Dental transpositions: An update for clinicians.

Transposition of teeth may present to the general dental practitioner and in some circumstances transposed teeth may present with other dental anomalies. Although dental transpositions are rare anomalies, management of transposed teeth can often be complex, requiring multidisciplinary management. It is therefore important for dentists to be familiar with the clinical and radiographic presentation of transpositions and understand the aetiology to aid early diagnosis and appropriate management.Clinical relevance: Dentists are best placed to detect transposed teeth and should be familiar with the clinical and radiographic presentation, aetiology, and classification of transpositions in order to aid early diagnosis and their subsequent management.

Unconventional use of Invisalign® in the treatment of ectopic palatal maxillary canines.

BACKGROUND: The proper development of the dental arches, including the eruption and correct positioning of the canines in the arch, is essential for the oral health of growing patients. Impacted canines not only give rise to functional challenges but also pose esthetic issues for patients. The aim of this article is to show if it is possible to benefit from the exclusive use of transparent aligners to guide the eruption of ectopic upper canines into the arch in the correct position. CASE REPORT: The subject of the study is the clinical case of a 13-year-old female growing patient who presented displaced upper permanent canines located in the palatal ectopic site. Following the surgical extraction of the retained deciduous elements, treatment with aligners for repositioning the ectopic canines in the arch was performed in two phases. At the end of the treatment, a Class I canine was achieved with satisfactory repositioning of the upper canines in the arch. CONCLUSION: The use of transparent aligners makes it possible, with some procedural precautions and in carefully selected cases, to reposition the ectopic palatal canines in the dental arch using a treatment that is both esthetic and effective.

Apical incisor root resorption due to ectopic maxillary canine eruption: Association with time of diagnosis and type of intervention in a retrospective population-based cohort study.

OBJECTIVES: The primary aim was to study upper incisor severe apical root resorption (RR) related to ectopic canine eruption and its association with timing of diagnosis and type of intervention conducted. The secondary aim was to correlate resorption with other dental anomalies. MATERIALS AND METHODS: Digital journals and radiographic material of all ectopic maxillary canines registered in 2012 in the regional public paediatric dental clinics in the Council of Aarhus were inspected retrospectively. Data related to 10 variables were retrieved. Post-treatment radiographs were used for evaluation of incisor RR. RESULTS: A total of 260 ectopic maxillary canines were diagnosed in 2012. The majority were found in the 9-13-year-old age group (0.8% prevalence within the total population). In all, 244 canines were assessed for eligibility and 181 had adequate final radiographs for evaluation of RR. Among ectopic maxillary canines, 9.4% caused severe incisor RR to neighbouring teeth. Timely palpation for canine eruption significantly reduced the odds for upper incisor resorption by 80%. Multiple regression showed that when the permanent canine cannot be palpated and the deciduous has been extracted, delaying the first X-rays was associated with a 38% odds ratio increase for RR for each year of delay after the age of 10 years. No significant associations were found between incisor RR and intervention conducted or other dental anomalies. CONCLUSION: Palpation of erupting maxillary canines is crucial for timely diagnosis of ectopic eruption and initiation of treatment to avoid RR. If the canine cannot be palpated at 10 years of age, radiographic examination is highly recommendable.

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

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

Management Of Ectopic Eruption Of Bilateral Mandibular First Permanent Molars: A Case Report And Literature Review.

Ectopic eruption of the first permanent molars is a local eruption disturbance. The frequency of ectopically erupted first permanent molars is predominant in boys and primarily affects the maxilla. Interceptive treatment for irreversible ectopic eruptions should be initiated early to prevent space loss and the impaction of the second premolars. Herein, we report the case of a six-year-old girl with irreversible ectopic eruption of the bilateral mandibular first permanent molarstreated with a modified lingual arch. The mandibular first permanent molars were successfully distalised after six months of treatment, and one year of follow-up showed a satisfactory outcome. The modified lingual arch satisfies not only the clinical aspects of treatment but also the patient's well-being. However, the lingual arch may disturb tooth eruption in the mixed dentition stage.

[Diagnosis and orthodontic treatment strategy of complete canine transposition].

Tooth transposition is a challenge for orthodontists, especially in correcting the order of teeth. At present, the literature on transposition canines mainly focuses on epidemiological studies and case reports, and no systematic treatment guidance has been formed. In this article, the definition and classification, epidemiology and etiology, imaging diagnosis, treatment and risk control of transposed canines are systematically described in order to provide reference for clinical practice.

Mandibular second premolar distoangulation: a longitudinal follow-up from the mixed to the permanent dentition.

OBJECTIVE: The aim of this study was to assess the frequency of mandibular second premolar (MnP2) distoangulation among orthodontic patients and the angular changes after a longitudinal follow-up. METHODS: The sample was collected from the orthodontic records of 865 patients. The distoangulation group was composed of 42 patients (mean age 9.29 ±â€…1.24 years, 16 male, 26 female) with distoangulation of MnP2. The control group was composed of 32 patients (mean age 9.38 ±â€…1.10 years, 15 male, and 17 female) without distoangulation of MnP2. Panoramic radiographs taken in the mixed (T1) and the early permanent dentition (T2) were analyzed in both groups. Longitudinal angular changes (distal angle θ and premolar-molar angle γ), degree of root formation, second premolar depth, and prevalence of associated dental anomalies were analyzed. Intergroup comparison was performed with Mann-Whitney, t-tests, and chi-square tests (P < 0.05). RESULTS: The prevalence of MnP2 distoangulation in the mixed dentition was 4.85%. The distoangulation group showed a smaller initial distal angle (59.34o ±â€…8.41) when compared to control group (79.88o ±â€…7.60). The spontaneous eruption of the MnP2 with distoangulation was observed in 76.57% of the sample. MnP2 distoangulation was significantly associated with agenesis of its antimere, small maxillary lateral incisors, and deciduous molar infraocclusion. LIMITATIONS: Severe cases of MnP2 distoangulation were absent in this study. CONCLUSIONS: The frequency of MnP2 distoangulation among orthodontic patients was 4.85%. Mild to moderate distoangulated Mnp2 spontaneously uprighted from the mixed to the permanent dentition. Small lateral incisors, second premolar agenesis, and infraocclusion of deciduous molar were frequently found in cases with MnP2 distoangulation.

Early prevention of maxillary canine impaction: a randomized clinical trial.

OBJECTIVES: To investigate the effect of three interceptive measures (slow maxillary expansion (SME) with removable plates (1), extraction of both upper deciduous canines (DC) (2) and no intervention (3)) on maxillary canine (MC) position in patients with early mixed dentition (EMD) and lack of upper arch space. These three groups were additionally compared to a control group (4) with adequate upper arch space. NULL HYPOTHESIS: None of the studied strategies outperforms the others regarding improvement of MC position. TRIAL DESIGN: Four-arm parallel group prospective randomized controlled trial. PARTICIPANTS: Patients in EMD with at least one impacted MC, non-resorbed DC, and no crossbite. INTERVENTIONS: Patients with a lack of space were randomly distributed to protocols (1), (2), and (3). PRIMARY OBJECTIVE: To assess the change in MC position after 18 months follow up. SECONDARY OBJECTIVES: To assess canine eruption and need for orthodontic intervention within 18-60 month follow up. OUTCOME ASSESSMENT: Five variables defined canine position: sector, canine-to-midline angle, canine-to-first-premolar angle, canine-cusp-to-midline distance, and canine-cusp-to-occlusal-plane distance on two panoramic radiographs at 0 (T1) and 18 months (T2). Mean differences between groups were compared with linear mixed models, corrected for age and sex. RANDOMIZATION: The patient allocation sequence was generated by an electronic randomization list. BLINDING: The operator taking the measurements was blinded to the groups. RESULTS: Seventy-six patients were included (142 canines, mean age 9.2 years, 60.5 per cent male, mean follow up 1.9 years), 19, 17, 14, and 26 patients in groups 1-4, respectively. In absence of dental crossbite in patients with lack of space and impacted MC, SME improved the canine sector (P = 0.040), compared to no intervention (P = 0.028). Canine-to-midline angle and canine-to-occlusal-plane distance significantly decreased in all groups at T2. Extraction improved the canine-to-first-premolar angle at T2 more than other strategies in EMD (P = 0.015-0.000). CONCLUSIONS: Early SME improves the canine sector and reduces the need for major orthodontic intervention in the long term. Taking a first panoramic radiograph in EMD allows timely intervention in case of MC impaction. TRIAL REGISTRATION NUMBER: NCT05629312 (Clinical Trials.org). Trial status: follow up ongoing.

Do the various interceptive treatment modalities improve the position of palatally displaced permanent canines? A meta-analysis.

BACKGROUND: Removal of maxillary primary canines and other interceptive treatment modalities in the mixed dentition have been suggested as methods used to increase the rate of normal eruption of palatally displaced permanent canines (PDCs). However, the information on the overall effect on PDCs' position has been inconclusive. OBJECTIVE: To assess whether this practice improves the position of PDCs and to investigate the quality of the evidence. SEARCH METHODS: Unrestricted searches in 7 databases and manual searching of the reference lists in relevant studies were performed up to June 2022 (Medline via PubMed, CENTRAL, Cochrane Database of Systematic Reviews, Scopus, Web of Science, ClinicalTrials.gov, ProQuest Dissertations, and Theses Global). SELECTION CRITERIA: We looked for data on the positional changes of PDCs (mesial inclination, vertical position, canine crown cusp tip to midline) from randomized controlled trials assessing the various interceptive treatment modalities. DATA COLLECTION AND ANALYSIS: Following study retrieval and selection, relevant data were extracted, and the risk of bias was assessed using the Cochrane Risk of Bias 2 Tool. Exploratory synthesis and meta-regression were conducted using the random effects model and the overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation approach. RESULTS: Five studies (3 at low risk of bias) were identified, involving 238 individuals, followed for up to 18 months post-intervention with OPG (orthopantomogram) or CBCT (cone-beam computed tomography). Exploratory data synthesis showed that PDCs' position improved more in the extraction sites compared to non-extraction. Analysis of the studies at low risk confirmed the above observations (6- and 12-month). Improvements were observed in patients using headgear after extraction of primary canines compared to extraction alone, but not in patients with double extraction of primary canines and first molars. The quality of available evidence was rated at best as moderate. CONCLUSIONS: Interceptive treatment modalities in the mixed dentition may improve the position of PDCs. However, more studies are necessary in order to determine the clinical significance of the changes. REGISTRATION: PROSPERO (CRD42015029130).

Simple approach for correcting an entrapped ectopic permanent mandibular first molar caused by poor marginal adaptation of a preformed metal crown on an adjacent primary second molar: a case report with a 5-year follow-up.

Ectopic eruption of the permanent first molar can lead to malocclusion if left untreated. Despite several reported etiologic factors and treatment options, ectopic eruption caused by an improper restoration on an adjacent tooth and a simple solution have never been documented. Case report: An 8-year-old boy presented with an entrapped ectopic permanent mandibular first molar under the poorly adapted margin of a preformed metal crown (PMC) on the adjacent primary second molar. Replacement with a PMC that had well-contoured margins followed by inserting a separating module between the proximal contact of the two teeth resulted in successful management of this situation in 1 month. Conclusion: This simple approach with good interdisciplinary communication is practical for correcting eruption problems due to a poorly adapted PMC, with long-term satisfactory results. To avoid subsequent malocclusion and unnecessary treatments, dental practitioners must be vigilant when manipulating PMCs and assessing the marginal adaptation prior to their cementation.

Is there a better interceptive treatment for unerupted palatally displaced canines? A network meta-analysis.

This systematic review aimed to investigate if there is a better interceptive treatment for palatally displaced canines (PDC) in the mixed dentition stage. The PubMed/MEDLINE, CENTRAL, Scopus, and EMBASE databases were searched for randomized clinical trials related to the research topic. The gray literature and reference lists were also assessed. Network meta-analysis was conducted to analyze the effects of different approaches on PDC eruption. The surface under the cumulative ranking area was calculated to rank the treatments. The certainty of the evidence was evaluated using the GRADE approach. Of the 892 eligible studies, 18 were selected for full-text analysis and 9 for meta-analysis, involving 506 participants and 730 PDC, to compare 9 approaches. The proportion of erupted PDC was significantly higher for all interceptive treatments compared with control (no intervention). Furthermore, the proportion of erupted PDC was higher in patients subjected to rapid maxillary expansion (RME) than those who underwent double extraction of primary canine and primary molar (relative risk (RR) = 2.68 ICr95%: 1.12-9.35). A higher proportion of erupted PDC was found for RME (RR = 3.07 ICr95%: 1.31-10.67), RME plus use of transpalatal arch (TA) plus extraction of primary canine(s) (EC) (RR = 1.43 ICr95%: 1.09-1.95), EC plus use of cervical pull headgear (RR = 1.38 ICr95%: 1.11-1.79), and EC plus use of TA (RR = 1.36 ICr95%: 1.00-1.9) than for EC. RME was most likely to be considered as the best interceptive treatment. Overall, the certainty of the evidence was considered low due to imprecision and indirectness. In conclusion, no intervention in the mixed dentition stage is the worst choice for PDC.

Pain, discomfort, and functional impairment after extraction of primary teeth in children with palatally displaced canines - a randomized control trial comparing extraction of the primary canine versus extraction of the primary canine and the primary first molar.

CONCLUSION: Primary canines and first molars can be extracted in a way that is associated with relatively low levels of pain and discomfort during and after the procedures. Double extractions induced more pain and discomfort than single extractions, which should be accounted for in the treatment planning. MATERIAL AND METHODS: Twenty-eight children, aged 9.5-14 years with displaced permanent maxillary canines were randomly assigned for extraction of the primary canine only or the primary canine and the primary first molar. Pain and discomfort were rated on visual analogue scales, and influence on daily activities was assessed by a questionnaire that has been previously tested for reliability and validity. Differences between groups were assessed by independent samples t-tests, Mann-Whitney U-tests or the Fisher's exact test. OBJECTIVE: To assess pain, discomfort, and functional impairment in children experiencing extraction of primary canine or primary canine and primary first molar as an interceptive treatment for palatally displaced permanent canines. RESULTS: Tooth extraction was associated with low levels of pain and discomfort on a group level. Extraction of both the canine and the first molar was associated with significantly more pain and discomfort than was the extraction of the canine only. Extractions were associated with chewing problems among one-third to half of the children, otherwise, few children reported any jaw impairment after extraction.

A Retrospective Study of Ectopic Eruption in 35 Dogs.

Ectopic eruption results from a disturbance in tooth development and eruption, leading to an erupted or non-erupted tooth being in an unexpected anatomical location. This retrospective case series describes the location, position, form, and clinical signs associated with ectopic eruption in dogs. Thirty-five dogs (46 teeth) were diagnosed with ectopic eruption at three clinical practices during 2017-2020. The cases were described in terms of the location, the development and eruption status, the clinical signs, the consequences, and the treatment performed. The collected data were statistically analyzed to establish possible ramifications. The results showed that the ectopic eruption in the evaluated cases involved permanent teeth, mainly located in the maxilla, and mostly unerupted. Those located in the mandible were significantly more impacted than those located in the maxilla. This study concluded that tooth crowding and malocclusion (39.1%), facial swelling (8.6%), and periodontal disease (8.6%) were associated with the presence of ectopic eruption, and consequently, treatment was required in the majority (65.2%) of cases.

Evaluation of the position of the permanent maxillary canine and its relationship to dental anomaly patterns in the paediatric patient.

AIM: To evaluate the prevalence of ectopic eruption of the permanent maxillary canine in patients 6 to 10 years of age and its relationship to other dental anomalies, age and sex of the patient. MATERIALS: Study design: Descriptive, cross-sectional, observational, and retrospective study METHODS: A total of 260 panoramic radiographs were collected from patients who had their first visit at the Paediatric Dentistry Department of the Hospital HM Nens, HM Hospitals in Barcelona from January to May 2021. The prevalence of ectopic eruption was evaluated based on the following variables: age, sex, inclination angle and mesiodistal position of the crown of the permanent maxillary canine. Additionally, the presence of other dental anomalies was recorded. The statistical analysis to evaluate the relationship between two categorical variables was carried out using the Chi-square (or Fisher) test with unrelated samples and the Mann-Whitney test with related samples. A p-value of 0.05 and a 95% reliability level were considered statistically significant. CONCLUSION: The prevalence of ectopic eruption of the permanent maxillary canine was 9.23%. In this sample, no relationship was found between patients with maxillary canine with abnormal position and inclination and the presence of other dental anomalies.

Interceptive orthodontic management of mandibular lateral incisor-canine transposition using simplified and efficient biomechanical approach: A case report.

PURPOSE: Ectopic eruption anomaly, manifesting as tooth transposition, often presents a complex therapeutic challenge. Mandibular lateral incisor- canine transposition, although observed with rarity, tends to have major impact on development of proper dentition and adversely influence physical, nutritional, aesthetic and overall psychosocial well being of the patient. This report chronicles individualized one-phase orthodontic management of the case of incomplete transposition between mandibular right lateral incisor and canine in a 9-year-old boy during mixed dentition period. METHODS: Interceptive orthodontic treatment was initiated with placement of 2×4 fixed appliance in lower arch. A combination of continuous arch wire technique involving the use of improved superelastic nickel-titanium wire in conjunction with TMA rectangular wire loop was utilized to achieve biomechanically efficient mesial movement of mandibular lateral incisor. Treatment continued with sequential bonding of brackets to the rest of the mandibular dentition until the levelling and alignment of the buccal segment dentition was achieved. RESULTS: Well-timed early interceptive treatment involving simplified and controlled movements helped reinstate tooth order, promote free eruption of buccal segment teeth, reduce anchorage burden and achieve predictable and biologically compatible outcome without the use of lingual arch as an additional source of reinforcing anchorage. CONCLUSION: From an aesthetic, occlusal and functional standpoint, the treatment approach used in the reported case and the therapeutic outcome proved to be highly satisfactory. By optimizing the eruption and alignment patterns of the permanent teeth, preadolescent interceptive orthodontic treatment helps mitigate the burden of malocclusion and risks of complex orthodontic treatment in permanent dentition.

Artificial intelligence-aided detection of ectopic eruption of maxillary first molars based on panoramic radiographs.

OBJECTIVES: Ectopic eruption (EE) of maxillary permanent first molars (PFMs) is among the most frequent ectopic eruption, which leads to premature loss of adjacent primary second molars, impaction of premolars and a decrease in dental arch length. Apart from oral manifestations such asdelayed eruption of PFMs and discoloration of primary second molars, panoramic radiographs can reveal EE of maxillary PFMs as well. Identifying eruption anomalies in radiographs can be strongly experience-dependent, leading us to develop here an automatic model that can aid dentists in this task and allow timelier interventions. METHODS: Panoramic X-ray images from 1480 patients aged 4-9 years old were used to train an auto-screening model. Another 100 panoramic images were used to validate and test the model. RESULTS: The positive and negative predictive values of this auto-screening system were 0.86 and 0.88, respectively, with a specificity of 0.90 and a sensitivity of 0.86. Using the model to aid dentists in detecting EE on the 100 panoramic images led to higher sensitivity and specificity than when three experienced pediatric dentists detected EE manually. CONCLUSIONS: Deep learning-based automatic screening system is useful and promising in the detection EE of maxillary PFMs with relatively high specificity. However, deep learning is not completely accurate in the detection of EE. To minimize the effect of possible false negative diagnosis, regular follow-ups and re-evaluation are required if necessary. CLINICAL SIGNIFICANCE: Identification of EE through a semi-automatic screening model can improve the efficacy and accuracy of clinical diagnosis compared to human experts alone. This method may allow earlier detection and timelier intervention and management.

Eruption pattern of the maxillary canines: features indicating treatment needs as seen in PTG at the late mixed stage-Part II.

AIM: To describe features of maxillary permanent canines in the late mixed stage as seen in panoramic radiograph (PTG) that later needed treatment to erupt into the oral cavity and to compare them with naturally erupted canines. METHODS: The cross-sectional part of this retrospective register-based study consisted of 1454 PTGs of children (mean age 9.3 years) living in Eastern Finland, while the longitudinal part involved patient data on 184 treated maxillary canines. The variables examined were treatment needs, overlapping and inclination of the maxillary canines, the development stage of the canines and lateral incisors and dental age. RESULTS: Only 11.6% of the maxillary canines needed treatment, including interceptive procedures. The treated canines significantly more often had overlapping (p < 0.001), larger inclination (p = 0.001) and incomplete lateral incisors (p = 0.002) than did the naturally erupted canines. The children treated significantly more often had a delayed dental age (p = 0.035). Clear overlapping was closely associated with all treatment modalities, whereas some overlapping and a large inclination angle (≥ 25°) were associated especially in cases of late treatment. An incomplete lateral incisor and delayed dental age were associated with treatment. CONCLUSION: An association with treatment needs was found especially in the case of overlapping and a large inclination angle of the maxillary canine a couple of years before eruption into the oral cavity. These features can be early signs and indications for instant or later treatment of a maxillary canine and underline the importance of monitoring space conditions and erupting canines.