SummaryBackground and objectivesThe objective was to systematically review transalveolar transplantation of maxillary canines and the long-term outcome for an average follow-up period of 2 years or more.Data collection and analysisA systematic review of the currently available literature until December 2017 was conducted, using Medline, Cochrane Central, Web off Science, and PubMed. Articles were screened for 1. indications, 2. contra-indications, 3. surgical planning, 4. surgical technique, 5. associated risk factors, and 6. long-term outcome for transalveolar transplantation of maxillary canines with the following outcome measures: bone-related outcomes, tooth-related outcomes, soft tissue-related outcomes, and aesthetic outcome measures. Descriptive statistics, as well as a quality assessment of included articles, were performed. Following study retrieval and selection, relevant data was extracted and the risk of bias was assessed using the Methodological index for non-randomized studies (MINORS).ResultsTwelve articles were included in this review. These studies included outcome data for 783 autotransplanted maxillary canines, with long-term studies indicating a clinically acceptable overall outcome.LimitationsSince the lack of randomized controlled trials considering this topic, the quality of the evidence in the present review is considered low. However, impacted maxillary canines are a rare anomaly and different aspects, such as position of the impacted canine, patient’s age and patient’s demands, and expectancies must be taken into account, it is practically impossible to randomize treatment.ConclusionsThere is sufficient evidence to justify the transalveolar transplantation of maxillary canines as a legitimate treatment technique for impacted maxillary canines deemed difficult to treat with surgical exposure and subsequent orthodontic alignment. Long-term studies have shown that a good overall outcome is to be expected. There is no clear agreement in the literature on the indications and contra-indications for transalveolar transplantation of maxillary canines.Implication of key findingsIt is highly desirable that further research on this issue be undertaken, high-quality observational studies are recommended.RegistrationPROSPERO (CRD42017056348)

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Classification of impacted maxillary canines facilitates interdisciplinary communication. Cone beam computed tomography (CBCT) has proven to be superior for the localization of impacted maxillary canines compared with 2D imaging. The purpose of this study was to retrospectively classify a cohort of impacted maxillary canines, using a new developed 3D classification for impacted maxillary canines that is easy to use and does not require complex analysis of the 3D images. A retrospective cohort study was designed, containing CBCT data of 130 patients (male/female: 48/82; median age 16) with a total of 162 impacted maxillary canines. The proposed classification was based on four criteria: vertical crown position, mesiodistal tooth postion, bucco‐lingual crown position, and associated pathology. For all included patients, classification criteria were identified and correlated to treatment selection using a newly developed 3D classification. The most common positions were vertical crown position at apical one third of neighboring teeth, mesiodistal tooth angulation, and palatal crown position. The most frequent associated pathologies were dilaceration of the root and resorption of a neighboring tooth. Significant associations among classification variables and treatment options were observed. Limitations of this study are the retrospective design. CBCT enabled 3D assessment of impacted maxillary canines allowing a classification system that may have an impact on further treatment strategies.

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Interventions for impacted maxillary canines: A systematic review on the relationship between initial canine position and treatment outcome. Running title: Initial canine position and outcome.