Alveolar bone retention following treatment of dilacerated labial inversely impacted maxillary central incisors-a retrospective study.

The root of late-dental-age labial inversely impacted maxillary central incisors (LIIMCIs) typically develops to severe dilacerated morphology. Therefore, reliable posttreatment periodontal estimates of orthodontic treatment prognosis would be critical to the treatment value of impacted incisors. This study aims to analyze further changes in dimensions of the alveolar bone following the closed-eruption treatment of late-dental-age dilacerated LIIMCIs. Cone beam computed tomography (CBCT) scanning data of 16 patients with unilateral dilacerated late-dental-age LIIMCIs were collected, including the pretreatment (T1) and at the 2.23 ± 0.78 years follow-up stage (T2) respectively. Patients underwent closed-eruption treatments to bring the impacted incisor into the dental arch. Dolphin imaging software was used to measure alveolar bone height labially, palatally, and proximally to the site at T1 and T2, as well as alveolar bone thicknesses at 0, 2, 4, 6 and 8 mm below the initial measurement plane (IMP). The alveolar bone heights on the impacted and contralateral sides increased from T1 to T2 (p < 0.05). Alveolar bone growth on both sides had no significant difference. In T2, the mean values of labial and distal alveolar heights on the contralateral sides were greater than on the impacted sides (p < 0.05). The mean values of total alveolar bone thicknesses on the impacted sides in T1 were significantly smaller than those on the contralateral sides in IMP-0, 2, 4, 6, 8 (p < 0.05). The total thicknesses on the impacted sides in T2 increased and were significantly greater than on the contralateral sides (p < 0.05), except for the thickness in IMP-0. The closed-eruption treatment of dilacerated late-dental-age LIIMCIs results in no significant changes to alveolar bone height, except on the labial and distal sides, with increased alveolar bone thickness, suggesting that this approach may be viable first choice therapy for non-extraction orthodontic cases.

Therapeutic reassessment of impacted or transposed teeth / Réévaluation thérapeutique des dents incluses ou transposées

Introduction: Impacted or transposed teeth present a common yet challenging issue in dentistry. These conditions occur when teeth fail to erupt properly or emerge in abnormal positions within the dental arch. Material and Method: This article explores the evolving landscape of therapeutic strategies for impacted or transposed teeth, emphasizing a multidisciplinary and patient-centered approach. Results: By adopting a multidisciplinary approach involving orthodontists, oral surgeons, and other dental specialists, clinicians can tailor treatment plans to address individual needs and optimize outcomes. Discussion: Therapeutic reassessment of impacted or transposed teeth represents a paradigm shift in modern dentistry, emphasizing personalized care, minimally invasive techniques, and interdisciplinary collaboration.

Introduction: Les dents incluses ou transposées présentent un problème courant, quoique difficile à gérer. Ces conditions surviennent lorsque les dents ne parviennent pas à faire leur éruption correctement ou émergent dans des positions anormales au sein de l'arcade dentaire. Matériel et méthode: Cet article explore le paysage évolutif des stratégies thérapeutiques proposées pour la prise en charge des dents incluses ou transposées, en mettant l'accent sur une approche multidisciplinaire centrée sur le patient. Résultats: En adoptant une approche multidisciplinaire réunissant des orthodontistes, des chirurgiens oraux et d'autres spécialistes dentaires, les cliniciens peuvent adapter les plans de traitement au mieux pour répondre aux besoins individuels de chaque patient et optimiser les résultats. Discussion: La réévaluation thérapeutique des dents incluses ou transposées représente un changement de paradigme en dentisterie moderne, mettant l'accent sur les soins personnalisés, les techniques mini-invasives et la collaboration interdisciplinaire.

Uprighting horizontally impacted third molars by super-elastic nickel-titanium wire in patients with an extracted first molar.

Protracting lower second molars and uprighting horizontally impacted third molars is a significant orthodontic challenge in patients who require the extraction of severely decayed first molars. Here, we describe the use of biomechanics to upright 90°-tilted lower third molars following second molar protraction. Herein, we introduce a technique for uprighting the lower third molars by (1) the placement of superelastic nickel titanium archwires, (2) bonding, and (3) repositioning of a buccal tube in a tilted position to compensate for the efficiency of Ni-Ti (nickel-titanium) wire. The treatment mechanics used for our two cases showed that even severely impacted third molars can be uprighted by routine continuous straight-wire techniques. This technique proved to be a simple, efficient and reliable treatment option for uprighting horizontally impacted third molars.

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.

Appropriate timing of treatment contributes to better root development of impacted anterior teeth in children.

INTRODUCTION: This study investigated the effects of different timings of orthodontic treatment on the root development of impacted anterior teeth in children. METHODS: The cone-beam computed tomography (CBCT) data of 45 children with impacted anterior teeth were divided into unformed root (UR) group or basically formed root (BFR) group to evaluate root length (RL) and root growth length (RGL) of impacted teeth and contralateral nonimpacted teeth pretreatment and posttreatment. In addition, 22 patients with impacted dilaceration were selected to assess the effects of the crown-root angle and root development stage on RL and RGL. The Student t test, Wilcoxon test, analysis of variance, and multiple linear regression analysis were used for statistical evaluations. RESULTS: The RL of treated impacted teeth pretreatment and posttreatment was significantly shorter than contralateral nonimpacted teeth values (P <0.05). Posttreatment, the RL and RGL of impacted teeth of the UR group were significantly greater than those of the BFR group (P <0.05). The RGL of the dilacerated root in the UR group was considerably higher than in the BFR group (P <0.05). The larger crown-root angle group had a longer posttreatment RL (P <0.05). Multiple linear regression analysis revealed that the Nolla stage of impacted teeth and RL of contralateral teeth pretreatment significantly influenced the RL of impacted teeth posttreatment. CONCLUSIONS: Prompt orthodontic treatment is necessary for children with impacted anterior teeth to release the impacted state and achieve better root development. The root length of a dilacerated tooth continued to develop under treatment, but the crown-root angle partly constrained it.

Will supplemental cone beam computed tomography change the treatment plan of impacted maxillary canines based on 2D radiography? A prospective clinical study.

AIM: To evaluate the impact of cone beam computed tomography (CBCT) on treatment planning for impacted maxillary canines; secondly, to identify CBCT factors influencing a change in the treatment plan; and thirdly, to assess 2D radiographic factors that can aid in selecting appropriate candidates for CBCT. MATERIAL AND METHODS: Patients with impacted maxillary canines and an overlap of a neighboring tooth in 2D radiographs and the suspicion of root resorption were referred for CBCT examination. An initial treatment plan was based on 2D radiographs, and the final treatment plan was established after the CBCT examination. Logistic regression analyses and t-tests were performed to evaluate differences in radiographic findings between the groups with and without a change in treatment plan. RESULTS: The study prospectively included 125 impacted canines, and 43 (34.4%) of them had a change in treatment plan after the CBCT examination. The most common change was a modification in the direction of cantilever traction (n = 28; 22.4%), while the least common was the change in decision to remove/keep the canine (n = 4; 3.2%). The size of the alpha and lateral angles had a significant impact on the decision to change the treatment plan. Other radiographic findings did not influence a change in treatment plan. CONCLUSIONS: One-third of the canines had a change in treatment plan after supplemental CBCT examination. Canines with large alpha and lateral angles measured in the panoramic image were found to be significantly more likely to undergo changes in the initial direction of cantilever traction or changes to the canine extraction strategy following CBCT examination.

Prevalence, etiology, clinical features and management associated with impacted and transmigrated mandibular canines: a systematic review.

BACKGROUND: The occurrence of mandibular canine impaction and/ or transmigration is a rare clinical entity but diagnosis and treatment planning is of clinical significance. The associated etiological factors and the clinical guidelines for the management are still not clear. The aim of this systematic review was to summarize the available data to report the prevalence and identify the etiological factors, clinical features, and various treatment outcomes in patients with mandibular canine impaction and/or transmigration. METHODS: The review protocol was registered in PROSPERO (CRD42021222566) and was conducted and reported according to the PRISMA and Cochrane Handbook / Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A computerized search of studies published up to April 30, 2023, was conducted using the following databases: Medline, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and Latin American and Caribbean Health Sciences Literature. A manual search of the reference and citation lists of eligible articles and existing systematic reviews for any additions were also conducted. The Newcastle-Ottawa Scale quality assessment tool was used to assess the studies' quality. RESULTS: After removing 6 duplicates, 3700 articles were identified. For the final analysis, 19 studies published between 1985 and 2023 met all the eligibility criteria and were included. A total of 7 studies presented as good and 12 studies presented as satisfactory. Patients were screened in ten studies and diagnostic records from archives were retrieved in nine studies. The total number of diagnostic records screened was 138.394, and the total number of patients from the included studies was 43.127. CONCLUSIONS: Based on the findings from this systematic review, the prevalence of mandibular canine impaction ranged from 0.008% to 1.29% while canine transmigration from 0.12% to 0.98%. Crowding of the mandibular arch, the presence of a retained deciduous canine, and odontoma or cyst are the etiological factors more commonly associated with mandibular canine impaction and or transmigration. Surgical extraction and surgical exposure followed by orthodontic traction are the two most frequently carried out treatment modalities in the management of mandibular canine impaction and or transmigration.

Management of Severe Infraocclusion of the Primary Second Molar Leading to Impaction of Second Premolar.

Infraocclusion is a local etiologic factor of malocclusion that can have deleterious effects on normal dental development. Therefore, early recognition and diagnosis are the two most important factors in the management of infraocclusion. The purpose of this case report is to describe the management of a patient who was diagnosed at seven years of age with an eruption disturbance, whose severe sequela could have been prevented had the infraocclusion been diagnosed early.

Impaction of multiple dilacerated primary incisors: a case report.

Dental complications such as defective alveolar bone development, delayed eruption, and tooth impaction are related to neonatal oral intubation. This case report presents an example of potential complications that occur in children who have undergone oral intubation as neonates. A 20-month-old girl visited our pediatric clinic. We observed delayed, non-erupted teeth #51, #71, and #81 and determined a history of intubation during the neonatal period as a related factor. After 22 months of observation, tooth #71 erupted spontaneously. After 40 months of monitoring, teeth #51 and #81 were extracted surgically, and normal permanent teeth erupted six months later. This study is helpful for pediatric anesthesiologists, pediatricians, and dentists who diagnose and treat eruption disorders of the primary dentition.

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.

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.

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.

[Clinical study of a adjustable movable retractor for maxillary labially inverted impacted central incisor].

PURPOSE: To evaluate the orthodontic treatment outcome of a new adjustable movable retractor for patients with maxillary labially inverted impacted central incisors. METHODS: Ten patients, aged 7 to 10 years, who had a maxillary labially inverted impacted central incisor, were treated using a new adjustable movable retractor. Cone-beam CT(CBCT) was taken before treatment and after treatment immediately. Pulp electrical activity test and periodontal probing were performed after treatment. The parameters of the treated incisors and contralateral ones served as controls were compared.SPSS 23.0 software package was used for data analysis. RESULTS： The success rate of treatment in 10 patients was 100%. The mean duration of treatment was（8.60±1.26） months. There were no loosening, gingival swelling and redness, periodontal pockets, and pulp necrosis in the treatment group. However, the labial gingival height of the treatment group was (10.58±0.45) mm, significantly higher than that of the control group [(9.47±0.31) mm]. The growth and development level of the treatment group was higher than that of the control group during traction. The root length[(2.80±1.09) mm] and apical foramen [(1.79±0.59) mm] of the treatment group were higher than those of the control group[(1.84±0.97) mm and (0.96±0.40) mm]. Before treatment, the root growth of the treatment group was retarded. The root length of the treatment group[(7.28±1.03) mm] was shorter than that of the control group[(9.80±1.46) mm]; meanwhile, the apical foramen width of the treatment group[(2.18±0.63) mm] was larger than that of the control group[(1.26±0.40) mm]. After treatment, the root length [(10.08±0.63) mm] of the treatment group was still shorter than that of the control group [(11.75±0.90) mm]. The labial alveolar bone level of the treatment group [(1.77±0.37) mm] was higher than that of control group[(1.25±0.26) mm]. The palatal alveolar bone level of treatment group[(1.23±0.21) mm] was also slight higher than that of the control group[(1.05±0.15) mm]. The thickness of the alveolar bone in the treatment group[(1.49±0.31) mm] was thinner than that in the control group[(1.80±0.11) mm]. CONCLUSIONS： The effect of the new adjustable movable retractor for maxillary labially inverted impacted central incisor is reliable. Traction therapy can promote root development, and the periodontal and endodontic condition is well after treatment.

Maxillary Sinus Volume and Its Effect on Treated Impacted Canines.

The goal of study was to explore the role of 3D CBCT (cone beam computer tomography) in detecting impacted canines and their movement to evaluate the influence of orthodontic therapy parameters on treatment options, and to monitor quality of healing process based on shape and size of sinus maxillae volume. It is known that the volume of maxillary sinus plays an important role in patients with impacted teeth. The prospective study consisted of 26 individuals. For each individual, pre-treatment and post-treatment CBCT data were acquired. Changes of size, and position of impacted canine in 3D CBCT image before and after therapy were prepared using 3D reconstruction. Volumetric measurements of the maxillary sinuses were performed before and after orthodontic therapy of impacted canines, using InVivo6 software. The main effects MANOVA performed on linear measurements showed metric differences between pre-op and post-op images. A paired t-test showed no statistically significant differences between pre-op and post-op values of the sinus volume. Changes of size and position of impacted canine in 3D image before and after therapy were precise and reproducible, using 3D reconstruction in three planes - horizontal, midsagittal, and coronal. The linear measurements showed metric differences between pre-op and post-op images.

Combined orthodontic-orthognathic management of a patient with generalized short root anomaly and anterior open bite.

Short root anomaly is a rare dental disorder affecting tooth root development. It is characterized by reduced root-to-crown ratios (1:1 or less) and rounded apices. The short roots introduce a potential complication during orthodontic treatment. This case report describes managing a girl with generalized short root anomaly, an open bite, impacted maxillary canines, and a bilateral crossbite. In the first phase of treatment, the maxillary canines were extracted, and the transverse discrepancy was corrected with a bone-borne transpalatal distractor. In the second phase of treatment, a mandibular lateral incisor was removed, fixed appliances were placed in the mandibular arch, and bimaxillary orthognathic surgery was performed. A satisfactory result was obtained without further root shortening, adequate smile esthetics, and 2.5-year posttreatment stability.

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.