Canine incisors
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Canine Incisors: Periodontal Outcomes, Resorption, and Treatment Approaches
Periodontal Outcomes of Impacted Maxillary Canines and Incisors
Surgical Exposure and Orthodontic Alignment
Impacted maxillary central incisors and canines often require surgical exposure followed by orthodontic alignment. A systematic review and meta-analysis evaluated the periodontal outcomes of these procedures. The findings indicated that aligned impacted maxillary canines, compared to their non-impacted counterparts, exhibited increased Plaque Index scores, clinical attachment loss, pocket probing depth, and bone loss, along with reduced keratinized gingival width. These adverse periodontal effects, although modest, highlight the need for careful post-treatment monitoring.
Resorption of Adjacent Incisors Due to Ectopic Canine Eruption
Predisposing Factors and Clinical Implications
Ectopic eruption of maxillary canines can lead to resorption of adjacent lateral incisors. Studies have shown that resorption is more common in girls and is associated with a more medial position of the canine in the dental arch. Additionally, the extent of resorption can be significant, with computerized tomography (CT) revealing that 38% of lateral incisors and 9% of central incisors adjacent to ectopically erupting canines experience resorption. The severity of resorption varies, with some cases involving the middle and apical thirds of the root.
Palatally Displaced Canines and Root Resorption
Palatally displaced canines (PDCs) are another concern, as they can cause incisor root resorption (IRR). Research indicates that 74% of lateral incisors adjacent to PDCs are affected by IRR, with the resorption often located in the mid and apical thirds of the root. Predictors for PDC-IRR include canine contact with adjacent incisors, size of the canine dental follicle, and the presence of peg-shaped lateral incisors.
Treatment Approaches for Missing or Impacted Canines and Incisors
Canine Substitution for Missing Lateral Incisors
For patients with congenitally missing lateral incisors, canine substitution is a viable treatment option. This approach involves repositioning the canine to function as a lateral incisor, often requiring restorative procedures such as porcelain veneers or crowns to achieve optimal esthetics and function . The interdisciplinary treatment planning is crucial to ensure successful outcomes.
Managing Mandibular Lateral Incisor-Canine Transposition
Mandibular lateral incisor-canine transposition is a rare developmental anomaly where the positional interchange of these teeth occurs. This condition is often associated with other dental anomalies such as tooth agenesis and peg-shaped maxillary lateral incisors. Genetic factors are believed to play a significant role in the development of this anomaly.
Impact of Canine Traction on Maxillary Incisors
Orthodontic traction of impacted maxillary canines can affect the inclination and position of maxillary incisors. Studies have shown that bilateral canine impaction leads to greater labial inclination and protrusion of maxillary incisors compared to unilateral impaction. These changes should be considered during treatment planning to avoid undesirable esthetic outcomes.
Conclusion
The management of impacted or ectopically erupting maxillary canines and incisors presents several challenges, including periodontal complications and the risk of resorption of adjacent teeth. Careful diagnosis, interdisciplinary treatment planning, and consideration of individual patient factors are essential to achieve optimal functional and esthetic outcomes. Further research is needed to refine treatment protocols and improve patient-centered outcomes.
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