Aligners as a Therapeutic Approach in Impacted Canine Treatment: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Protocol
2.2. Focus Question and Eligibility Criteria
2.3. Search Strategy, Information Sources, and Study Selection
2.4. Data Collection Process and Data Items
2.5. Risk of Bias and Quality Assessment
2.6. Quality Assessment
3. Results
3.1. Literature Search Results and Study Selection
3.2. Study Characteristics
3.3. Main Study Outcomes
3.4. Quality Assessment of the Included Studies
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Inclusion Criteria | Exclusion Criteria | |
---|---|---|
Population | Patients with impacted or significantly ectopic canines | - |
Intervention | Orthodontic treatment carried out using aligner orthodontic therapy | Orthodontic treatment carried out without orthodontic aligners |
Comparison | No comparison group was included | - |
Outcomes | Any | Only tooth alignment after treatment |
Study design | Any | Reviews, letters, editorials, commentaries, conference abstracts, books |
Database | Search String |
---|---|
PubMed | (“Orthodontic aligner treatment” [All Fields] OR “Invisalign” [All Fields] OR “Clear aligner treatment”) AND (“Impacted Canine” [All Fields] OR “Impacted Tooth” [All Fields] OR “Ectopic Canine” [All Fields] OR “Ectopic Tooth” [All Fields]) |
Google Scholar | “Orthodontic aligner treatment” OR “Invisalign” OR “ Clear aligner treatment” AND “Impacted Canine” OR “Impacted Tooth” OR “Ectopic Canine” OR “Ectopic Tooth” |
EBSCO Complementary Index MEDLINE Ultimate Springer Nature Journals Oxford Medicine Online Academic Search Ultimate Dentistry and Oral Sciences Source Elsevier Web of Science | TS = (“Orthodontic aligner treatment” OR “Invisalign” OR “Clear aligner treatment”) AND TS = (“Impacted Canine” OR “Impacted Tooth” OR “Ectopic Canine” OR “Ectopic Tooth”) |
Study | Group Size and Study Design | Patient Age | Patient Gender | Malposition of Canine | Period of Orthodontic Aligners Usage |
---|---|---|---|---|---|
Aldo Giancotti et al. 2021 [21] | 1; case study | 13 | Female | High vestibular ectopic transposition with lateral displacement and low exposition | Whole treatment |
Qijan Xia et al. 2022 [27] | 1; 1 model was made into 4 3D finite models for 2 scenarios, 3D finite element analysis (FEA) | 23 | Male | Impacted in vestibular position, above premolar (scenario A) or above lateral incisor (scenario B) | Whole treatment |
Mario Greco et al. 2022 [22] | 2; different cases with different sequences of the treatment | 16 and 43 | Male and female | Impacted palatally | In cases 1 and 2, whole treatment except for hybrid treatment during canine traction with TAD |
Gianluca Mampieri et al. 2021 [23] | 1; case report | 17 | Female | Two slightly impacted in the alveolar crest | Whole treatment |
Capuozzo R et al. 2023 [24] | 2; case 1 had palatally displaced canine and case 2 had buccally displaced canine | 17 and 18 | Female | Case 1: impacted palatally Case 2: highly vestibular | After short period of traction with TAD |
Memè L et al. 2024 [25] | 1; case study | 13 | Female | Ectopic palatal with very low exposition | Whole treatment |
Bocchino T et al. 2023 [26] | 1; case report | 19 | Male | Impacted palatally | 2nd phase of the treatment |
Study | Treatment Protocol | TAD Use During Treatment | Usage of Fixed Orthodontic Appliance | Elastics Used | Aligner/Treatment Time |
---|---|---|---|---|---|
Aldo Giancotti et al. 2021 [21] | Resolve malocclusion and traction of ectopic canine into the arch, with the extraction of deciduous canine and two supernumeraries. Phase 1: Four months to create space for canines, with aligner changes every 2 weeks, then 5 months of canine traction with elastics. Phase 2: Residual canine extrusion and torque control, leveling the gingival anterior contour, with aligner changes every week. Phase 3: Class II correction with elastics and finishing. | No | No | Light auxiliary elastic stretched over the aligner between the palatal and buccal surfaces of the canine, then class II elastics to correct class II malocclusion and canine position. | 24 months of treatment: Phase 1: 40 aligners, 9 months; Phase 2: 27 aligners, 3 months; Phase 3: 8 aligners, 12 months; Total: 67 aligners. |
Qijan Xia et al. 2022 [27] | Finite element models were created from a male model, including the maxillary dentition with maxilla, periodontal ligaments, clear aligners, traction attachments, and right labial canine. Two scenarios were investigated: impacted canine above the premolar vestibular (A) and impacted canine impacted above the lateral incisor vestibular (B). Three traction models with clear aligners and one fixed appliance model were created for every scenario. Traction was performed with 0.6N elastics from the canine to the attached auxiliary (7 mm power arm, 3D attachment, or Angel Button on aligners and hook on fixed appliance). ABAQUS software (version 6.14; SIMULIA, Aix-en-Provence, France) was used for nonlinear iterative calculations. | No | Control scenario: 0.018 × 0.025 stiff wire. | Straight to the auxiliary (power arm, button, or 3D-printed “hook like” attachment). | Due to the characteristics of the FEA study, neither the treatment time nor number of aligners were the subject of the calculations. |
Mario Greco et al. 2022 [22] | Case 1: Phase 1: Correcting malocclusion and recreating space for the impacted canine with aligners. Phase 2: Surgical exposure and canine disimpaction and traction using TADs and sectional wires. Phase 3: Refinement of canine position and finishing. Case 2: Phase 1: Canine-first technique with surgical exposure, disimpaction of canine with TADs and sectional wires, and displacement of the TAD during treatment. Phase 2: Final correction of canine position and torque with aligners, and finalization of wire extrusion. | Case 1: Palatally between premolars and the premolar and molar. Case 2: Mesially from 1st molar in the palate later in the vestibule between canine and 1st premolar. | Case 1: During canine traction, a sectional 0.18SS Australian wire was used from the canines to the TADs. Then, to not reposition them, a 0.17 × 0.25 TMA was used from the 2.5 to the canine labially. Case 2: During canine traction, a 150 g closed coil spring with a metal ligature was used from the canine to the TAD. For finishing, a sectional 0.016 × 0.022 CuNiTi wire from the lateral to the 1st premolar was used. | Triangular criss-cross. | Case 1: 18 months of treatment: Phase 1: 25 aligners; Phase 2: TAD and sectional wire; Phase 3: 18 aligners; Total: 43 aligners. Case 2: Approximately 24 months of treatment: Phase 1: TAD + sectional wire; Phase 2: 38 aligners + sectional wire; Total: 38 aligners. |
Gianluca Mampieri et al. 2021 [23] | Phase 1 was aimed at recovering space in the arch for canines, expansion, and the correction of incisor inclination. Phase 2 included deciduous canine removal, surgical exposure of both canines, and cuspid traction with elastic forces from the canines to the aligner and eruption guides. Phase 3 included residual positioning of canines and finishing for better esthetic and occlusal outcomes. | No | No | Intra-arch 6 mm/180 g elastics from canine hooks to buttons hidden inside pontics over the aligners, then replaced with buttons on canines, dovetail hook on aligners and 4 mm/180 g elastics. | 18 months of treatment: Phase 1: 21 aligners; Phase 2: 17 aligners; Phase 3: 13 aligners; Total: 61 aligners. |
Capuozzo R et al. 2023 [24] | Case 1: Phase 1: Surgical exposure of canines, traction of impacted canines using TAD and sectional wire in cantilever spring (canine-first technique), and then extraction of the deciduous one. Phase 2: Use of aligners with bite ramps for leveling and alignment of both arches, and traction of canines with elastics. Phase 3: Residual canine traction and torque, followed by finishing. Case 2: Phase 1: Surgical exposure of canines, extraction of deciduous canines, and traction using TAD with cantilever spring (canine-first technique). Phase 2: Aligners used for space creation with eruption compensator, alignment, and leveling of both arches; class II elastics used to improve occlusion and canine traction. Phase 3: Aligners used for expansion to resolve crowding and transverse discrepancy, followed by torquing and final positioning of the canine. | Case 1: Palatally between 1.5 and 1.6. Case 2: Between 2.5 and 2.6 buccally. | Case 1: A 0.017 x 0.025 TMA 50 g cantilever spring was used from the canine to the TAD. Case 2: A 0.018 × 0.025 TMA 50 g cantilever spring from the TAD to the canine was used. | Case 1: Elastic ligature from the canine to the eruption compensator. Case 2: From the canine to 3.6, class II elastics and later, wrap around aligner elastics to a buccal button on the canine. | Case 1: 20 months of treatment: Phase 1: TAD + sectional wire; Phases 2 and 3: Approx 52 aligners (14 months). Case 2: 18 months of treatment: Phase 1: TAD + sectional wire; Phases 2 and 3: Approx 48 aligners (12 months). |
Memè L et al. 2024 [25] | Phase 1: Upper arch expansion to make space for canines with pontics. Phase 2: Increase in posterior vertical dimension through fake build-ups implemented in aligners, followed by canine traction. Phase 3: Occlusion refinement, short class II for better canine position, and mesial derotation of molars. | No | No | Class II elastics with a size of 3/16” and 4.5 ounces were used from the canines to the lower premolars. | 21 months of treatment: Phase 1: 7 aligners; Phase 2: 31 aligners; Phase 3: 26 aligners; Total: 64 aligners. |
Bocchino T et al. 2023 [26] | Phase 1: Canine-first approach; this procedure included surgical disimpaction of the canine, moving the crown away from the roots of the adjacent incisors with a cantilever and a skeletal anchorage (TAD). Phase 2: Canine traction with Alastik to 5.3 and composite ramping. Phase 3: Extraction of 5.3, sectional brackets on 1.6 and 1.3 with a cantilever for canine traction and torque. Phase 4: Alignment and mesialization of posterior segments and the canine into absent lateral incisor with aligners, followed by class III elastics to promote desired movements. | Between 2nd premolar and 1st molar palatally. | A 0.019 x 0.025 TMA 100 g cantilever spring from the TAD to the canine was used, with a bracket on 1.6 with the TAD for additional anchorage. A 0.019 × 0.025 TMA cantilever was used on the canine vestibular, followed by a bracket on the canine. | Alastik from 53 to 13 during the second course of traction, followed by class III on the canines during aligner treatment. | 14 months + phase 3 treatment time; Phase 1: TAD + sectional wire (3 months); Phase 2: Alastik from 53 to 13 (4 months); Phase 3: Sectional wire bonded on 16 and 13 + TAD; Phase 4: 24 aligners (7 months). |
Checklist Question | Aldo Giancotti et al. [21] | Mario Greco et al. [22] | Gianluca Mampieri et al. [23] | Capuozzo R et al. [24] | Memè L et al. [25] | Bocchino T et al. [26] |
---|---|---|---|---|---|---|
Were the patient’s demographic characteristics clearly described? | Yes | Yes | Yes | Yes | Yes | Yes |
Was the patient’s history clearly described and presented as a timeline? | Yes | Yes | Yes | Yes | Yes | Yes |
Was the current clinical condition of the patient upon presentation clearly described? | Yes | Yes | Yes | Yes | Yes | Yes |
Were diagnostic tests or assessment methods and the results clearly described? | Yes | Yes | Yes | Yes | Yes | Yes |
Was the intervention(s) or treatment procedure(s) clearly described? | Yes | Yes | Yes | Yes | Yes | Yes |
Was the post-intervention clinical condition clearly described? | Yes | Yes | Yes | Yes | Yes | Yes |
Were adverse events (harms) or unanticipated events identified and described? | No | No | No | No | No | No |
Does the case report provide takeaway lessons? | Yes | Yes | Yes | Yes | Yes | Yes |
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Share and Cite
Wolny, M.; Sikora, A.; Olszewska, A.; Matys, J.; Czajka-Jakubowska, A. Aligners as a Therapeutic Approach in Impacted Canine Treatment: A Systematic Review. J. Clin. Med. 2025, 14, 3421. https://doi.org/10.3390/jcm14103421
Wolny M, Sikora A, Olszewska A, Matys J, Czajka-Jakubowska A. Aligners as a Therapeutic Approach in Impacted Canine Treatment: A Systematic Review. Journal of Clinical Medicine. 2025; 14(10):3421. https://doi.org/10.3390/jcm14103421
Chicago/Turabian StyleWolny, Mateusz, Agata Sikora, Aneta Olszewska, Jacek Matys, and Agata Czajka-Jakubowska. 2025. "Aligners as a Therapeutic Approach in Impacted Canine Treatment: A Systematic Review" Journal of Clinical Medicine 14, no. 10: 3421. https://doi.org/10.3390/jcm14103421
APA StyleWolny, M., Sikora, A., Olszewska, A., Matys, J., & Czajka-Jakubowska, A. (2025). Aligners as a Therapeutic Approach in Impacted Canine Treatment: A Systematic Review. Journal of Clinical Medicine, 14(10), 3421. https://doi.org/10.3390/jcm14103421