Treatment options for impacted maxillary canines and occurrence of ankylotic and resorptive processes: a 20-year retrospective study.

BACKGROUND: This 20-year retrospective study aimed to evaluate the treatment methods used in patients with impacted maxillary permanent canines and to determine the occurrence of ankylotic and resorptive processes and their association with potential risk factors. METHODS: The cohort consisted of 351 consecutive Caucasian patients (120 males and 231 females, mean age 18.4 and 19.9 years, respectively) with 420 impacted maxillary permanent canines. CT and CBCT findings were subsequently confirmed during surgery. Statistical analyses were performed by the generalized linear models, Pearson x2 and Fisher exact tests using the statistical programs R and Statistica v. 14. RESULTS: A total of 273 (65.0%) impacted canines were aligned in the dental arch by orthodontic traction after surgical exposure, this treatment was predominant in patients under 20 years of age. Surgical extraction was performed in 115 (27.2%) impacted canines and was more common in older patients. Ankylotic changes were recorded in 61 (14.5%) impacted canines. The probability of ankylosis increased with age, particularly after the patient's 20th year of life (p < 0.001). Patients were 1.2% likely to develop ankylosis at age 15 years, 4.3% at age 20 years, 14.1% at age 25 years, and 96.8% at age 45 years. Invasive cervical root resorption (ICRR) was found in 8 (1.9%) canines. In 4 canines (1.0%), root ankylosis in addition to ICRR was observed. In contrast to ankylosis, whose frequency of occurrence increased with age, the occurrence of ICRR resulting from PDL damage during surgery was more typical in younger patients. Canines in a high position above the root apices of the adjacent teeth, with a horizontal inclination of the longitudinal axis, with the crown located deep in the center of the alveolar bone and with labiopalatal position, should be considered critically impacted canines with a high risk to failure of orthodontic traction. CONCLUSION: In conclusion, the treatment of impacted canines depends mainly on the age of the patient, and the position and inclination of the longitudinal axis of the impacted tooth. To select an adequate treatment method, we recommend CBCT examination, which allows a precise analysis of the position of impacted canines.

Computer-assisted open exposure of palatally impacted canines for orthodontic eruption: A randomized clinical trial.

OBJECTIVE: This randomized clinical trial aimed to assess the feasibility of computer-assisted open exposure of palatally impacted canines. MATERIALS AND METHODS: Patients aged 11-30 years who required orthodontic eruption for the full palatal impaction of their canines were included in this study. Exclusion criteria were psychosocial and dental contraindications of orthodontic treatment, congenital craniofacial disorders, and trauma in the patient's history in the vicinity of the surgical site. Virtual planning software was used to register the intraoral scans and cone-beam computed tomography data and to design a surgical template. In the test group, exposure of the canines was guided by a surgical template, whereas in the control group, the surgeon relied on the surgical plan to localize the impacted canine. The success of the intervention, duration of surgery, and complications, including excessive hemorrhage, damage to the canine or neighboring anatomical landmarks, and postoperative inflammation of the surgical site were assessed. Postoperative pain was reported by the patients using the visual analog pain scale (VAS). RESULTS: Surgery was deemed successful in all patients in both groups. During healing, no complications were observed. The duration of surgery decreased significantly in the test group (4 min 45.1 s ± 1 min 8.4 s) compared to that in the control group (7 min 22.3 s ± 56.02 s). No statistically significant differences were observed between the VAS scores of the two study groups. CONCLUSIONS: The application of virtual planning and static navigation is a viable approach for the open exposure of palatally impacted canines. CLINICAL TRIAL REGISTRATION NUMBER: NCT05909254. CLINICAL SIGNIFICANCE: Computer-assisted surgery is a feasible method for open exposure of palatally impacted canines, which decreases the duration of surgery compared to the freehand method.

Método de extrusión dentaria unitaria con fines protésicos: caso clínico / Single tooth extrusion method for prosthetic purposes: a clinical case

La pérdida de estructura dentaria por debajo del margen gingival y de la cresta ósea alveolar, ya sea por caries, fracturas traumáticas, desgaste, reabsorción radicular o perforaciones iatrogénicas, dificulta el tratamiento protésico y requiere un abordaje multidisciplinario para conseguir resultados óptimos y estables a largo plazo. Se presenta el caso de una paciente adulta que acude a consulta con la pieza 2.3, que no permite una adecuada restauración protésica sin invadir el espacio biológico. Dentro del abanico de posibilidades terapéuticas se selecciona la extrusión dentaria unitaria guiada, para poder exponer un remanente dentario adecuado supragingival, y conseguir un adecuado efecto ferrule para la posterior rehabilitación protésica. La técnica presentada es eficaz, simple, cómoda, higiénica y útil en pacientes que no desean realizarse tratamiento de ortodoncia en ambas arcadas (AU)

Marsupialization of a dentigerous cyst followed by orthodontic traction of two retained teeth: A case report.

This case report discussed a combined surgical-orthodontic rescue of two impacted teeth in a large dentigerous cyst by the means of fixed orthodontic appliances. After careful evaluation of the 3D radiographic exams, extraction of the deciduous elements was carried out, followed by marsupialization and orthodontic traction of the impacted teeth. Surgical procedures, pre- and posttreatment records and orthodontic biomechanical evaluations are discussed.

Combined orthodontic, surgical, and restorative approach to treat a complicated crown-root fracture in a maxillary central incisor.

This case report shows the treatment of a severe traumatic tooth injury. For the maxillary right central incisor, the trauma was considered a complicated crown-root fracture. The level of the fracture line, the length of the remaining root segment, and the presence and condition of the tooth fragment determined the type of therapy. Traumatized teeth with fractures below the alveolar crest are often considered hopeless. As this report shows, the treatment of a complicated crown-root fracture in the esthetic region can be challenging. Orthodontic extrusion and crown-length surgery were performed to bring the fracture line above the alveolar bone crest. A multidisciplinary approach was required for complete rehabilitation of the traumatized maxillary incisor. Suggestions are made to improve treatment planning of complicated crown-root fractures.

Periodontal status of anterior teeth following clinical crown lengthening by minimally traumatic controlled surgical extrusion.

BACKGROUND/AIMS: The number of fractured anterior teeth following trauma has been increasing while not every patient is able to afford a dental implant instead of maintaining the injured tooth. Thus, a tooth conservation solution is required to place an aesthetic and functional restoration without biologic width violation. The aim of this study was to evaluate the effectiveness of minimally traumatic controlled surgical extrusion in fractured anterior teeth crown lengthening by assessing the periodontal status through clinical examination and radiographs. METHODS: This longitudinal observational study investigated a group of 18 patients (six males and 12 females) at the Department of Periodontology, National Hospital of Odonto-stomatology, Ho Chi Minh City, Vietnam. Following pre-surgery procedures and examination, minimally traumatic controlled surgical extrusion was carried out using a periotome. Patients were examined at four follow-up appointments after 1 week, 1, 3 and 6 months to record the following experimental variables: periodontal parameters including the gingival index (GI), pocket depth (PD), bleeding on probing (BOP), mobility, marginal gingiva position, alveolar ridge resorption, periapical osteogenesis, tooth resorption and ankylosis. RESULTS: All periodontal parameters were significantly decreased at 3 and 6 months post-procedure (P < 0.001). Tooth mobility decreased gradually following surgery, and at 6 months, all teeth became normal at level 0. Periapical osteogenesis changes were significantly increased at 1, 3 and 6 months in comparison with pre-surgery (P < 0.001). Marginal gingiva position and alveolar ridge resorption were not significantly different between pre-surgery and 1, 3 and 6 months post-surgery. No cases of root resorption or ankylosis were observed at 6 months post-surgery. CONCLUSION: A minimally traumatic controlled surgical extrusion technique for clinical crown lengthening yielded highly successful results in both aesthetic and functional aspects, and no cases had unfavourable outcomes during the 6-month follow-up period.

Surgical extrusion with an atraumatic extraction system: A clinical study.

STATEMENT OF PROBLEM: Clinical studies evaluating the feasibility of a novel technique for the surgical extrusion of nonrestorable teeth with subgingival caries are lacking. PURPOSE: The purpose of this clinical study was to investigate the success rate and incidence of biological and technical complications after tooth extrusion with an atraumatic extraction system (AES). MATERIAL AND METHODS: Participants were recruited from 61 consecutive patients initially referred to a specialist oral surgery practice. Fifty-one participants who underwent surgical extrusion with an AES followed by endodontic treatment and coronal restoration could be re-evaluated clinically and radiographically. RESULTS: The mean observation period was 3.1 years (range: 0.8 to 6.5 years). The participants varied in age between 24.8 and 86.3 years. The amount of extrusion was between 2.5 and 5.0 mm (mean 3.2 mm). At recall, 92.2% (47 of 51) of the extruded teeth were considered successful. All extruded teeth were asymptomatic, without clinical signs of inflammation. Percussion appeared normal and did not differ from that of the adjacent teeth, indicating absence of ankylosis. Transient resorption with a slightly altered root contour was detected in 5 of the 51 teeth. Minor reduction of the bone level (less than 10%) was detected in 8 of the 51. In a further 2 teeth, bone loss amounted to 25% and 30%. Periapical periodontitis at recall was seen in 4 of the 51 teeth, and a preexisting periapical lesion healed in 10 of 13. Root perforation was identified in 3 of the 51, and a further 3 of 11 were not available for recall. Thus, the technical complication rate was 9.7% (6 of 62). CONCLUSIONS: The AES may be successfully used for surgical extrusion to save apparently nonrestorable teeth, irrespective of patient age.

Effectiveness of Nd:YAG Laser Fiberotomy in Clinical Crown Lengthening by Forced Eruption.

Crown lengthening by forced eruption is usually followed by conventional surgical procedures. The aim of the present study was to evaluate clinical use of Nd:YAG laser fiberotomy in crown lengthening by forced eruption as an alternative to surgery. Patients who needed crown lengthening were enrolled in this prospective case series and underwent forced eruption. Fiberotomy by Nd:YAG laser was performed 2 days after initiation of forced eruption and every 2 weeks afterward to reach optimum clinical crown length. Measurements included sulcus depth (SD), distance between the gingival margin and the acrylic stent (GM-S), distance from the dental tissue to the gingival margin (clinical crown length) (DT-GM), and distance from the top of the alveolar bone crest to the stent (AC-S) at the mesiofacial, midfacial, distofacial, and midlingual surfaces. A total of 20 patients (9 men and 11 women) with a mean age of 35.25 were enrolled. The SD, GM-S, and AC-S did not change significantly after fiberotomy (P = .32, P = .33, and P = .08, respectively). The DT-GM increased significantly following fiberotomy (P = .001). The results of this study showed that the location of the gingival margin and alveolar bone crest remained unchanged following fiberotomy by Nd:YAG laser during forced eruption, and that Nd:YAG laser can be used as a proper method for fiberotomy in such procedures.

Root length and alveolar bone level of impacted canines and adjacent teeth after orthodontic traction: a long-term evaluation

Abstract Objective The aim of this retrospective study was to evaluate the long-term effects of orthodontic traction on root length and alveolar bone level in impacted canines and adjacent teeth. Material and Methods Sample consisted of 16 patients (nine males and seven females), mean initial age 11 years and 8 months presenting with unilaterally maxillary impacted canines, palatally displaced, treated with the same surgical and orthodontic approach. Teeth from the impacted-canine side were assigned as Group I (GI), and contralateral teeth as control, Group II (GII). The mean age of patients at the end of orthodontic treatment was 14 years and 2 months and the mean post-treatment time was 5 years and 11 months. Both contralateral erupted maxillary canines and adjacent teeth served as control. Root length and alveolar bone level (buccal and palatal) were evaluated on cone-beam computed tomography (CBCT) images. The comparison of root length and alveolar bone level changes between groups were assessed by applying paired t-test, at a significance level of 5% (p<0.05). Results There were no statistically significant differences in root length and buccal and palatal bone levels of canines and adjacent teeth among groups. Conclusions Impacted canine treatment by closed-eruption technique associated with canine crown perforation, has a minimal effect on root length and buccal and palatal alveolar bone level in both canine and adjacent teeth, demonstrating that this treatment protocol has a good long-term prognosis.

Implant Site Development for Enhancing Esthetics of Soft and Hard Tissue and Simplification of Implant Surgery Using a Forced Eruption.

The keys to successful esthetic implant therapy in the anterior region are natural-looking implant restorations and an adequate alveolar ridge volume. Destruction of periodontal tissue resulting from periodontal and/or endodontic inflammation causes esthetic problems. Forced eruption is a valuable adjunct to augmenting the soft and hard tissue where the alveolar ridge is insufficient for esthetics. In this article, forced eruption was adopted for implant site development prior to implant placement and the periodontal tissue was augmented vertically using this technique. This technique simplified the surgical implant procedure without a need for advanced augmentation.

[Reason for failure in the treatment of impacted and retained teeth]. / Échec de la mise en place de dents retenues et incluses.

The positioning of an impacted or retained tooth in either children or adults presents a real challenge for the two practitioners involved, the orthodontist and the surgeon in charge of the surgical exposure. The maxillary canine is the tooth most often impacted in the anterior segment, with a prevalence of 2% in the general population. One can understand, therefore, the functional and esthetic challenge for the surgical-orthodontic team whose aim will be to reposition the impacted or retained tooth in the arch. A large number of mistakes must be avoided in order to achieve a satisfactory result for both the patient and the practitioner. Modern imaging techniques should be used to obtain a precise diagnosis of the location of the tooth and to perform surgery which will spare the tooth in question as well as the surrounding anatomic structures. The directions and forces of the traction used will need to be carefully thought out in order to move the tooth into its final position on the arch in optimal conditions. The periodontal setting will be optimized and checked at every step of the treatment. The aim, in fact, is to anticipate the onset of periodontal problems on the grounds that prevention is easier than cure.

Atraumatic surgical extrusion to improve tooth restorability: A clinical report.

This clinical report describes the use of an "atraumatic" vertical extraction system to facilitate the restorative treatment of a tooth that would otherwise be considered unrestorable because of subgingival caries. Minimally invasive surgical root extrusion was undertaken using the Benex extraction system, which can provide controlled tooth extrusion with minimal deformation of the bone socket. A carious endodontically treated mandibular premolar was extruded to provide routine restorative treatment and endodontic retreatment.

Extrusion of severely impacted mandibular first molar using partial orthodontics and temporary anchorage miniscrews.

BACKGROUND: This study reports a case in which a severely impacted lower first molar was recovered with a combined orthodontic therapy and minimally invasive oral surgery with special focus to patient's aesthetic demands. CASE REPORT: A 12-year- old female patient was complaining delayed eruption of mandibular right first molar. Radiographic exam showed a severe tooth impaction with a close relationship between tooth roots and mandibular nerve. As the patient refused full arches orthodontic treatment, a partial orthodontic approach was projected. During treatment, temporary miniscrews were placed in both upper and lower arches, in order to allow dental movement with maximum anchorage. After a 24 month-therapy the tooth was extruded, so the appliance and the miniscrews were removed. CONCLUSION: The present case shows that severe tooth impaction can be resolved with a combined partial orthodontic- minimally invasive surgical treatment.

Recovering teeth from a large dentigerous cyst: A case report.

A dentigerous cyst is an odontogenic lesion caused by the expansion of the follicle surrounding the crown of impacted, embedded or unerupted teeth. These cysts may cause destruction of the bone, displacement of adjacent teeth, resorption of their roots and prevent the eruption of cyst-associated permanent teeth. This paper discusses successful use of marsupialization combined with orthodontic treatment to treat cyst-associated impacted permanent teeth and to correct a class II open bite malocclusion.

Predictive variables derived from panoramic radiographs for impacted maxillary cuspids treated with easy cuspid system.

The aim of the current study was to find, by means of panoramic radiographs, a viable statistical method to forecast the duration of orthodontic traction of impacted maxillary cuspids. The treatment sample consisted of 51 palatal impacted cuspids (19 unilateral and 32 bilateral) in 35 patients (aged between 10.5 and 17.5 y) with a cervical vertebral maturation between cervical stage 1 and 4. Each patient underwent the same combined surgical-orthodontic technique. Anamnestic data as well as pretreatment panoramic radiograph and cephalogram with European Board of Orthodontics analysis were recorded for each case. Eight radiographic indicators were derived from panoramic films to define the reliable position of the impacted cuspid. Multiple regression analysis was used. All cuspids were successfully treated with an average traction time of 99 days (range, 33-188 d). The pretreatment radiographic features assessed on the panoramic radiographs did not significantly affect the duration of traction. The formula based on α angle, d1 distance, and S sector forecasted an average traction time of 123 days (range, 63-210 d), which is longer than the real time. No relevant correlations were found between orthodontic traction time and pretreatment radiograph parameters derived from panoramic film at the beginning of the treatment. The classic formula elaborated by Crescini could not be applied to the patients of this study, who were treated with the Easy Cuspid method.

Efficacy of the technique of piezoelectric corticotomy for orthodontic traction of impacted mandibular third molars.

Our aim was to assess the efficacy of piezoelectric corticotomy for orthodontic traction of mandibular third molars close to the inferior alveolar nerve. Thirty patients with impacted third molars close to the nerve were included in the study, 15 of whom were treated with conventional orthodontic traction and 15 with piezoelectric corticotomy. We recorded duration of treatment including exposure and orthodontic traction, and time to the final extraction. Postoperative complications including trismus, swelling, and pain were also noted. Alveolar bone levels mesial and distal to the second molars were evaluated on cone-beam computed tomographic (CT) images. Student's t test was used to assess the significance of differences between the groups. After orthodontic treatments all impacted third molars were successfully removed from the inferior alveolar nerve without neurological damage. The mean (SD) duration of surgical exposure in the piezoelectric corticotomy group was significantly longer than that in the conventional group (p=0.01). The mean (SD) duration of traction was 4 (2.3) months after piezoelectric corticotomy, much shorter than the 7.5 (1.3) months in the conventional group (p=0.03). There were no significant differences in postoperative complications between the groups. There was a significant increase in the distal alveolar height of second molars after treatment in both groups (p<0.01). We conclude that the use of piezoelectric corticotomy allows more efficient and faster traction of third molars with a close relation between the root and the inferior alveolar nerve, although it took longer than the traditional technique.

Εvaluation of a treatment protocol for unerupted maxillary central incisors: retrospective clinical study of 46 children.

AIM: To evaluate the clinical outcome of a treatment protocol performed in children with unerupted permanent maxillary central incisors, including surgical removal of any related obstruction and traction initiation in one stage, under fully repositioned flap, combined with pre- and post-operative orthodontics for space creation and final alignment. METHODS: Forty-six patients aged 7.3-12.7 years (mean = 9.44 ± 1.36) having 54 impacted maxillary central incisors were reviewed. The study group included 37 patients fully treated by us and nine referrals with eruption failure of impacted incisors following previous surgical removal of various obstructions. Detailed patient's clinical and radiographic data were recorded. RESULTS: Aetiology of unerupted incisors included 9 patients with odontomas, 24 with supernumerary teeth, 1 with skeletal lack of space, 1 with a dentigerous cyst, 4 with dilaceration, 1 with severe incisor MIH, 5 with luxation injuries to primary predecessors and 1 with coexisting dilaceration and odontoma. The total treatment time following the standardised protocol ranged from 5 to 21 months (mean 9.88 ± 3.10), while the time needed using different approaches (no pre-operative orthodontics or obstruction removal and then to wait over an assessment period) ranged from 12 to 18 months (mean 15 ± 2.12) and 17 to 30 months (mean 23.73 ± 5.14), respectively (p < 0.05). The time needed for full alignment depended on the inclination, the height of the impacted tooth (p = 0.001) and the patient's age (p = 0.002). Additionally, the absence of pre-operative orthodontics for space creation dramatically increased treatment time (p = 0.018). In contrast, the maturity of the impacted tooth and the developmental stage of the anterior teeth did not affect treatment time. Finally, when the location of the impacted tooth and the space availability allowed waiting for spontaneous eruption, treatment time was not statistically different from that of the main treatment protocol (p = 0.545). CONCLUSIONS: The studied treatment protocol appears ideal for successful results and minimum treatment time. Space creation followed by surgical removal of any obstruction together with orthodontic traction initiation produces excellent results, while waiting for spontaneous eruption is indicated only in cases of favourable patient's age and tooth location. Treatment initiation with operation in the absence of the required eruption space is not recommended, whereas in unfavourable cases obstruction removal without simultaneous orthodontic traction increases dramatically the total treatment time and requires an unnecessary second operation for traction.

An efficient biomechanical approach for the management of an impacted maxillary central incisor.

Treatment of an impacted maxillary central incisor poses a unique challenge to the orthodontist because of its position within the esthetic zone, requiring careful management of the soft tissues and an effective biomechanical setup for alignment. This article describes a novel method of extending an extrusion wire from cross tubes attached on the base archwire for forced eruption of impacted central incisors. The effectiveness and versatility of this method are demonstrated with 2 patients.

An idiosyncratic post-traumatic tetrad: compound odontome, dentigerous cyst, impaction, and double-dilaceration.

OBJECTIVE: This report describes the case of a 13-year-old patient who experienced traumatic intrusion of the primary maxillary right central incisor and subsequently suffered an atypical tetrad, comprising of an unerupted compound odontoma associated with a dentigerous cyst, and an impacted, doubly dilacerated permanent maxillary right central incisor; however, the high interconnectivity of the occurrence of four pathologies together is unusual has not previously been reported. SUMMARY: The pathologies were detected 7 years after trauma; surgical removal of odontome along with the dentigerous cyst was performed, followed by orthodontic extrusion of the impacted double-dilacerated permanent central incisor. The 18-month follow-up shows no pathology, no gingival recession, and normal probing depth.

Orthodontic traction in a patient with cleidocranial dysplasia: 3 years of follow-up.

This case report describes the treatment and long-term follow-up care of a patient diagnosed with cleidocranial dysplasia who had multiple impacted permanent and supernumerary teeth. The aim of the treatment was to provide an adequate esthetic and functional reconstruction of the occlusion with good periodontal care. The patient was treated with a multidisciplinary therapeutic protocol including orthodontic and surgical procedures, and traction of 11 permanent teeth. The proposed objectives of good occlusion, normal function, healthy periodontium, and balanced profile were achieved, and the 3-year follow-up records showed stable results.