Julia Naoumova

A systematic review of the interceptive treatment of palatally displaced maxillary canines

The aim of this study was to assess whether interceptive treatment in the mixed dentition prevents impaction of palatally displaced canines (PDC) by systematically reviewing the literature. A literature search of PubMed, the Cochrane Library electronic databases, and Scopus was performed covering the period from January 1966 to May 2009. The inclusion criteria were mixed dentition with unilateral or bilateral PDC, randomized controlled trials (RCT), prospective and retrospective studies with untreated controls, and clinical trials comparing at least two treatment strategies. Three reviewers selected and extracted the data independently and evaluated the quality of the studies. Inter-examiner reliability was measured using the intraclass correlation coefficient (ICC). The search strategy resulted in 686 articles, of which two met the inclusion criteria. Because of the unequivocal results and heterogeneity in the study methods, the scientific evidence was too weak to fully evaluate the effect that interceptive treatment might have on PDC and which treatment modalities are most effective. The quality of the studies was rated as low because of inadequate sample selection and deficient description of sample size, confounding factors, uncertainty of randominization, and no blinding in measurements. The ICC value for total scores was >0.80, e.g. perfect agreement. To obtain reliable scientific evidence as to whether interceptive treatment prevents impaction of PDC and which treatment modalities are the most effective, better controlled and well-designed RCTs are needed. Future studies should also include assessment of patient satisfaction and pain experience as well as analysis of the costs and side-effects of treatments.

Cone-beam computed tomography for assessment of palatal displaced canine position: A methodological study

OBJECTIVE To assess the inter- and intraexaminer reliability of a measurement method for evaluation of eruption angles and position of palatal displaced canines (PDCs) with cone-beam computed tomography (CBCT) images and to test the validity of the measured angles on a dry skull. MATERIALS AND METHODS Twenty patients (eight boys, 12 girls; age 11.4±1.2 years) were randomly chosen among 67 patients from a study evaluating the interceptive effect of extracting the deciduous canine in children with PDCs. In total, 60 images were analyzed, because each patient had three CBCT examinations (baseline, 6-month control, and endpoint). Two observers assessed the following measurements twice: mesioangular and sagittal angle, vertical position, canine cusp tip, and canine apex to dental arch. The validity of the angular measurements was tested against angular measurements on a dry skull using mathematical formulations. RESULTS The inter- and intraexaminer mean differences for angular and linear measurements were all low and statistically insignificant (P>.05). The mean differences between the physical and 3D measurements were 0.5±0.39 mm for the sagittal angle and 0.22±0.19 mm for the mesioangular angle. CONCLUSIONS Linear and angular measurements on CBCT images are accurate and precise and can be used to assess the precise position of a PDC.

Pain, discomfort, and use of analgesics following the extraction of primary canines in children with palatally displaced canines

BACKGROUND. Pain following the extraction of the primary canine in children with palatally displaced canines (PDC) as an interceptive treatment has not been investigated. AIMS. To describe pain, discomfort, dental anxiety, and use of analgesics following the extraction of primary canines in children with PDC. DESIGN. Forty-four children, aged 10-13 with PDC, were included. Pain intensity, discomfort, and analgesic consumption were rated the first evening and 1 week after the extraction of the primary canine. Dental anxiety was assessed pre-extraction, using the dental anxiety scale (DAS). A matched reference group also completed the DAS. RESULTS. No significant differences were found between the study and the reference group regarding the pre-extraction assessments. Post-extraction pain and discomfort was low. The experience of the injection was graded worse than the extraction, and more pain was rated at the evening post-extraction than during the extraction. Analgesics were used only the first evening. High correlation was detected between DAS and pain during injection and extraction. CONCLUSIONS. The experience of pain and discomfort during and after extraction of the primary canines is low, despite that 42% of the children used analgesics. Therefore, appropriate analgesics and recommendation doses pre- and post-extraction should be prescribed.

The use of panoramic radiographs to decide when interceptive extraction is beneficial in children with palatally displaced canines based on a randomized clinical trial

Objective To evaluate which palatally displaced canines (PDCs) benefit from interceptive extraction of the deciduous canine, to assess possible side effects from the extraction, and to analyse other dental deviations in patients with PDCs. Design, settings, participants, and intervention A sample of 67 patients (40 girls, mean age: 11.3 ± 1.1; 27 boys, mean age ± SD: 11.4 ± 0.9) with unilateral (45) or bilateral (22) PDCs were consecutively recruited and randomly allocated to extraction or non-extraction using block randomization. No patients dropped out after randomization or during the study. The patients were given a clinical examination and panoramic radiographs were taken at baseline and after 6 (T1) and 12 months (T2). An individual therapy plan was made for the PDCs that had not erupted at T2. Measurements were performed blindly and the outcome measures were: canine position and angulation, root development, midline shift, rotation, or movement of adjacent teeth into the extraction site, and frequency of other dental deviations. Results Interceptive deciduous canine extraction is beneficial if the alpha angle is between 20 and 30 degrees. A PDC located in sector 4 with an alpha angle >30 degrees should have immediate surgical exposure, while canines angulated less than 20 degrees and located in sector 2 can be observed without prior interceptive extraction. Deciduous canine extraction was more beneficial in younger patients with less advanced root development. Minor side effects, such as rotation or migration of teeth into the extraction space, were observed in 15 out of 35 patients. A majority of the patients had other dental deviations than PDC in the dentition. Limitations The results are only valid for patients with no space deficiency in the maxilla and with PDCs located in sector 2-4. Harms No harms were detected. Conclusions The alpha angle and sector position are good diagnostic predictors of when interceptive extraction is beneficial. Minor side effects are seen after the extraction and the majority of the patients had other dental deviations too. Registration This trial was registered at http://www.fou.nu/is/sverige, registration number: 211141.

Glass-ionomer open exposure (GOPEX) versus closed exposure of palatally impacted canines: a retrospective study of treatment outcome and orthodontists’ preferences

Objectives To investigate which surgical technique orthodontists prefer for exposing palatally impacted canines (PICs), and to compare closed exposure and glass-ionomer open exposure (GOPEX) with regard to pre- and post-surgical orthodontic variables. Materials and methods A questionnaire with 19 questions and three cases visualising superficial, deep, or medial PICs was sent to 48 orthodontists working in a Swedish county. Sixty case records for patients with unilateral PICs from two centres were analysed; 30 patients having GOPEX (Centre A), and 30 undergoing closed exposure (Centre B). Pre- and post-surgical orthodontic variables were collected from the dental records. Results The response rate was 81 per cent. There was an equal distribution of preference between open and closed exposure. Glass-ionomer cement (GIC) was predominately used as surgical packing in open exposure. No active traction was initiated until the canine erupted spontaneously. In the closed exposure cases, traction started shortly after exposure. The clinicians mentioned similar advantages of choosing one technique over the other and the main basis for the decision was the clinicians preference and not the location of the canine. There were no differences regarding post-exposure complications between the techniques. The overall treatment time was the same but there were fewer appointments and significantly shorter active treatment time with traction of the PIC in the GOPEX group. Limitations Despite the homogeneity of the baseline patient characteristics, pre- and post-surgical orthodontic variables were analysed retrospectively, therefore, it is difficult to assess what impact these confounding factors may have had on the treatment time. Conclusions The choice of exposure technique depends on the clinicians preferences. The active treatment time is shorter and the number of appointments fewer with open exposure when GIC is used as surgical packing.

Space conditions, palatal vault height, and tooth size in patients with and without palatally displaced canines:: A prospective cohort study

OBJECTIVES: To assess palatal vault height, tooth size, and dental arch dimensions in patients with unilateral and bilateral palatally displaced canines compared with a control group. MATERIALS AND METHODS: A sample of 66 patients (mean age: 11.5 ± 1.0 years) with 22 unilateral palatally displaced canines (UPDCs), 22 bilateral palatally displaced canines (BPDCs), and 22 controls (C) were consecutively recruited. All three groups had dental casts that were scanned digitally using the OrthoX three-dimensional model scanner. Tooth size, palatal vault height, dental arch width, dental arch depth, dental arch length, and dental arch space were measured by the same examiner using the GOM software. Remeasurements were made in 10 randomly identified patients. RESULTS: The palatal vault height was significantly lower in the BPDC group compared with controls. A significantly smaller mesial-distal crown width and, in general, more spacing in the maxilla were found in the UPDC and BPDC groups. No differences in arch length or arch width at the molar region were seen between the groups, while the arch length at the canine region was smaller in the UPDC and BPDC groups. However, this was observed in BPDC patients with both deciduous canines present and in most UPDC patients where the deciduous canine was present, compared with the control group, who had more permanent canines present. CONCLUSIONS: Patients with PDC had greater reduction in tooth size compared with the control group. The arch length and arch width were similar in patients with and without PDC.

A comparative study of cone beam computed tomography and conventional radiography in diagnosing the extent of root resorptions

BackgroundRoot resorptions are assessed and diagnosed using different radiographical techniques. A comparison of the ability to assess resorptions on two-dimensional (2D) and three-dimensional (3D) radiographs is, hitherto, lacking. The aims of this study were to evaluate the accuracy of 2D (periapical radiographs, PA and panoramic radiograph, PAN) and 3D (cone beam computed tomography, CBCT) radiographic techniques in measuring slanted root resorptions compared to the true resorptions, a histological gold standard, in addition to a comparison of all the radiographic techniques to each other.MethodsRadiographs (CBCT, PA, and PAN), in addition to histological sections, of extracted deciduous canines from thirty-four patients were analyzed. Linear measurements of the most and least resorbed side of the root, i.e., “slanted” resorptions, were measured using an analyzing software (Facad ®). For classification of slanted root resorptions, a modified Malmgren index was used.ResultsPAN underestimated the root length on both the least and most resorbed side. Small resorptions, i.e., low modified Malmgren scores, were more difficult to record and were only assessed accurately using CBCT. The root resorption scores were underestimated using PA and PAN. In assessment of linear measures, PAN differed significantly from both CBCT and PA.ConclusionsCBCT is the most accurate technique when measuring and scoring slanted root resorptions.