Impacted Canines Classification Systems Among Orthodontic Patients

Abstract

This review covers all aspects from the viewpoint of impacted canines that were missed by some articles. Most review studies focus on the epidemiology and incidence of the disease but rarely on the detailed investigation of this therapeutic disorder; therefore, appropriate awareness of canine impaction diagnosis and management is critical prior to any orthosurgical treatment procedures. Hence, it is crucial to emphasize the means of proper diagnosis and interception of this clinical condition. This study aimed to compare and review the various diagnostic methods used to identify canine impaction, its advantages, shortcomings, research, and clinical implications to guide the evaluation and management of cases in general dental practice. Based on the current literature, the epidemiology of canine impaction, diagnosis, classification systems, and surgical options for exposing impacted canines are discussed. To determine the anatomical position of impacted canines, a thorough clinical examination and appropriate diagnostic imaging should be performed. The surgical method for exposing impacted canines should consider the tooth’s anatomical position in regard to the alveolar ridge and the amount of keratinized mucosa/gingiva. The article concludes that displacement and non-eruption of impacted canines can be managed by administering an accurate and adequate diagnosis of canine impaction, proper investigation of tooth position, length, direction, and related structures, selecting the appropriate management approach, and also reducing the biomechanics involved during canine retraction using fixed orthodontic appliances when they are impacted, and thus can restrict the risk of s urgical t rauma o n t he a djacent h ard a nd s oft t issues in th e p atients . T his a rticle m ay su ggest th at 3 D im aging is re quired to as sist cl inicians in de veloping a su ccessful t reatment p lan f or d etecting i mpaction a nd t he s urrounding structures . CPD/Clinical Relevance: Canine impactions are frequent during routine examinations. Appropriate identification, investigation, and, if necessary, referral are crucial to the outcome o f t reatment s uccess.

Impacted Canines Localization and Its Impact on Dental Arch in Orthodontic Patients: A Novel CBCT Clinical Study

“…Prior to any orthosurgical treatment procedures, it is essential to emphasize the strategies of proper diagnosis and interception for this clinical condition. 5,19 In clinical orthodontics, identifying dental arch form is critical for esthetics and long-term occlusal stability by preserving the original arch form and dimension. 17 The current investigation found insignificant between impacted canines and dental arch forms.…”

“…However, CBCT models were used instead because of the disadvantages of long-term storage for study models, such as displacement of the model, friction, damage, distortion, and loss of some details, which may cause a problem with measurements. CBCT models, on the other hand, are a valid and reliable tool for dental arch measurements, 3,19 as the radiographic image is digitized and remains the same as the first day it was obtained; hence all measurements were carried out on radiographs rather than models. These findings of the current study are also supported by the suggestion from Refaat and El-Desouky, 26 who reported that McConnell et al used measurements derived from stone cast to assess the relationship between discrepancies in the maxillary morphology and maxillary impacted canines, but the results of these studies were often contradictory and controversial.…”

“…27,30 The findings of this study were similar to those reported in other studies, while the dissimilarities were attributed to inclusion criteria, study method, and ethnic and genetic variances. 19 The treatment of impacted canines is influenced by the type of impaction, patient's age and surgical procedure, overall oral health, spacing and crowding, and related complications such as cystic degeneration and adjacent tooth resorption. Interceptive treatment, surgical exposure, orthodontic alignment, or autotransplantation are all options for treatment.…”

“…5,17 Genetic factors such as ethnicity, gender, agenesis of adjacent teeth, aplasia, and supernumerary teeth were assumed to be a result of genetic and environmental multifactorial inheritance, according to genetic theory. 5,18,19 Since the impacted canines are adjacent to vital anatomical structures, a thorough radiographic evaluation to determine the position of impacted canines is required before any treatment planning. A CBCT scan can clearly indicate its location for a clinician.…”

“…3 Orthodontists and dental professionals have used CBCT to diagnose impacted teeth because it eliminates the superimpositions inherent in two-dimensional (2D) imaging and offers several advantages over conventional computed tomography (CT), including faster scanning, image precision, user-friendly software, reduced exposure time, and low cost. 3,4,12,18,19 Accurate diagnosis is required for both efficient treatments of impacted canines and the collection of more scientific data. IMW and AL were deficient in patients with canine impaction based on Fattahi et al 20 However, this investigation determined dental arch using 2D analysis, which did not provide enough information on the dental arch in 3D, which is required to obtain more scientific data.…”