Interventions for impacted maxillary canines: A systematic review of the relationship between initial canine position and treatment outcome.

BACKGROUND: The objective of this review was to critically assess the existing literature on the relationship between the initial position of impacted canines and treatment outcomes. METHODS: We performed a systematic review of the available literature until February 2020 using the MEDLINE, Cochrane Central, Web of Science and PubMed databases. Prospective and retrospective studies (randomized controlled trials [RCTs], cohort studies, longitudinal follow-up studies) considering impacted maxillary canines that were orthodontically and/or surgically treated, and clearly reporting the initial position using 2D and/or 3D classifications, were included if they assessed at least one of the following: treatment success, treatment duration, number of treatment visits, radiographic outcome, periodontal health, esthetics and/or treatment complications. The included studies were assessed for risk of bias according to the Cochrane guidelines. RESULTS: Seventeen studies were reviewed (2 RCTs and 15 non-RCTs). The included studies enrolled a total of 1247 patients with an average age of 14.1 years and a total of 1597 impacted canines. Various causal relationships were detected between the success of treatment modalities and the initial state of the impacted canine (bucco-palatal position, vertical position, canine angulation, root development). DISCUSSION: Evidence, though limited, suggests that a higher alpha angle, higher vertical position and more mesial sector of the impacted canine are related to less successful interceptive and active treatment solutions, prolonged treatment time and inferior outcomes.

Survival and success of autotransplanted impacted maxillary canines during short-term follow-up: A prospective case-control study.

OBJECTIVES: This prospective clinical trial aimed to examine the predictability of maxillary canine transplantation as compared to biological canine eruption. Additional objectives were to examine hard and soft tissue outcomes, including aesthetic outcome compared to outcomes with the contralateral canines. SETTINGS AND SAMPLE POPULATION: The sample comprised 17 consecutively transplanted maxillary canines in 17 patients (mean age at surgery, 18 years; range, 11-29 years). Minimal follow-up time was 12 months post-transplantation. Clinical and radiographic parameters were recorded for the transplanted and contralateral canines, showing a natural eruption pattern. MATERIAL AND METHODS: The Maxillary Canine Aesthetic Index (MCAI) and the Autotransplanted Maxillary Canine Radiological Index (AMCRI) were scored for all upper canines. Successful transplantation was considered as the absence of pathology during intermittent clinical and radiographic controls and a good-to-excellent outcome compared to the contralateral biological erupted canine, as defined by the MCAI and AMCRI. RESULTS: The mean follow-up period was 28 months (±9; range, 12-40 months). The overall survival rate was 100%, and the success rate reached 68% at 1 year post-operatively. Significant predictors of success were the extra-oral time during transplantation, amount of damage to the root surface, quality of surrounding tissues and immediate post-operative oral hygiene. CONCLUSION: Standardized measurements demonstrated clinically satisfactory outcomes with maxillary canine autotransplantation compared to outcomes with the contralateral canine during 1-3 years of follow-up. The potential predictors of success identified here should be confirmed with long-term follow-up studies.

Surgically assisted orthodontic alignment of impacted maxillary canines: A retrospective analysis of functional and esthetic outcomes and risk factors for failure.

INTRODUCTION: The initial position of an impacted maxillary canine might influence the outcome of surgically assisted exposure and orthodontic alignment. Therefore, the purpose of this study was to evaluate existing correlations between the initial position of the maxillary canine and the outcomes of treatment. METHODS: A retrospective cohort study was designed, containing data of 132 patients (47 males, 106 females; median age at the date of surgical exposure 14 ± 4.6 years; range, 10-39 years) with a total of 153 impacted maxillary canines. The sample was based on orthodontic referrals over 4 years at the Department of Oral and Maxillofacial Surgery, Rijnstate Hospital, Arnhem, the Netherlands. The esthetic outcome, treatment duration, and success and failure rate were investigated in relation to the initial position of the maxillary canine as assessed on pretreatment panoramic radiographs (vertical and anteroposterior sector position and angulation of the canine [α-angle]). The esthetic evaluation was performed using the Maxillary Canine Aesthetic Index. The success of treatment was defined as achieving a fully functional eruption of the canine, with an esthetically excellent result, without the need for reinterventions. Failure of treatment was defined as the need for reintervention or removal of the canine. RESULTS: In 96% of the impacted canines, a successful orthodontically assisted eruption was achieved. Age, vertical distance, and angulation are predictors of the esthetic outcome of impacted canines after treatment. Age, bilateral impaction, sector, vertical distance, and angulation are predictors of treatment duration. Age, vertical distance, and buccolingual position are predictors of the need for reintervention. CONCLUSIONS: Pretreatment radiographic variables can help in predicting the outcome and treatment duration of surgically exposed maxillary impacted canines.

A retrospective long-term pulpal, periodontal, and esthetic, follow-up of palatally impacted canines treated with an open or closed surgical exposure technique using the Maxillary Canine Aesthetic Index.

INTRODUCTION: The primary objective of this study was to compare the aesthetic outcome of palatally impacted canines treated with an open or closed surgical exposure technique using the Maxillary Canine Aesthetic Index (MCAI) at least 1 year after debonding. Secondary objectives were set on the periodontal outcome, tooth color, pulpal status, and self-reported contentment. METHODS: The sample of this retrospective study consisted of 53 patients with an average age of 20 years and 7 months at the time of the investigation. A total of 53 canines were investigated. All canines were aesthetically scored with the MCAI. Other outcome variables were investigated, such as gingival inflammation, pocket probing depth, vitality, percussion sensitivity, and tooth color. All patients received a questionnaire to evaluate their appraisal of different parameters. RESULTS: A statistically significant difference (P < 0.001) was found between the groups treated with an open and closed technique in terms of the MCAI. The closed technique scored excellent in terms of aesthetics, whereas the open technique scored good. The closed technique had more discoloration (P < 0.001) and a delayed response to the cold test (P = 0.021). In general, patients were satisfied with both techniques but considered the treatment time to be very long. CONCLUSIONS: A closed surgical exposure of palatally impacted maxillary canines is preferred in terms of aesthetics when measured with the MCAI. There was no difference between the 2 techniques in terms of periodontal outcome. Canines treated with a closed exposure tended to have a darker color and delayed response to cold testing.

Autogenous transalveolar transplantation of maxillary canines: a systematic review and meta-analysis.

Background and objectives: The objective was to systematically review transalveolar transplantation of maxillary canines and the long-term outcome for an average follow-up period of 2 years or more. Data collection and analysis: A systematic review of the currently available literature until December 2017 was conducted, using Medline, Cochrane Central, Web off Science, and PubMed. Articles were screened for 1. indications, 2. contra-indications, 3. surgical planning, 4. surgical technique, 5. associated risk factors, and 6. long-term outcome for transalveolar transplantation of maxillary canines with the following outcome measures: bone-related outcomes, tooth-related outcomes, soft tissue-related outcomes, and aesthetic outcome measures. Descriptive statistics, as well as a quality assessment of included articles, were performed. Following study retrieval and selection, relevant data was extracted and the risk of bias was assessed using the Methodological index for non-randomized studies (MINORS). Results: Twelve articles were included in this review. These studies included outcome data for 783 autotransplanted maxillary canines, with long-term studies indicating a clinically acceptable overall outcome. Limitations: Since the lack of randomized controlled trials considering this topic, the quality of the evidence in the present review is considered low. However, impacted maxillary canines are a rare anomaly and different aspects, such as position of the impacted canine, patient's age and patient's demands, and expectancies must be taken into account, it is practically impossible to randomize treatment. Conclusions: There is sufficient evidence to justify the transalveolar transplantation of maxillary canines as a legitimate treatment technique for impacted maxillary canines deemed difficult to treat with surgical exposure and subsequent orthodontic alignment. Long-term studies have shown that a good overall outcome is to be expected. There is no clear agreement in the literature on the indications and contra-indications for transalveolar transplantation of maxillary canines. Implication of key findings: It is highly desirable that further research on this issue be undertaken, high-quality observational studies are recommended. Registration: PROSPERO (CRD42017056348).

Treatment for critically impacted maxillary canines: Clinical versus scientific evidence - A systematic review.

BACKGROUND: Critically impacted maxillary canines are prone to fail to respond to conventional surgical exposure and orthodontic traction. Correct identification of a critical impaction requires enhanced diagnosis modalities and might lead to incorporating alternative surgical strategies in the treatment plan. Predictability of techniques such as apicotomy or tooth autotransplantation is, however, yet to be determined. The objective of this study was to systematically review treatment perspectives for critically impacted maxillary canines. METHODS: A systematic review of the available literature until april 2020 was conducted using an electronic search in Embase, Cochrane Central, Web of Science and PubMed databases. Randomised and non-randomised studies investigating treatment options and treatment outcome for buccally and/or palatally critically impacted maxillary canines were considered for the review. Information recorded concerned study design and setting, participants' characteristics and details regarding the type of intervention, types of outcomes measured and follow-up time. The included studies received a methodological quality scoring and risk of bias analysis according to a tool suggested by Murad et al (2018). RESULTS: Five studies were included in the quality analysis, all case series. The included studies enrolled a total of 302 patients and counted 346 critical maxillary canine impactions. Apicotomy and autotransplantation were listed as potential surgical approaches with surgical outcome presented for both surgical strategies. Adequate esthetical and/or functional outcomes were reported in most of the included studies. According to the quality assessment tool used, the reviewed studies scored medium on the proposed scale. DISCUSSION: Literature featuring protocols for identifying and treating critical maxillary canine impaction only consists of case series and case reports, which provide low level of evidence. The rather good results reported by the reviewed studies must be put into perspective as the methodology of these studies was insufficient and potential bias was identified. Comprehensive clinical research is needed to further investigate treatment options and form a basis for clinical guidelines.

Three-dimensional position of impacted maxillary canines: Prevalence, associated pathology and introduction to a new classification system.

Classification of impacted maxillary canines facilitates interdisciplinary communication. Cone beam computed tomography (CBCT) has proven to be superior for the localization of impacted maxillary canines compared with 2D imaging. The purpose of this study was to retrospectively classify a cohort of impacted maxillary canines, using a new developed 3D classification for impacted maxillary canines that is easy to use and does not require complex analysis of the 3D images. A retrospective cohort study was designed, containing CBCT data of 130 patients (male/female: 48/82; median age 16) with a total of 162 impacted maxillary canines. The proposed classification was based on four criteria: vertical crown position, mesiodistal tooth postion, bucco-lingual crown position, and associated pathology. For all included patients, classification criteria were identified and correlated to treatment selection using a newly developed 3D classification. The most common positions were vertical crown position at apical one third of neighboring teeth, mesiodistal tooth angulation, and palatal crown position. The most frequent associated pathologies were dilaceration of the root and resorption of a neighboring tooth. Significant associations among classification variables and treatment options were observed. Limitations of this study are the retrospective design. CBCT enabled 3D assessment of impacted maxillary canines allowing a classification system that may have an impact on further treatment strategies.

Long-term outcome of autogenously transplanted maxillary canines.

The aim of this study was to determine the long-term outcome of autotransplanted maxillary canines and to investigate the influencing parameters. Seventy-one patients (84 transplanted canines) volunteered to participate in this study. The mean follow-up time was 21 years. In case of tooth survival and when patients were found willing for recall, teeth were investigated clinically and radiographically. Transplanted teeth were compared to the contralateral canine and scored with an aesthetic and radiographic index. The survival rate was 67.9%, considering that 27 transplanted teeth were lost before examination. The mean survival time was 15.8 years. Maxillary canine autotransplantation may have a successful outcome up to 21 years after transplantation requiring minimal patient compliance and low financial costs. The survival rate can be considered favorable realizing that autotransplantation is a treatment option in a selected group of cases.

Secondary hyperparathyroidism causing increased jaw bone density and mandibular pain: a case report.

We present the case of a 32-year-old male patient complaining of recurrent mandibular pain for 3.5 years. Panoramic radiography indicated increased cortical density of the mandibular lower border. Scintigraphy and single-photon emission computed tomography revealed metabolic hyperactivity in that region without pathologic lymph nodes. A bone biopsy specimen of the mandibular lower border did not have inflammation or cytologic atypia. Endocrinologic investigation confirmed secondary hyperparathyroidism as a result of hypovitaminosis D. Several weeks after starting therapy with oral vitamin D supplements, the symptoms completely disappeared. Increased cortical density is a rare manifestation of secondary hyperparathyroidism, which normally causes the lamina dura to vanish and produces a ground-glass appearance as a result of blurring of the trabecular bone pattern. Because focal hyperostosis can have multiple benign or malignant causes, radiologic examination of the jaw bones is indispensable for evaluating orofacial pain. Increased cortical density may be caused by metabolic diseases, requiring further investigations, including biopsy and blood analysis.

Development and validation of the autotransplanted maxillary canine radiological index.

The purpose of this study was to propose and validate an index evaluating 2D and 3D radiographic variables of autotransplanted maxillary canines. Setting and sample population are from the Department of Oral and Maxillofacial Surgery at University Hospitals Leuven. Eight oral-maxillofacial surgeons rated 12 autotransplanted maxillary canines and adjacent bone using 11 rating variables. A new autotransplanted maxillary canine radiological index (AMCRI) was proposed. It consisted of 11 variables. These variables were based on 2D (intraoral) and 3D Cone Beam Computed Tomography (CBCT) radiographs. Intraclass correlation coefficient (ICC) and Fleiss's kappa statistics were performed to analyze intrarater and interrater agreement. Considering cumulative assessment of the AMCRI, the mean ICC value for the interrater agreement of the eight examiners was 0.94, representing an excellent agreement. Intrarater agreement was 0.91. The AMCRI is an objective tool in rating radiological outcome of autotransplanted canines and adjacent bone, when compared with the contralateral canine.

Development and validation of the Maxillary Canine Aesthetic Index.

Aesthetic appraisal is rarely included in the objective assessment of outcome studies of impacted maxillary canines treatment. The present study aimed to validate a new index for assessing the aesthetic appearance of maxillary canines and adjacent soft tissues. The Department of Oral and Maxillofacial Surgery at University Hospitals Leuven. Four oral-maxillofacial surgeons, two orthodontists, two prosthodontists, and two lay persons rated 11 maxillary canines and adjacent soft tissues according to the new index. Each of the examiners repeated the examination three times with a 2-week interval. Twelve relevant aesthetic variables were selected on the basis of the anatomic form, color, and surface characteristics of the canine crown and on the basis of the anatomic form, color, and surface characteristics of the adjacent soft tissues. Intraclass correlation (ICC) coefficient and Fleiss' kappa statistics were performed to analyze the intrarater and interrater agreement. The index proofed to be a reliable assessment tool. Considering the cumulative assessment of the Maxillary Canine Aesthetic Index (MCAI), the mean ICC value for the interrater agreement of the 10 examiners was 0.71, representing a good agreement. Intrarater agreement ranged from 0.10 to 0.91. Interrater agreement (Fleiss' kappa statistics) calculated for each variable ranged from 0.08 to 0.98. The MCAI is a tool in rating aesthetic outcome of impacted canine treatment and adjacent soft tissues. The MCAI can be used to evaluate the aesthetic outcome after surgical exposure or transalveolar transplantation of maxillary canines.

Case of a cerebral abscess caused by Porphyromonas gingivalis in a subject with periodontitis.

We report the case of a 65-year-old man presenting with generalised seizures after developing a right frontal brain abscess. Stereotactic aspiration and subsequent matrix assisted laser desorption/ionisation time-of-flight analyzer (MALDI-TOF) spectrometry revealed Porphyromonas gingivalis as the only causative anaerobe microorganism. Secondary incision and drainage was required due to neurological deterioration with increased dimensions of the abscess, intracranial pressure and formation of a subdural occipitoparietal empyema. Oral imaging was positive for apical periodontitis of multiple elements; therefore, the remaining dentition was removed. Targeted antibiotic treatment included intravenous ceftriaxone and ornidazole. The patient was discharged to our revalidation unit 59 days after admission to make a full recovery. To the best of our knowledge, this is the sixth reported case of P. gingivalis causing an intracranial abscess and the third case of a true intracerebral parenchymal abscess caused by this bacterium.

Retrospective Analysis of Dental Implants Placed Between 2012 and 2014: Indications, Risk Factors, and Early Survival.

PURPOSE: The aim of this study was to review the indications for implant placement, early outcomes, and associated risk factors. MATERIALS AND METHODS: A retrospective cohort study design was used. The study was composed of a group of 509 consecutive patients, which represented the total number of patients treated from 2012 to 2014 in the Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium. The authors analyzed the indications for implant placement and the potential risk factors for early implant failure. RESULTS: A total of 509 patients received 1,139 dental implants. The group consisted of 240 men and 269 women, with a median age of 58 years. The most frequent indication for implant placement was restoration of a partially edentulous arch (80.1%, n = 408). For 152 implants (13.3%), additional bone-augmentation or sinus elevation procedures were required. Early failures were recorded for 52 (4.6%) implants in 33 patients (6.5%). Smoking, male gender, total edentulism, implant diameter, and bone augmentation surgery were found to be associated with early implant failure. CONCLUSION: Patients referred for implant placement were more likely to be partially edentulous and older than 50 years. Singletooth replacement in the posterior mandible was the most frequent indication (24.4%) for treatment. This study found an early success rate of 95.4% and identified risk factors for early failures.

Numb chin syndrome as a sign of mandibular metastasis: A case report.

INTRODUCTION: Metastasis to the oral cavity can be located in both the soft and bony tissues and comprise only 1% of all oral malignancies; however, it is clinically significant because it indicates widespread metastatic disease and an unfavorable prognosis. A numb chin is an important presentation of oral metastasis, but other dental and systemic pathology may be involved. PRESENTATION OF CASE: We present the case of a 54-year-old woman who presented with numb chin syndrome 8 years after a diagnosis of primary breast carcinoma. The former was caused by mandibular ramal metastasis of the tumor, which also spread to the spinal canal, ribs, pelvic bones, sacrum, and proximal femur. Because of widespread metastasis, palliative treatment was administered. DISCUSSION: Despite its low incidence, oral metastasis should be considered as a diagnostic option when patients present with numb chin syndrome. Bony metastasis may produce symptoms late, in contrast to soft tissue metastasis. Pain is the first presenting symptom in most cases, but paresthesia, hypoesthesia and anesthesia in the facial region are possible symptoms too. Most oral bony metastasis are located in the mandible, especially in the molar region. Despite treatment, the average survival after diagnosis of mandibular metastasis is 6-7 months. CONCLUSION: In most cases with oral metastasis, palliative treatment is indicated. Early detection of oral lesions could improve treatment outcome and survival. A full diagnostic work-up is therefore of great importance.

Septic arthritis of the temporomandibular joint after acute otitis media in a child.

Septic arthritis of the temporomandibular joint as a complication of acute otitis media is rare in the Western world. This report describes the case of a 7-year-old boy who had pain in his right ear and limited mouth opening, following the onset of acute otitis media. A contrast-enhanced computed tomography scan revealed right-sided mastoiditis and hydrops of the right temporomandibular joint, suggesting septic arthritis. Real-time PCR and microbiologic analysis identified Streptococcus pyogenes and Staphylococcus epidermidis in the joint aspirate. Treatment with arthrocentesis and antibiotics led to full recovery of temporomandibular joint function.

Primary intraosseous squamous cell carcinoma of the mandible arising from an infected odontogenic cyst: A case report and review of the literature.

Primary intraosseous squamous cell carcinoma (PIOSCC) derived from a odontogenic cyst is a rare form of odontogenic carcinoma. The incidence of carcinomas arising from odontogenic cysts is particularly uncommon and is reported to occur in 1-2 individuals for every 1,000 cases. The present case describes a 25-year-old man who was initially diagnosed with a chronically infected odontogenic cyst of the mandible. Biopsy and subsequent histology revealed the presence of squamous cell carcinoma. Therefore, neck dissection and hemimandibulectomy were performed. Ultimately, the situation in the mouth healed, though with a severe amount of scarring. Although the development of PIOSCC from an odontogenic cyst is rare, it should be included in the differential diagnosis for jaw bone radiolucency.

Differences in human papillomavirus-positive and -negative head and neck cancers in Belgium: an 8-year retrospective, comparative study.

OBJECTIVES: This study investigated the prevalence of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) and compared patient profiles and outcomes between HPV-positive and HPV-negative groups. STUDY DESIGN: This retrospective study included all patients treated for OPSCC in the University Hospitals of Leuven between 2004 and 2012. Paraffin-embedded tumor tissue was available for all patients. Patient characteristics, treatment, and follow-up data were retrieved from medical files. HPV status was determined by immunohistochemical staining for the p16 epitope. RESULTS: Among 94 patients, the prevalence of HPV-positive OPSCC was 22.34%. Compared with HPV-negative tumors, HPV-positive tumors were correlated with less smoking and alcohol consumption, tonsillar sublocalization (P < .05), and younger age. HPV-positive OPSCC was associated with better overall survival (62.2%) compared with HPV-negative OPSCC (42.5%; P = .0588). CONCLUSIONS: Among patients with OPSCC, those with HPV exhibited profiles different from those without HPV. HPV-positive OPSCC was associated with better overall survival compared with HPV-negative OPSCC. HPV-positive OPSCC prevalence increased over time.