Impacted maxillary canines and root resorption of adjacent teeth: A retrospective observational study

Feasibility study of a novel digital template-guided flapless extraction for maxillary palatal impacted teeth

OBJECTIVE

With the increasing maturity of 3D printing technology, the application of digital guide template in the extraction of impacted teeth has become more sophisticated. However, for maxillary palatal deeply impacted teeth, there still exist significant clinical challenges. This experiment introduces a novel digital guide template and innovatively employs a flapless technique to explore a minimally invasive approach for the extraction of palatal deeply impacted teeth.

METHODS

This experiment included 40 patients diagnosed with palatal completely impacted teeth, randomly divided into an experimental group and a control group. The experimental group used the new digital guide template for flapless extraction, while the control group employed the traditional freehand flap technique.

RESULTS

The experimental group can significantly reduce the localization time of palatally impacted teeth (P < 0.001), with total surgery times of 18.15 ± 4.88 min and 22.00 ± 7.71 min for the experimental and control groups, respectively (P = 0.067). Although there were no significant statistical differences between the two groups in terms of intraoperative bleeding, adjacent tooth damage, infection, or damage to nearby important anatomical structures, the experimental group showed significant improvements in postoperative pain (P < 0.05), swelling (P < 0.001), and patient satisfaction (P < 0.001) compared to the control group.

CONCLUSION

Compared to traditional freehand flap surgery, flapless extraction of palatally impacted teeth guided by digital templates significantly reduces the localization time of impacted teeth and demonstrates notable advantages in some postoperative complications. Future studies with larger sample sizes are needed to substantiate the feasibility of this technique.

Long-term follow-up after the treatment of impacted canines in the maxilla causing severe root resorption of the lateral incisors: two case reports

BACKGROUND

Root resorption of adjacent teeth due to impacted canines is common, and orthodontic treatment often leads to secondary resorption or even loss of adjacent roots. Clinical reports of long-term stability after treatment are rare.

CASE PRESENTATION

This study reports two cases of maxillary impacted canines resulting in severe root resorption of the adjacent lateral incisors. Surgical exposure, orthodontic retraction, and alignment of the impacted canines were successful in both cases, and the resorbed lateral incisors were stable with no significant loosening and normal pulp vitality after treatment and at the 5- and 10-year follow-up appointments.

CONCLUSIONS

Light orthodontic force may be used to move adjacent teeth with root resorption due to tooth obstruction. The path and direction in which the teeth are moved must be specifically designed so that the adjacent roots are not resorbed and so long-term stability can be achieved.

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.

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.

Predictive Analysis of Maxillary Canine Impaction through Sella Turcica Bridging, Ponticulus Posticus Calcification, and Lateral Incisor Anomalies: A Retrospective Observational Study

Maxillary canine impaction is an increasing dental anomaly and is often related to other dento-skeletal anomalies. The aim of this work is to support the clinician in evaluating the relationship between a displaced maxillary canine and clinical (the features of lateral incisors)/skeletal (ponticulus posticus and sella turcica bridging) anomalies through orthopanoramic radiographs, lateral cephalograms, and plaster casts to identify the parameters that best predict maxillary canine impaction. A retrospective observational study was carried out on the analysis of the medical records, radiographic findings (panoramic radiographs and lateral cephalograms), and plaster casts of 203 orthodontic patients divided into a case group, with at least one impacted maxillary canine, and a control group, without an impaction. A chi-square test and logistic regression analysis were used to analyze the data. A statistically significant association was found between the impaction of the maxillary canine and the female sex, the bridging of the sella turcica, the ponticulus posticus calcification, and the anomaly of the lateral incisor; a logistic regression revealed that these significant variables were found to be positive predictors of impacted maxillary canines, particularly in reference to the impaction in the palatal area. Finding one of these clinical and radiographic elements can represent a predictive sign of the possible impaction of the maxillary canine.

Evaluation of Lateral Incisor Resorption Caused by Impacted Maxillary Canines Based on CBCT: A Systematic Review and Meta-Analysis

Background: Root resorption (RR) of the adjacent teeth due to upper canine impaction requires an appropriate modification of the orthodontic treatment plan and the mechanotherapy used. Aim: The aim of this review was to assess scientific evidence published during the last decade, concerning the prevalence of lateral incisor RR caused by impacted maxillary canines, based only on cone-beam computed tomography (CBCT). The location of RR on this tooth, as well as the prevalence of RR on the other adjacent teeth, were additionally evaluated. Methods: This review followed the criteria specified by the PRISMA statement. Four databases were searched for articles published between January 2008 and June 2021. Predefined and piloted data collection forms were used to record the necessary information. Results: A total of 5098 records were initially screened. Only seven articles were finally eligible for further analysis. A total number of 540 participants (176 males and 364 females) was derived from the included studies. RR of maxillary lateral incisors was common (50%). RR of mild severity was more common (62%), more frequently located in the middle (52%) and apical (42%) thirds of the root. Conclusions: Further research with more homogeneous groups is required.

Volumetric Evaluation of Maxillary Lateral Incisor Root Resorption due to Positional Variations of Impacted Canine

Introduction

The purpose of this study was to investigate the relationship of the volume of lateral incisor resorption and impacted canine features.

Materials and Methods

This study consisted of CBCT images of 47 samples with unilateral impacted maxillary canine (13 males and 34 females). The volume of lateral incisors in impacted side and nonimpacted side was calculated with the Mimics 10.01 software. Canine and lateral incisor angulations were measured in panoramic reformatted images. The canine cusp tip distance from midpalatal suture was measured in axial cross-section images.

Results

The difference between two sides volume was considered as the mean volume of resorption (MVR) that was statistically significant (P < 0.001). MVR was not statistically significant between two sexes (P=0.95), in buccopalatal and mesiodistal positions of impacted canine, and in different angulations or distances of the impacted canine to midline (P > 0.05). The concurrent effect of the canine distance to the midline and the angle of the canine with the lateral incisor on the MVR were statistically significant (P=0.049).

Conclusion

The maximum rate of lateral root resorption is when the distance from the canine to the midline is less than 5 mm and the angle of the canine to the lateral incisor is 30–60 degrees.

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.

Case report: coronectomy of an impacted and submerged second deciduous molar

Coronectomy is a widely-accepted technique available for the treatment of impacted wisdom teeth. The fundamental principle is to prevent trauma to the inferior dental nerve (IDN). Many publications have demonstrated its positive outcomes but there is no literature available regarding coronectomy of deciduous teeth. This case report highlights the complex approach to managing a severely infraoccluded 85 in the mixed dentition of a 10-year-old female. The report demonstrates and discusses the combined orthodontic and oral surgical approach to prevent damage to the IDN and to allow space for orthodontic movement. This case demonstrates how nerve sparing techniques in the mixed dentition are achievable.Clinical relevance statement When managing severely infraoccluded and impacted deciduous second molars, clinicians must be aware that the option of a coronectomy should be considered and may be the difference between sparing the nerve or causing permanent injury.Objective The reader should understand that coronectomy is a suitable treatment option in managing impacted deciduous teeth.

The relationships between the arrangement of teeth, root resorption, and dental maturity in bovine mandibular incisors

Objective

The objective of this study is to investigate the eruption pattern and root resorption of the bovine anterior dentition in relation to growth-related parameters based on dental maturity.

Methods

A cross-sectional study was conducted on 110 bovine anterior mandibles by using standard radiography, cone-beam computed tomography (CBCT), and actual measurements. We determined the relationships between the stages of dental maturity by using a modification of Demirjian's method and various growth-related parameters, such as the activity of the root-resorbing tissue and mobility of the deciduous teeth. The correlation of growth-related parameters with interdental spacing and distal unusual root resorption (DRR) of the deciduous fourth incisor was assessed. The cause of mesial unusual root resorption (MRR) of the deciduous fourth incisor was determined on the basis of the arrangement of the permanent third incisor.

Results

An independent t-test and chi-square test indicated significant differences in growth-related parameters associated with dental arch length discrepancy and factors related to the shedding of deciduous teeth between the low and high dental maturity groups. The samples with interdental spacing and DRR showed a larger sum of mesiodistal permanent crown widths and higher dental maturity than did the respective controls. Samples with MRR tended to show a lingually rotated distal tip of the adjacent tooth crown.

Conclusions

Dental maturity has relevance to the interdental spaces and unusual root resorption of mixed dentition. The position of the adjacent tooth crown on CBCT may be correlated with the occurrence of unusual root resorption of the incisor.