Surgical exposure and orthodontic alignment of palatally displaced canines: can we shorten treatment time?

This review will discuss the influence of various factors on the time taken to orthodontically align a palatally displaced maxillary permanent canine following surgical exposure. Previously unpublished data from a clinical trial, involving participants with unilateral PDC randomly allocated to either a closed or open surgical exposure, will be included to strengthen the debate.

Space closing versus space opening for bilateral missing upper laterals - aesthetic judgments of laypeople: a web-based survey.

OBJECTIVE: To investigate the opinions of laypeople regarding the aesthetic outcome of treating patients with developmental absence of both maxillary lateral incisors using either orthodontic space closure (OSC) or space opening and prosthetic replacement (PR). DESIGN: Cross sectional, web-based survey. METHODS: A panel of five orthodontists and five restorative dentists examined post-treatment intra-oral images of 21 patients with developmental absence of both upper lateral incisors. A consensus view was obtained about the 10 most attractive images (5 OSC; 5 PR). The 10 selected images were used in a web-based survey involving staff and students at the University of Sheffield. In the first section, the participants were asked to evaluate the attractiveness of the 10 randomly arranged single images using a 5-point Likert scale. In the second section, an image of OSC was paired with an image of PR according to their attractiveness ranking by the clinician panel, and the participants were asked to indicate which of the two images they preferred. RESULTS: The survey received 959 completed responses with 9590 judgements. The images of OSC were perceived to be more attractive (mean rating 3·34 out of 5; SD 0·56) compared with the images of PR (mean rating 3·14 out of 5; SD 0·58) (mean diff 0·21; P < 0·001). Female and staff judges tended to give higher attractiveness ratings. Both females and males preferred the OSC images closing in 3 out of 4 paired images. CONCLUSION: Space closing was perceived to be more attractive than space opening by lay people. The findings have implications for advising patients about the best aesthetic outcome when both maxillary lateral incisors are missing.

Esthetic judgments of palatally displaced canines 3 months postdebond after surgical exposure with either a closed or an open technique.

INTRODUCTION: The aim of this study was to compare the esthetic judgments of orthodontists and laypeople regarding the appearance of palatally displaced canines 3 months after treatment with either a closed or an open surgical exposure and orthodontic alignment. METHODS: A multicenter randomized controlled trial was undertaken in 3 hospitals in the United Kingdom. Patients with unilateral palatally displaced canines were randomly allocated to receive either a closed or an open surgical exposure. The teeth were aligned with fixed appliances, and 3 months after debond, intraoral photographs were taken. The photographs were projected in random order to 2 panels of judges (orthodontists and laypeople), who completed a questionnaire. RESULTS: The images of 67 participants (closed, 33; open, 34) were included. The laypeople were able to identify the operated tooth only 49.7% of the time (95% CI, 45.3%-54.0%); this was no better than chance (P = 0.880). The orthodontists were more successful but still identified the treated canine with certainty only 60.7% of the time (95% CI, 53.7%-67.8%; P = 0.003). Both panels more frequently assessed the unoperated canine to have a better appearance than the contralateral operated canine; however, there were no differences between the closed and open groups (proportion preferring unoperated canine-laypeople: closed, 58.7%; open, 57.0%; P = 0.43; and orthodontists: closed, 60.9%; open, 60.6%; P = 0.27). CONCLUSIONS: There is an esthetic impact to aligning a palatally displaced canine, but it is mostly minor and unlikely to be detectable by laypeople. The esthetic impact was the same, whether the canine was exposed with a closed or an open surgical technique.

Periodontal health of palatally displaced canines treated with open or closed surgical technique: a multicenter, randomized controlled trial.

INTRODUCTION: The aim of this study was to investigate differences in the periodontal outcomes of palatally displaced canines (PDC) exposed with either an open or a closed surgical technique. METHODS: A multicenter, randomized controlled trial was undertaken in 3 hospitals in the United Kingdom, involving 2 parallel groups. Patients with unilateral PDC were randomly allocated to receive either an open or a closed surgical exposure. Periodontal health was assessed 3 months after removal of fixed appliances. Parameters measured included clinical attachment levels, recession, alveolar bone levels, and clinical crown height. RESULTS: Data from 62 participants (closed, 29; open, 33) were analyzed. There was no difference between PDC exposed with an open vs a closed surgical technique (mean difference, 0.1 mm; 95% confidence interval [CI], -0.2-0.5). There was, however, a statistical difference in mean attachment loss between the operated and unoperated (contralateral) canines (mean difference, 0.5 mm; 96% CI, 0.4-0.7; P <0.001). Twenty of the 62 subjects had some recession on the palatal aspect of the operated canine, whereas only 4 subjects had some visible root surface on the palatal aspect on the unoperated side (P = 0.001). CONCLUSIONS: There is a periodontal impact when a unilateral PDC is exposed and aligned. This impact is small and unlikely to have clinical relevance in the short term; however, the long-term significance is unknown. When the open and closed techniques were compared, no difference in periodontal health was found.

No difference in surgical outcomes between open and closed exposure of palatally displaced maxillary canines.

PURPOSE: To investigate differences in surgical outcomes between open and closed exposure for palatally displaced maxillary canines. MATERIALS AND METHODS: This multicenter randomized controlled trial involved 2 parallel groups. The settings were 1 dental teaching hospital in and 2 hospital units near Sheffield, UK. Participants were younger than 20 years, had a unilateral palatally displaced maxillary canine, and provided informed consent. They were randomly allocated to receive the open or the closed surgical procedure. The outcomes were time spent in the operating room and 10-day postoperative patient questionnaire findings. Statistical differences between the 2 techniques were tested using independent t tests for continuous variables and χ(2) tests for frequencies. RESULTS: The final study sample was composed of 71 participants (64% female). There were no differences in the gender ratios (open: 27 female, 13 male; closed; 25 female, 16 male) or mean ages (open: 14.3 yrs; standard deviation [SD], 1.3 yrs; closed: 14.1 yrs; SD, 1.6 yrs) of the 2 groups at the start. The mean operating times for the open and closed techniques were 34.3 minutes (SD, 11.2 min) and 34.3 minutes (SD, 11.9 min), respectively (P = .986). There were no statistically significant differences between the 2 treatment groups for any patient-assessed outcome (P > .05). CONCLUSIONS: There were no differences in the surgical outcomes investigated in this study between open and closed exposure for palatally displaced maxillary canines.