Effect of surgical exposure technique, age, and grade of impaction on ankylosis of an impacted canine, and the effect of rapid palatal expansion on eruption: A prospective clinical study

Private practice, Rethymno, Greece. Electronic address: .
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics (Impact Factor: 1.38). 03/2013; 143(3):342-52. DOI: 10.1016/j.ajodo.2012.10.017
Source: PubMed


This study had 2 aims: (1) to assess whether the surgical exposure technique, the patient's age, and the grade of impaction are associated with ankylosis of the impacted canine; and (2) to investigate the effect of rapid palatal expansion on an impacted canine's automatic eruption.
The sample for this prospective longitudinal study consisted of 118 orthodontic patients (72 female, 46 male) who were treated surgically and orthodontically by the first author (S.I.K.) over 18 years. The patients' ages at the beginning of therapy ranged from 11.2 to 46.1 years. They had 157 impacted canines (150 maxillary, 7 mandibular), grouped in 7 categories (grades I-VII) according to their radiographic position in the orthopantomogram at the onset of treatment. Univariate and multivariate generalized estimating equation logistic regression analyses were used to assess the effect of the predictors of interest on ankylosis. (In this research, a broad definition of "ankylosis" was used, to include impacted canines immobilized a priori or during traction, due to all the possible causes that could contribute to immobilization, such as all types of external tooth resorption and other known or unknown factors.)
Thirty-eight canines erupted spontaneously after space gaining, and the other 119 were treated surgically with an open (57 cases) or a closed (62 cases) exposure technique. Eleven canines of the 119 that were treated surgically had ankylosis, either a priori or during orthodontic traction. The percentages of ankylosis were 3.5% in the open technique and 14.5% in the closed technique. Evidence of statistical association was found between age and ankylosis, grade of impaction and ankylosis, and rapid palatal expansion and automatic eruption of the impacted canine.
Evidence of an association between exposure technique and ankylosis was found. Additionally, there was evidence that the grade of impaction and the patient's age are significant predictors of ankylosis, as is the use of rapid palatal expansion a predictor of automatic eruption.

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    • "However, in the same research, ankylosis was pointed out as a significant etiological factor that interfered in the success rate, corresponding to 32.4% of impacted canine failures. The ankylosis of the displaced teeth can be a consequence of the action of the low-speed drill during the surgery, chemical injury, and cervical periodontal ligament trauma by the magnitude and direction of orthodontic force [21]. Extensive surgery can be an additional factor compromising the cervical root area and promoting root resorption. "
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    ABSTRACT: Objective. The purpose of this study was to present a case report that demonstrated primary failure in a tooth traction that was subsequently treated with apicotomy technique. Case Report. A 10-year-old girl had an impacted upper right canine with increased pericoronal space, which was apparent on a radiographic image. The right maxillary sinus showed an opacity suggesting sinusitis. The presumptive diagnosis was dentigerous cyst associated with maxillary sinus infection. The plan for treatment included treatment of the sinus infection and cystic lesion and orthodontic traction of the canine after surgical exposure and bonding of an orthodontic appliance. The surgical procedure, canine position, root dilaceration, and probably apical ankylosis acted in the primary failure of the orthodontic traction. Surgical apical cut of the displaced teeth was performed, and tooth position in the dental arch was possible, with a positive response to the pulp vitality test. Conclusion. Apicotomy is an effective technique to treat severe canine displacement and primary orthodontic traction failure of palatally displaced canines.
    12/2013; 2013(4):168232. DOI:10.1155/2013/168232
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    ABSTRACT: Impaction of both mandibular canine and lateral incisor is a rare clinical finding which is often treated by way of surgical extraction. This decision is often taken because of the anatomical limitations presented by the mandible, and the horizontal position of the impacted teeth, which have occasionally transmigrated, placing them in close proximity to the roots of neighboring teeth and with a high risk for causing their resorption. In addition, this condition significantly increases the likelihood that the area involved will undergo gingival recession and loss of crestal bone if an unsophisticated ortho-surgical approach is undertaken. The present report describes a novel ortho-surgical technique which maintains the alveolar crestal bone and utilizes a lingual arch attached to the first molars with traction through tunneling with super-elastic springs. This combined approach eliminated the need for extraction of the impacted teeth, and accomplished their full alignment without any of the aforementioned side effects. Every dentist (general practitioners as well as specialists) should be aware of this procedure and refer patients to a specialist.
    Quintessence international (Berlin, Germany: 1985) 01/2014; 45(4). DOI:10.3290/j.qi.a31338 · 0.73 Impact Factor
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    ABSTRACT: An impacted mandibular first molar tends to cause serious bone defects of the adjacent teeth. When choosing between the 2 typical treatment options-extraction or orthodontic relocation of the impacted tooth-the decision should be based on assessment of the prognosis. A 22-year-old man with severe mesioangulation and impaction of the mandibular first molar and a related vertical bone defect on the distal side of the second premolar was treated with extraction of the second molar and orthodontic relocation of the first molar with a retromolar miniscrew. Comprehensive orthodontic treatment involving premolar extraction was conducted. Strategic extraction of the molar and adequate orthodontic movement helped to restore the bone structure on the affected side. This case report suggests the effectiveness of restoration of bone defects by using viable periodontal tissues around the impacted tooth for the longevity of the periodontium. Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.
    American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 04/2015; 147(4 Suppl). DOI:10.1016/j.ajodo.2014.04.026 · 1.38 Impact Factor
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