. CBCT assessment of maxillary impacted canines can provide accurate measurements of angular, linear, and resorption parameters.

The Relationship between Dental Follicle Width and Maxillary Impacted Canines’ Descriptive and Resorptive Features Using Cone-Beam Computed Tomography

Objectives

To assess the relationship between dental follicle width and maxillary impacted canines' descriptive and resorptive features with three-dimensional (3D) cone-beam computed tomography (CBCT).

Methods

The study comprised 102 patients with cone-beam computed tomography 3D images and a total of 140 impacted canines. The association between maxillary impacted canine dental follicle width and the variables of gender, impaction side (right and left), localization of impacted canine (buccal, central, and palatal), and resorption of the adjacent laterals was compared. Measurements were analyzed with Student's t-test, Kruskal-Wallis test, and Mann–Whitney U statistical test.

Results

According to gender, no statistically significant differences were found in the follicle size of the maxillary impacted canine between males and females (p > 0.05). Widths of the follicles were determined for the right and left impaction sides, and no statistically significant relation was found (p > 0.05). There were statistically significant differences between root resorption degrees of lateral incisors and maxillary impacted canine follicle width (p < 0.05). Statistically significant higher follicle width values were present in degree 2 (mild) resorption than in degree 1 (no) and degree 3 (moderate) resorption samples (p < 0.05).

Conclusions

No significant correlation was found between follicle width and the variables of gender, impaction side, and localization of maxillary impacted canines. Our study could not confirm that increased dental follicle width of the maxillary impacted canines exhibited more resorption risk for the adjacent lateral incisors.

Root Resorption a 6-Year Follow-up Case Report

This paper describes the clinical course of a pediatric patient developing cervical external root resorption (CERR). An 11-year old male patient had sustained dental trauma and was diagnosed with crown fracture affecting the incisal and middle thirds of the maxillary right permanent central incisor and the maxillary right permanent lateral incisor with pulp exposure and CERR after 24 months. Diagnosis and treatment of CERR are a challenge for dental practitioners. In this case, preservation of natural dentition is shown as a successful treatment in a 6-year follow-up.

Cone beam computed tomography use in orthodontics

Cone beam computed tomography (CBCT) is widely used by orthodontists to obtain three-dimensional (3-D) images of their patients. This is of value as malocclusion results from discrepancies in three planes of space. This review tracks the use of CBCT in orthodontics, from its validation as an accurate and reliable tool, to its use in diagnosing and treatment planning, and in assessing treatment outcomes in orthodontics.