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| Year : 2014 | Volume
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| Issue : 1 | Page : 125-127 |
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| Four impacted canines in an adult patient: A challenge in orthodontics |
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Orlando Motohiro Tanaka1, Ana Letícia Rocha Avila2, Ariel Adriano Reyes Pacheco2, Matheus Melo Pithon3
1 Graduate Dentistry Program in Orthodontics, Pontifical Catholic University of Parana, Curitiba, Brazil, Brazil
2 Orthodontic Postgraduate Student (MSc Program), Pontifical Catholic University of Parana, Curitiba, Brazil
3 Department of Orthodontics, Southwest Bahia State University - UESB, Bahia, Brazil
Click here for correspondence address and email
| Date of Submission | 14-Nov-2010 |
| Date of Decision | 12-Jan-2011 |
| Date of Acceptance | 03-Mar-2011 |
| Date of Web Publication | 21-Apr-2014 |
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 Abstract | | |
This case report illustrates the management of four impacted canines in an adult patient associated with prolonged retention of the four deciduous teeth. The treatment plan was formulated to extract the lower deciduous teeth, application of the forced eruption with the permanent canines, and extract the upper permanent canines and maintenance of the maxillary deciduous canines. No reshaping of the maxillary deciduous teeth was performed because the patient was satisfied with the results. Keywords: Adult patient, deciduous canines, impacted canines, included canines
How to cite this article:
Tanaka OM, Avila AR, Pacheco AR, Pithon MM. Four impacted canines in an adult patient: A challenge in orthodontics. Indian J Dent Res 2014;25:125-7 |
How to cite this URL:
Tanaka OM, Avila AR, Pacheco AR, Pithon MM. Four impacted canines in an adult patient: A challenge in orthodontics. Indian J Dent Res [serial online] 2014 [cited 2023 Jun 3];25:125-7. Available from: https://www.ijdr.in/text.asp?2014/25/1/125/131168 |
After the third molars, the maxillary canines are the most commonly impacted permanent teeth. [1] The mandibular canine is impacted less often but poses every bit as much of a treatment challenge. [2]
The management of the severely impacted canines often requires the combined expertise of a number of clinicians that communicate with each other to provide an optimal treatment plan. The surgical, periodontal, and orthodontic considerations in the management of impacted canines must be clarified to the patient. The clinician must be familiar with the differences in the surgical management of labially and palatally impacted canines as well as the best method of selecting and placing an attachment for appropriate orthodontic force application.
Whenever an adult patient presents with an impacted tooth, a calculated risk is taken in offering orthodontic treatment to resolve the impaction. The patient should be informed of the possibility of failure, a factor that, together with the increased treatment time, must be brought into the decision-making process from the outset, [3] but the in selective cases can be successfully treated.
| Report of Case | |  |
The patient was a 29-year and 5-month-old white woman with an unremarkable medical history and presenting Angle Class Idental relationship with a normal overbite and overjet. All four deciduous canines displayed a minimum of resorption and both maxillary and mandibular canines were impacted. The maxillary canines appeared to be palatally positioned and the mandibular canines were located in the center of the alveolar process [Figure 1]. | Figure 1: Initial – Both, maxillary and mandibular canines impacted. Prolonged retention of the four deciduous canine
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It must be considered in a patient with an impacted canine a comprehensive evaluation of the malocclusion. The clinician should then consider the various treatment options available for the patient, including the following: (a) no treatment, (b) extraction of lower deciduous and traction of the permanent canines, (c) extraction of maxillary deciduous canines and traction of the permanents, (d) removal of all four included permanent canines, maintenance of the deciduous teeth, and re-shaping of the deciduous teeth into permanent teeth, (e) removal of the deciduous and closing of the space, and (f) removal of permanent and deciduous canines for implants and porcelain veneer.
Based on the patient's overall analysis, good soft tissue profile and high positioned upper permanent canines and no root resorption in the deciduous, we decided to extract the included ones and the lower deciduous teeth, and perform traction on the mandibular permanent canines.
A 0.022-in standard non-torqued, non-angulated fixed orthodontic appliance was placed on all teeth except the maxillary deciduous canines. Light elastic chains were used for traction of the impacted canine. Initial leveling was accomplished with a 0.0175-in multistrand wire, followed by a 0.016-in stainless steel wire. The evolution of the traction and integrity of the adjacent teeth were appraised by panoramic and periapical radiographs. Elastic chains were initially used to move through the gingival tissue. For final positioning boot loops were used to provide light force with minimal side effects for the adjacent teeth. In the mandibular arch, interproximal enamel stripping was performed to provide space for lower left canine positioning [Figure 2]. | Figure 2: Treatment progress. Extraction of lower deciduous and traction the permanent canines. Extraction of the maxillary deciduous and permanent canines
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The initial goals of orthodontic treatment were achieved with the lower canines positioned in place. No gingival recession occurred, and a Class I relationship was established on both sides. The maxillary deciduous canine was positioned [Figure 3]. The total treatment time was 60 months. Success of traction was evident in the clinical crown length, lack of gingival recession, and healthy gingival marginal appearance; thus, the treatment chosen appears to have been the right decision. No reshaping of the maxillary deciduous teeth was undertaken, because the patient was satisfied with the results. Retention involved a wraparound maxillary removal appliance and a 0.028-in mandibular lingual retainer bonded to the canines. | Figure 3: Final the lower canines positioned in its place. Maxillary deciduous canine in position
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| Discussion | | |
The minimum root resorption displayed in deciduous canines justified our choice of maxillary permanent canine extraction. Different methods can be used to movea canine toward the correct position, but the patient's age and the location of the impacted tooth are major determinants of the length of the forced impacted canine eruption. [4] Surgical extraction and implant therapy are valid alternatives for adults. [5]
From a biomechanical perspective, it is desirable to deliver a light, point force in the occlusal direction to erupt impacted canines when sufficient space for the canine exists or has been created. When elastic chains or threads are used to deliver the single erupting force to the canine from a rigid base archwire, the forces must be kept light due to the high load deflection rate and rapid decay of the force delivered by the elastic. Including many teeth helps to distribute the unwanted intrusive side effects among a larger cumulative root surface area and thus to minimize localized deleterious effects. [6],[7]
In a similar case with four impacted permanent canines butin a child, Crawford, [2] positioned all four canines into proper alignment with the remaining permanentteeth, but the maxillary and mandibular incisors, however, did experience minor to moderate root resorption. Active treatment was discontinued after 60 months because of poor compliance and parental request.
| Conclusion | | |
Mandibular canines were properly aligned with the aid of orthodontic traction, surgical assistance and the maintenance of the maxillary deciduous canines.
| References | | |
| 1. | Suri S, Utreja A, Rattan V. Orthodontic treatment of bilaterally impacted maxillary canines in an adult. Am J Orthod Dentofacial Orthop 2002;122:429-37. 
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| 2. | Crawford LB. Four impacted permanent canines: An unusual case. Angle Orthod 2000;70:484-9.
[PUBMED] |
| 3. | Becker A, Chaushu S. Success rate and duration of orthodontic treatment for adult patients with palatally impacted maxillary canines. Am J Orthod Dentofacial Orthop 2003;124:509-14.
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| 4. | Kokich VG. Surgical and orthodontic management of impacted maxillary canines. Am J Orthod Dentofacial Orthop 2004;126:278-83.
[PUBMED] |
| 5. | Bishara SE. Impacted maxillary canines: A review. Am J Orthod Dentofacial Orthop 1992;101:59-71.
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| 6. | Suri S, Utreja A, Rattan V. Orthodontic treatment of bilaterally impacted maxillary canines in an adult. Am J Orthod Dentofacial Orthop 2002;122:429-37.
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| 7. | Tanaka O, Guidelli SL, Ribeiro JS, Filho OG, Taffarel IP. The biomechanical challenge of maxilary impacted canines in adults. Rev Clin Dental Press 2008;7:90-7.
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Correspondence Address:
Orlando Motohiro Tanaka
Graduate Dentistry Program in Orthodontics, Pontifical Catholic University of Parana, Curitiba, Brazil
Brazil
 Source of Support: None, Conflict of Interest: The authors report no commercial,
proprietary, or fi nancial interest in the products or companies described in
this article.  | Check |
DOI: 10.4103/0970-9290.131168
[Figure 1], [Figure 2], [Figure 3] |
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| This article has been cited by | | 1 |
Attempted traction of impacted and ankylosed maxillary canines: An update |
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| Marlio Vinícius de Oliveira, Matheus Melo Pithon | | AJO-DO Clinical Companion. 2021; 1(1): 86 | | [Pubmed] | [DOI] | | | 2 |
Clinical Outcome of an Impacted Maxillary Canine: From Exposition to Occlusion |
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| Orlando Motohiro Tanaka, Armando Y Saga, Ivan P Taffarel, Leonardo L Locks, Gerson LU Ribeiro | | The Journal of Contemporary Dental Practice. 2018; 19(12): 1553 | | [Pubmed] | [DOI] | |
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