Prevalence of Ectopic Canine in Different Sagittal and Vertical Skeletal Patterns.

AIM: The present investigation aims to find out the prevalence of ectopic canines among skeletal class I, II, and III malocclusions and to evaluate its variability among different genders and their growth patterns. MATERIAL AND METHODS: The study sample included orthopantomograms (OPGs), lateral skull views, and study models of 999 patients collected from departmental archives. Among the selected samples, 258 were males and 738 were females. They were divided into skeletal class I, II, and III malocclusions sagittally and hypodivergent, normodivergent, and hyperdivergent groups according to their angle formed between point A-Nasion - point B (ANB) and angle formed between the Sella-Nasion (SN) plane and Gonion (Go) - Gnathion (Gn) plane (SnGoGn) values respectively. RESULTS: Of the 999 samples, 738 (73.9%) were female and 260 (25.8%) were male patients. When compared to men, females had a higher proportion of ectopic canines. An estimated 62.3% of skeletal class I, 29.1% of skeletal class II, and 8.6% of skeletal class III cases were found to have ectopic canines. An estimated 720 (72.1%) patients were found to have maxillary ectopic canines and out of the available sample, 474 patients have horizontal growth patterns, 335 have average growth patterns and 190 patients have vertical growth patterns. Labial impaction was the commonest (65.4%) followed by palatal (24.8%). Bilateral impaction was comparatively more (51.1%) than unilateral impaction (48.2%). Maxilla was more prevalent (72.1%) as compared to the mandible (16.3%) and for both the arches it was (11.6%). Ectopic canines were identified in a total of 62.3% of cases with skeletal class I, 29.1% of cases with skeletal class II, and 8.6% of cases with skeletal class III. CONCLUSION: The bilateral ectopic canine was mostly seen in skeletal class I and class III malocclusions, whereas, a unilateral presentation was mostly seen in skeletal class II malocclusions. CLINICAL SIGNIFICANCE: Knowing the likelihood of a maxillary canine erupting ectopically will aid clinicians in starting with interceptive therapy since this condition necessitates complex orthodontic mechanics.

Pulp Revascularization After Autotransplantation of the Mandibular Canines With Partially Resected Roots: Report of 5 Cases With Follow-ups Between 26 and 80 Months.

INTRODUCTION: Transmigrated (migrated through the midline) mandibular canines constitute a treatment challenge. Advanced transmigration can be successfully treated by autotransplantation. In developing canines, pulp revascularization is typical after transplantation. On the contrary, the pulp of teeth with completed apex formation does not undergo revascularization. In this case, root canal treatment becomes compulsory and decreases the success of autotransplantation. The aim of this observational retrospective study was to evaluate whether partial resection of the root (performed during the autotransplantation of mature canines) would enable revascularization of the pulp after the surgery. METHODS: Five transmigrated mandibular canines with complete apex formation before the surgery were evaluated. During the autotransplantation surgery, the resection of 2 to 4 mm of the root apex was performed to open the path for revascularization of the pulp after surgery. The transplanted teeth were observed during healing after the surgery for the presence of pulp obliteration. Clinical and radiographic examinations were performed. RESULTS: All treated canines survived the minimum observation period of 2 years (ranging from 26 to 80 months, mean: 55 months) without pulp healing complications. The survival was 100%, and the success was 80%. In one canine, the external cervical root resorption was diagnosed and treated 1 year after the surgery. At the final examination, transplanted canines presented radiographic features of pulp obliteration, normal mobility, and healthy periodontal tissues. CONCLUSIONS: The surgical protocol proved to be successful in promoting revascularization to maintain pulp vitality, in all cases. The outcomes confirm that autotransplantation, combined with the resection of the root, constitutes a valid treatment for mature ectopic canines.

Ectopic and impacted maxillary canines: A quality evaluation of online information.

OBJECTIVE: To determine the quality of online information regarding ectopic and impacted maxillary canines (EIMCs). DESIGN: A cross-sectional survey on the Internet. MATERIAL AND METHODS: An online search using eight terms was carried out using four search engines. The relevant content of websites satisfying the inclusion and exclusion criteria were assessed for quality by applying three quality of information instruments and one readability tool. Statistical analyses were performed through GraphPad Prism 9.0. RESULTS: In total, 77 websites were evaluated. Most of the assessed content was associated with oral and maxillofacial surgery (49.35%) and orthodontic websites (31.18%). The overall mean DISCERN score was 38.05 ± 9.76/80 with 59.73% of websites recording a poor or very poor score. Three (3.9%) websites contained the HONCode seal. Twelve (15.58%) websites satisfied at least three out of a maximum four JAMA benchmarks and 11 (14.29%) satisfied none. The mean SMOG score was 9.81 ± 1.52 (95% confidence interval = 9.46-10.16; range = 6.7-15.1). CONCLUSION: The quality of online information related to EIMCs was poor and the content was difficult to read. Professional societies and clinicians should consider the use of quality of information and readability tools to enable the provision for reliable, high-quality and readable online information. This will assist EIMC treatment-related decision-making and management by patients and their families.

Oral Health Impact Profile in Orthodontic Patients with Ectopic Canine: A Prospective Clinical Intervention of Four Treatment Modalities.

This study evaluated the oral health-related quality of life (OHRQoL) in Saudi subjects with ectopic canine, severe crowding, and class I normal occlusion. Moreover, we assessed the differences among orthodontic treatment modalities (OTM) in the ectopic canine group. Study design: Retrospective and prospective evaluation. A total of 96 subjects were assessed for OHRQoL using the Oral Health Impact Profile, English version (OHIP-16). Initial comparison of the baseline data of ectopic canine subjects was made with severe crowding (>8 mm) and class I normal occlusion with the matched number and age of the subjects in later groups. Moreover, a comparison of OHIP-16 scores among four OTM in the ectopic canine group, baseline, 1 day, and 28 days after treatment were performed. OHIP-16 scores of ectopic canine, severe crowding, and class I normal occlusion group were 33.06, 33.09, and 26.43, respectively. Subjects with ectopic canine and severe crowding reported a significantly greater negative impact in terms of embarrassment, avoiding smiling, and lack of self-confidence. OHRQoL had no significant changes among the four OTM groups (p > 0.05). Untreated malocclusion had a significant negative impact on OHRQoL. The negative impact was seen in several domains 1 day after treatment, and gradual improvement was noted 28 days after treatment.

Frequency and association of maxillary ectopic canine with incisor root resorption and dental agenesis.

OBJECTIVE: To assess the frequency of maxillary ectopic canine both buccally and palatally displaced with incisor root resorption and dental agenesis. METHODS: The cross-sectional study was conducted from April 8 to June 29, 2019, at the Department of Orthodontics, Dr. Ishrat Ul Ebad Khan Institute of Oral Health Sciences, and Dow Dental College, Dow University Of Health Sciences, Karachi, and comprised orthodontic patients diagnosed with maxillary ectopic canine eruption. Root resorption and agenesis were diagnosed on panoramic films. Root resorption was further confirmed by periapical radiographs. Data was analysed using SPSS 21. RESULTS: Of the 98 subjects, 86(87.8%) had buccally displaced canines of which 38(44.2%) were associated with root resorption, while 12(12.2%) patients had palatally displaced canines of which 10(83.3%) had root resorption (p=0.011). Overall, 30(30.6%) lateral incisors were resorbed, 7(7.1%) both central and lateral incisors, 5(5.1%) premolars, and 6(6.1%) both lateral incisors and premolars were resorbed. Agenesis was detected in 10 (10.2%) subjects (p=0.62). CONCLUSIONS: There was found to be no association of maxillary ectopic canines with incisor root resorption and dental agenesis.

Double vs single primary tooth extraction in interceptive treatment of palatally displaced canines.

OBJECTIVES: To compare the impact of primary canine and primary first molar extractions with extractions of only the primary canine regarding correction of palatally displaced canines (PDCs). MATERIALS AND METHODS: Thirty-two children aged 9.5-13.5 years with 48 PDCs were randomly allocated to either the double-extraction group (DEG) or single-extraction group (SEG). Clinical and radiographic examinations were performed at baseline and at 6-month intervals until the canine emerged or orthodontic treatment was started. Outcome measures were: emergence of maxillary canine (yes/no), emergence of maxillary canine into a favorable position (yes/no), and maxillary canine positional change (angulation and sector). Factors influencing PDC emergence were analyzed using logistic regression. RESULTS: In the DEG, 64% (16/25) of canines emerged into the oral cavity vs 78% (18/23) in the SEG (P = .283). Favorable PDC position at trial end was seen in 64% (16/25) of the DEG vs 57% (13/23) of the SEG (P = .600). Significant distal movement of PDCs was recorded in the DEG and SEG, though no significant difference was observed between groups. Significant predictors of canine emergence were initial canine angulation (Angle A) (P = .008) and space conditions at T0 (P = .030). CONCLUSIONS: Double or single primary tooth extraction procedures are equivalent in supporting PDC eruption into the oral cavity and into a favorable position in the dental arch. Initial canine angulation and space assessments may be used as predictors of successful PDC eruption.

Class II malocclusion and ectopic canine treated with Pendulum appliance and TADs in a high-relapse potential Ehlers-Danlos patient: A case report.

The aim of this case report is to present the treatment plan, progress, and retention difficulty of an adolescent with a skeletal Class II malocclusion and ectopic canine eruption using a Pendulum appliance and skeletal anchorage. The patient was diagnosed with benign hypermobile EDS towards the end of treatment. This patient went through frequent relapses in a short period, which should be considered while treating patients with similar condition. This report emphasizes that forces applied in patients with Ehlers Danlos Syndrome will accelerate tooth movement but the clinicians should be cautious enough to avoid potential periodontal breakdown due to disturbaces in collagen remodeling.

Transmigración de canino mandibular: etiología, manejo quirúrgico y consideraciones especiales / Mandibular canine transmigration: etiology, surgical management and special considerations

En raras ocasiones, el canino mandibular derecho o izquierdo se coloca en el lado opuesto al habitual. Esta perturbación se define como la transmigración. Existen diversas teorías de su etiología, así como factores que la condicionan. La transmigración mandibular es un término que no está descrito en la literatura contemporánea y son pocos los casos reportados a nivel mundial. Presentamos un caso de trasmigración de canino mandibular derecho, posicionado por debajo del agujero mentoniano de lado izquierdo, cerca del borde basal mandibular, el cual se extrajo bajo anestesia general. Presentamos la etiología, técnica quirúrgica y consideraciones especiales en casos de trasmigración de canino mandibular (AU)

In rare occasions right or left mandibular canine is positionated at opposed side of habitual. This disturbance is defined as transmigration. There exist diverse theories about its etiology as well as conditioning factors. Mandibular transmigration is a non described term in modern literature and there are only a few reported cases at world level. We present one case of right canine transmigration positionated intimately below of left side mentonian hole near of mandibular basal edge which it was extracted under general anesthesia. We present also the etiology, surgical technique and special considerations of mandibular canine transmigration cases (AU)

Patterns and prevalence of canine anomalies in orthodontic patients.

OBJECTIVE: The aim of the present study was to present detailed information regarding the impacted maxillary and mandibular canines and their patterns of presentation into the oral cavity and to evaluate the prevalence of different canine anomalies, such as ectopic canine, transmigration, transposition and agenesis of permanent canines among central Indian population. METHOD: A total of 1593 patients OPG's were thoroughly evaluated and the prevalence of different canine anomalies like impacted maxillary and mandibular canine, transmigration, transposition, agenesis and ectopic canine eruptions were evaluated. The canine angulation, vertical position in relation to occlusal surface of adjacent tooth's and the overlapping of adjacent teeth's crown by impacted canine was evaluated by tracings. RESULT: Out of 1593 subjects, 22 patients had impacted canines. The prevalence of canine impaction was1.38%, with maxillary canine impaction of 0.93%, mandibular canine impaction of 0.37%, canine agenesis 0.06%, transmigration 0.12%, canine transposition 0.18% and the ectopic canine was 5.5%. CONCLUSION: There is no gender difference in canine impaction. The prevalence of canine impaction is 1.38%.

Management of an Unusual Ectopic Eruption of Maxillary Canine.

Transposition of teeth is a rare condition, with a prevalence of 0.3-0.4% in general population. They are more commonly observed in females, and may occur unilaterally/bilaterally with greater frequency of left side occurrence in unilateral transposition cases. A 17-year-old female patient reported with the chief complaint of unaesthetic smile. On clinical examination the patient was diagnosed with Angle's class I malocclusion with an ectopically erupted maxillary left canine labial to the left central incisor with retained deciduous canine. The treatment plan decided was to extract the retained deciduous canine, level and align the ectopic canine using an R-loop. The treatment for the patient was finished in 14 months and was retained using a fixed lingual retainer in the upper and lower arches.

Orthodontic management of a borderline case with ectopic maxillary canine by unilateral premolar extractions.

Management of orthodontic cases often requires extraction of permanent teeth. The decision making regarding extractions depends upon the arch length tooth material discrepancies, the growth pattern, general profile, and arch asymmetries. Unique orthodontic problems may command special treatment lines to be taken. The present report describes a case with unilateral buccally blocked out canine and bilateral posterior crossbite, for which unilateral premolar extractions were performed achieve esthetic and functionally stable occlusion.

The orthodontic management of ectopic canine.

The canines being the cornerstone of the arch and smile is one of the teeth, which has the longest eruption passage that gets influenced by local and general etiological factors easily. The initial calcification of the crowns starts at 4-5 months of age and proceeds toward eruption about 11-13 years of age with mesiobuccal crown angulation that gets corrected toward occlusion. It gets displaced buccally or palatally or may sometimes get impacted. Early intervention is the best suited to manage canine eruption patterns. Once erupted ectopically, they possess a great challenge in repositioning them back into their correct position. This case report discusses an orthodontic treatment planning and execution to correct a buccally placed canine with an anterior crossbite in an adult.

Paired maxillary and smaller mandibular mouthguard for rugby player with malalignment.

A rugby player who had frequently experienced soft tissue injuries while playing rugby and wearing a conventional custom-made mouthguard came to the hospital clinic. The patient had suffered traumatic soft tissue injuries such as lip lacerations and bite trauma. Severe crowding due to ectopic maxillary and mandibular canines was observed. In response to the patient's request for better protection, a set of maxillary and mandibular mouthguards was designed: one covering the entire maxillary dentition and the other the mandibular front teeth only. The mouthguards were to be worn simultaneously. In this paper, we describe how these mouthguards were fabricated and discuss the results. The patient has experienced no injury to the stomatognathic system, including the lips, for five seasons since he began wearing this set of mouthguards. This new pairing of mouthguards appears to offer sufficient protection against injury, despite severe malalignment. We believe that this new type of paired maxillary and mandibular mouthguards has the potential to reduce sports-related dental injuries.

Unusual presentation of an intraosseous hemangioma of the maxilla and displaced canine.

Intraosseous hemangiomas are benign vascular malformations which are extremely rare in the maxilla, but have been reported in the mandible, zygoma and orbital region. A 12 years old female presented to the oral and maxillofacial department with an ectopically positioned upper left canine in her zygomatic bone and buccal alveolar expansion between the upper left lateral incisor and upper left first premolar. This case shows the unusual presentation of an intraosseous hemangioma associated with an ectopically migrated upper left canine tooth. It is possible that this lesion caused migration of the tooth. The clinician should be aware of the possibility of this lesion for bony expansile lesions and the importance of radiographic examination in patients who present with delayed eruption of canine teeth. How to cite this article: Kalsi H, Scannell J. Unusual Presentation of an Intraosseous Hemangioma of the Maxilla and Displaced Canine. Int J Clin Pediatr Dent 2013;6(2):124-126.

Angulação radicular mesiodistal de caninos permanentes em crianças com fissura unilateral completa de lábio e palato / Mesiodistal root angulation of permanent canines in children with unilateral cleft lip and palate

Objetivo: analisar a influência da fissura unilateral completa de lábio e palato (FUCLP) na angulação mesiodistal dos caninos permanentes durante a dentadura mista. Material e método: Trinta radiografias panorâmicas de crianças (21 masculino e 9 feminino) com média de idade de 8 anos e 11 meses (oscilando de 6 anos e 10 meses a 10 anos e 4 meses) portadoras de FUCLP, com apenas cirurgias primárias de lábio e palato realizadas, foram retrospectivamente selecionadas. A angulação radicular mesiodistal, dos caninos permanentes superiores (no lado fissurado e não-fissurado) e inferiores, foi mensurada com referência ao plano oclusal. As diferenças entre os gêneros, entre os lados fissurado e não-fissurado na maxila e entre os lados direito e esquerdo na mandíbula foram analisadas estatisticamente pelo teste t não pareado. Resultados: Os resultados obtidos indicaram a ausência de interferência do gênero (P>0,05) e apontaram para uma significante assimetria na angulação radicular mesiodistal do canino superior no lado fissurado (P=0,001). Conclusão: Conclui-se que a FUCLP interferiu na angulação radicular mesiodistal do canino superior adjacente à fissura.

The aim of this study was to analyze the influence of unilateral cleft lip and palate (UCLP) in mesiodistal angulation of the permanent canines in the mixed dentition. Thirty panoramic radiographs of children (21 male and 9 female) with mean age of 8 years and 11 months (ranging from 6 years and 10 months to 10 years and 4 months), with UCLP with only primary lip and palate surgeries performed, were retrospectively selected. The mesiodistal root angulation of the maxillary permanent canines (the cleft and non-cleft sides) and mandibular were measured with reference to the occlusal plane. The differences between genders, between the cleft and non-cleft sides and between right and left jaw were statistically analyzed by unpaired t test. The results indicated no influence of gender (P> 0.05) and pointed to a significant asymmetry in mesiodistal root angulation of the maxillary canine on the cleft side (P = 0.001). We conclude that the UCLP influenced mesiodistal root angulation of the maxillary canine adjacent to the cleft.