Search Results (59)

Background/Objective: Maxillary canine impaction is a frequent orthodontic challenge. Three-dimensional CBCT assessment allows precise evaluation of periradicular bone density, which may play a role in eruption failure. This study aimed to compare bone density (HU) around impacted canines with that of the contralateral erupted tooth and to assess correlations with age and sex. Methods: A total of 26 patients (10 males, 16 females; 13–19 years) with unilateral maxillary canine impaction were examined. Pre-treatment CBCT scans acquired were analyzed. Bone density was measured in HU at three root levels (cervical, middle, apical) and in four regions (buccal, palatal, mesial, distal). Statistical analyses included Student’s t-tests, linear regression, and correlation coefficients, with significance set at p < 0.05. Results: Tooth 2.3 was the most frequently impacted (61.5%), with a slight predominance of palatal impactions (53.8%). Bone density was significantly higher around impacted canines than around the contralateral erupted teeth in all regions and levels (p = 0.000), with values increasing from the cervical portion toward the apex. In impacted canines, bone density increased significantly with age, whereas no meaningful differences were found between males and females. Conclusions: Higher bone density surrounding impacted canines supports its potential role in eruption failure. The age-related increase highlights the clinical importance of early diagnosis and timely orthodontic–surgical intervention. Full article

Background: Artificial intelligence (AI) integrated with cone-beam computed tomography (CBCT) has rapidly advanced the diagnostic capability of orthodontics, particularly for quantifying external root resorption (ERR). High-risk scenarios such as bilateral maxillary canine impaction require objective tools to guide treatment decisions and prevent irreversible damage. Objectives: To evaluate the diagnostic accuracy and clinical applicability of AI-assisted CBCT for orthodontically induced ERR, and to demonstrate its value in a complex clinical case where decision-making regarding canine traction versus extraction required precise risk quantification and definition of biological limits. Methods: A systematic review following PRISMA 2020 guidelines was conducted in PubMed, ScienceDirect, and Cochrane Library (2015–September 2025). Eligible studies applied AI-enhanced CBCT to assess ERR in orthodontic patients. Additionally, a clinical case with bilaterally impacted maxillary canines was evaluated using CBCT with automated AI segmentation and manual refinement to quantify root volume changes and determine prognostic thresholds for treatment modification. Results: Nine studies met the inclusion criteria. AI-based imaging, predominantly convolutional neural networks, showed high diagnostic accuracy (up to 94%), improving reproducibility and reducing operator dependency. In the clinical case, volumetric monitoring showed rapid progression of ERR in the lateral incisors (LI) associated with a persistent unfavorable 3D spatial relationship between the canines and incisor roots, despite controlled distal traction with skeletal anchorage, leading to a timely change in the treatment plan and extraction of the severely compromised incisors with substitution by the canines. AI-generated data provided objective evidence supporting safer decision-making and prevented further structural deterioration. Conclusions: AI-enhanced CBCT enables early, objective, and quantifiable ERR assessment, strengthening prognosis-based decisions in orthodontics. Findings of this review and the clinical case highlight the translational relevance of AI for managing high-risk cases, such as maxillary canine impaction with extensive LI resorption, supporting future predictive AI models for safer canine traction. Full article

Background/Objectives: The early and accurate identification of impacted teeth in the maxilla is critical for effective dental treatment planning. Traditional diagnostic methods relying on manual interpretation of radiographic images are often time-consuming and subject to variability. Methods: This study presents a deep learning-based approach for automated classification of impacted maxillary canines using panoramic radiographs. A comparative evaluation of four pre-trained convolutional neural network (CNN) architectures—ResNet50, Xception, InceptionV3, and VGG16—was conducted through transfer learning techniques. In this retrospective single-center study, the dataset comprised 694 annotated panoramic radiographs sourced from the archives of a university dental hospital, with a mildly imbalanced representation of impacted and non-impacted cases. Models were assessed using accuracy, precision, recall, specificity, and F1-score. Results: Among the tested architectures, VGG16 demonstrated superior performance, achieving an accuracy of 99.28% and an F1-score of 99.43%. Additionally, a prototype diagnostic interface was developed to demonstrate the potential for clinical application. Conclusions: The findings underscore the potential of deep learning models, particularly VGG16, in enhancing diagnostic workflows; however, further validation on diverse, multi-center datasets is required to confirm clinical generalizability. Full article

Although the increased use of three-dimensional (3D) cone beam computed tomography (CBCT) in orthodontic treatment, the necessity of the CBCT on treatment decision-making for maxillary impacted canines was not fully assessed compared to two-dimensional (2D) radiographs. This study aimed to assess differences in treatment decisions derived from CBCT data and 2D radiographs by analyzing survey responses from orthodontic specialists. Ten maxillary impacted canines with complete sets of two-dimensional (2D) radiographs and 3D CBCT data were selected and two sets of questionnaires were administered: using 2D radiographic data and 3D CBCT data. 31 orthodontists completed the survey. Diagnoses and treatment decisions were compared between the 2D and 3D imaging. Additionally, estimated angular and linear measurements of canine position were assessed with 2D and 3D and compared with actual CBCT measurements. The treatment decisions varied between 2D and 3D imaging. Notably, 51.5% of extraction decision with 2D were changed to orthodontic traction with 3D. The 3D imaging also improved the prediction of tooth collisions during traction and reduced the perceived treatment difficulty. CT proficiency influenced clinical decisions, with higher proficiency levels associated with fewer extractions and more accurate treatment predictions. 3D imaging offers greater diagnostic accuracy and improved treatment planning for impacted canines compared to 2D imaging, particularly for high and palatal impactions. Full article

Objectives: This study examined the link between impacted maxillary canines and changes in the position of adjacent lateral incisors (LIs) and first premolars (FPs), as well as opposite canines. It also explored the relationship between the position of impacted canines and the presence of palpable mucosal bulges. Methods: The clinical study involved 62 participants (35 females, 27 males; average age: 14.7 years), split equally into impacted canine (n = 31) and control (n = 31) groups. The study included 26 palatally impacted canines, 5 buccally impacted canines, 31 non-impacted contralateral canines, and 62 control canines. Three-dimensional study models assessed LI and FP positions, while CBCT analyzed vertical and horizontal positions of impacted canines and dental follicles. Clinicians evaluated the presence of mucosal bulges, and distance was measured between impacted canines and outer cortical bone radiographically. Results: Compared to controls, the LIs next to impacted canines showed significantly more rotation (13°), mesiodistal angulation (11.5°), and buccopalatal angulation. FPs showed increased rotation (10.0°) and mesiodistal angulation (8.7° more) but no change in buccopalatal inclination. Contralateral canines had significantly more rotation (11.3°) than controls. Buccally impacted canines led to greater positional differences in the LIs compared to palatally impacted canines. Follicle thickness had a moderate correlation with FP rotation and mesiodistal angulation but did not relate to LI malposition. Visible mucosal bulges indicated distances of 1.2 mm or less between the canine and cortical bone. Conclusions: This study found positional differences in lateral incisors showed altered rotation, angulation, and inclination, while first premolars had increased rotation and angulation. Buccally impacted canines showed more discrepancies for lateral incisors. A mucosal bulge may indicate impacted canine location if the impacted canine is close to the outer bone surface. Follicle thickness affected premolar position but not incisors. Full article

Background: Impaction of maxillary canines is a frequent clinical challenge in orthodontics. Early diagnosis is key to effective management. Methods: This narrative review included studies published from 2004 to 2024. An electronic search was conducted in PubMed, Scopus, and Google Scholar (September–November 2024), using predefined eligibility criteria. The selection and drafting were completed in the following months. Studies involving orthopedic, orthodontic, or surgical-orthodontic management of impacted maxillary canines were included. Case reports and procedures limited to avulsion or transplantation were excluded. Results: A total of 10 studies were analyzed, comprising 5529 patients, of whom 2530 met the criteria for treatment-specific analysis. Surgical exposure with orthodontic traction was the most frequent treatment (72%), followed by monitoring (12%), maxillary expansion (6%), and extractions (10%). Interceptive approaches were mainly applied in patients aged 7–18 years, with favorable outcomes especially before age 12. In adults, more invasive treatments were required, often with reduced success rates. Conclusions: Early diagnosis and interceptive extraction of deciduous canines reduce treatment complexity and improve success. Therapeutic outcomes are strongly influenced by patient age, tooth position, and angulation. A structured, radiographically guided approach, supported by the proposed decision-making flowchart, may optimize clinical outcomes. However, heterogeneity of included studies and lack of long-term follow-up limit the strength of available evidence. Full article

Objectives: This study aimed to compare the biomechanical effects of Ballista Spring and Elastic Thread systems on impacted maxillary canines using three-dimensional finite element analysis (FEA). Materials and Methods: Finite element models were constructed from CBCT images of a human maxilla, incorporating cortical bone, spongy bone, teeth, and periodontal ligament. Two orthodontic force application methods were simulated: Ballista Spring (0.016-inch stainless steel) and Elastic Thread (0.25 mm medical-grade latex). Both systems delivered a force of 150 g to the impacted canine. Stress distribution and initial displacement patterns were analyzed using ANSYS Workbench. Results: The Ballista Spring generated a more uniform stress distribution across the periodontal ligament and cortical bone, with a maximum von Mises stress of 0.0042 MPa. The impacted canine exhibited an initial displacement of 0.015 μm, primarily in the vertical and distal directions, indicating a controlled movement path. In contrast, the Elastic Thread showed a more concentrated stress pattern with a maximum von Mises stress of 0.0035 MPa, and the impacted canine experienced 0.013 μm of displacement, accompanied by greater lateral deviation and buccal tipping of the adjacent teeth. The Ballista Spring induced higher stress levels on anchorage teeth—particularly the first molars and premolars—while the Elastic Thread exerted more localized stress around the impacted canine and adjacent structures. All observed stress values remained within physiological thresholds, indicating no immediate risk of tissue damage. Conclusions: Both systems were effective in facilitating the eruption of the impacted canines. However, the Ballista Spring provided more favorable stress distribution and controlled displacement, making it suitable for complex cases requiring anchorage preservation. The Elastic Thread, while less biomechanically efficient, remained a practical and cost-effective alternative in patients with adequate periodontal support. Full article

Background/Objectives: Impacted teeth are characterized by having more than three-quarters of root development completed, however failing to erupt or demonstrate imminent eruption, as evidenced both by clinical and radiographic evaluation. Canine impaction is an entity of clinical significance considering its potential to affect both oral function and facial aesthetics. If not appropriately managed, this condition may adversely impact functional occlusion and structural smile integrity. The purpose of the study was to investigate the prevalence of impacted and transmigrant canines in a Greek orthodontic cohort and identify potential sex-based differences. Methods: A total of 2594 panoramic radiographs and clinical records of consecutive patients in the mixed and permanent dentition stages, treated at the Department of Orthodontics of the Aristotle University of Thessaloniki, Greece, were retrospectively retrieved and analyzed to detect the presence of impacted and transmigrant canines. Patients lacking complete clinical records or panoramic radiograph, undergoing or had undergone orthodontic treatment, or presenting conditions affecting normal permanent dentition development, including pathological conditions, cleft lip and palate or hereditary disorders, were excluded. Results: At least one impacted canine was detected in 109 patients (67% females, 33% males), with a median age of 15 years (IQR: 13–18), documenting a 4.2% prevalence (6.97% females, 2.32% males). The frequency of maxillary canine impaction was 3.97%, while in the mandible a frequency of 0.46% was reported. The frequency of bilateral canine impaction was 1%, with it being present in 25.7% of patients with canine impaction. The prevalence of transmigrant canines was 0.11%, with detection solely in the mandible. A statistically significant sex difference was detected solely in the prevalence of impaction. Conclusions: Considering the implications of canine impaction, the epidemiological investigation of this entity may facilitate an early diagnosis and treatment. Full article

Background: Canine impaction complicates treatment and prolongs duration, requiring precise localization. CBCT is the gold standard for diagnosis and assessment. However, it involves high radiation exposure and cost. This study aimed to evaluate the effectiveness of a combined biomechanical approach for orthodontic traction of impacted maxillary canines (IMCs) and to determine whether intraoral scans (STL files) could replace a final CBCT in assessing canine repositioning. Methods: The sample included 10 patients (7 males and 3 females) with 13 severely displaced IMCs, treated with a protocol combining Invisalign^® aligners, elastics, mini-implants, and sectional wires. In all, 9 IMC were palatally impacted, while 4 were buccally impacted. A representative clinical case is presented to illustrate the biomechanics used in one of the complex cases. Canine movement was evaluated at the cusp and apex through two methods: overlay of pre- and post-treatment CBCTs, and overlay of initial and final STL scans onto the initial CBCT. Results: A Class I canine relationship was successfully achieved in all patients. No statistically significant differences were found between the two measurement methods (p > 0.05). Conclusions: Orthodontic traction of IMC, especially in complex cases, can be achieved using aligners, elastics, mini-implants, and sectional wires. Once the canine crown has erupted and is clinically visible, STL scans overlaid with the initial CBCT can accurately assess the final position of the crown and root. This allows clinicians to avoid a second CBCT in selected cases, reducing patient radiation exposure while maintaining diagnostic accuracy. Full article

Background: The aim of this study was to evaluate the effect of Photobiomodulation Therapy (PBMT) on the eruption rate of impacted maxillary canines after surgery, using a split-mouth design. Methods: A 16-year-old patient was referred to the Department of Oral and Maxillo-Facial Sciences of “Sapienza” University of Rome. Clinical examination revealed the persistence of maxillary primary canines and the absence of a palpable canine bump. CBCT scans confirmed that both upper permanent canines were impacted in the palatal osteomucosal region and showed a mesial inclination. Conventional surgery with cold blade was performed for both impacted canines, and PBMT was applied on element 2.3 for three sessions after surgery. Since this is a case report, no statistical analysis was performed. Results: The eruption movement of the two impacted canines was evaluated 16 weeks after surgery. The extent of the spontaneous eruption movement of element 1.3 was 0.21 mm, while element 2.3, which underwent three sessions of PBMT following surgery, moved 3.16 mm. Conclusions: The element that underwent PBMT appears to respond positively in terms of spontaneous eruption following disinclusion surgery compared to the contralateral element that was not stimulated with the laser. These findings suggest that photobiomodulation therapy could be effective in accelerating the eruption of palatally impacted canines following surgery, avoiding the need to use orthodontic traction. Future randomized controlled clinical trials are needed to demonstrate these preliminary results. Full article

Maxillary canines have a vital importance in the dental arches, both esthetically and functionally. They are the second most frequently impacted teeth, with palatal impaction being the most common. The purpose of the study was to evaluate the prevalence of palatally displaced canines (PDC) and their association with dental and skeletal anomalies. A retrospective analysis was conducted on 68 patients. A panoramic and a lateral cephalometric radiograph were performed to determine impaction type and patients’ dental and skeletal characteristics. The analysis grouped all PDC cases together and then subdivided them by location (right, left, or bilateral impaction). The most frequent PDC was right-side impaction. When all cases were grouped together, patients showed no family history of PDC (p < 0.05) or presence of dental anomalies (p < 0.05). No relation to skeletal class was observed, but a normodivergent growth pattern did show an association (p < 0.05). When different PDC types were analyzed separately, we observed a relationship with dental midline deviation (F = 17.04, p < 0.05), family history of PDC (F = 12.56, p < 0.05), and lateral incisors anomalies (F = 9.58, p < 0.05). Therefore, an association was found between PDC and dental anomalies when the types of impaction were analyzed separately and with the growth pattern when PDC cases were grouped together. Full article

Objectives: This retrospective study evaluated the short-term effects of removable slow maxillary expansion (SME) on eruption patterns of labially ectopic canines in a Chinese pediatric population, comparing treated patients with untreated controls. Methods: Seventy-six patients (mean age 8.38 ± 0.88 years) underwent SME treatment for 11.04 ± 4.44 months. Canine positions were categorized as labial ectopic (TE: n = 40) or normally positioned (TN: n = 112). The TE group was stratified vertically: superior (TES; n = 15, canines above lateral incisors’ roots or adjacent to unerupted incisors) and inferior (TEI; n = 25, canines adjacent to erupted lateral incisors’ roots). Untreated controls (n = 58; mean age 8.46 ± 0.78 years) included labial ectopic (CE group; n = 32) and normal canines (CN group; n = 84), with CE further divided vertically into CES (n = 24) and CEI (n = 8). Panoramic radiographs at baseline (T0) and follow-up (T1) evaluated sector distribution, midline proximity (3c-ML: canine cusp to midline distance), vertical position (3c-OP: cusp to occlusal plane distance), and angular (3^ML: canine-midline angle). Results: SME significantly improved midline proximity (3c-ML increased) while reducing vertical height (3c-OP decreased) and angulation (3^ML reduced) in the TE group. Notably, TE patients revealed a significantly greater increase in 3c-ML compared to CE. Subgroup analysis showed that TEI canines exhibited significant improvements in all three parameters (3c-OP, 3c-ML, and 3^ML), whereas TES canines displayed minimal changes. The shifts in sector distribution were similar between the treatment and control groups. Conclusions: SME demonstrated short-term efficacy in guiding labially ectopic canines toward more favorable eruption trajectories, particularly when erupted beyond the roots of the lateral incisor. The observed positional improvements underscore SME’s potential to optimize eruption outcomes during early orthodontic intervention. Full article

Background: Impacted canines can adversely affect adjacent structures, particularly lateral incisors. The purpose was to determine the correlation between upper lateral incisor dimension and angular and linear positioning of upper impacted canines. Methods: The sample comprised 50 impacted canines, evaluated using cone-beam computed tomography (CBCT). Measurements included crown dimensions of lateral incisors and impacted canines, incisor root length, and the distance from the canine cusp to the occlusal plane. Angular positions of the canine were measured relative to the occlusal plane, facial midline, and palatine suture. Pearson correlations tested associations between canine position, lateral incisor dimensions, and maxillary transverse width. Results: Significant morphological differences for impacted canines and lateral incisors were found based on canine position and impaction type (unilateral or bilateral). A positive correlation was observed between lateral incisor crown size and canine cusp distance to the occlusal plane (r = +0.483, p < 0.001). Conversely, a negative correlation was noted between lateral incisor root length and canine angulation relative to the palatal suture (r = −0.356, p = 0.022). Conclusions: Impacted canine position is associated with changes in canine and lateral incisor dimensions, potentially affecting their alignment and root integrity. Correlations were also found between maxillary width, incisor morphology, and canine position. Full article

Background/Objectives: Oral health behaviors can be shaped by various factors, both global (such as the COVID-19 pandemic) and individual (e.g., gender, age). This retrospective study aims to assess the factors influencing the choice between conservative and surgical dental procedures among patients based on the example of the university specialized center in Poznan. Methods: We explored the patient dataset from the University Center of Dentistry and Specialized Medicine (Poznan, Poland), covering the period from 1 January 2017 to 31 December 2023. A total of 182,654 medical records were analyzed, focusing on procedures such as restorations, endodontic interventions, and extractions. Multivariate logistic regression and multidimensional correspondence analyses were employed to assess the impact of demographic factors (age and gender) and tooth-specific characteristics on clinical decisions. Results: Females, particularly younger, were more likely to choose restorative procedures, while males, especially those over 50, predominantly underwent surgical procedures. Endodontic treatments were most common in males aged 18–30, primarily for maxillary anterior teeth and premolars. Molar extractions, especially in the mandible, were the most frequent surgical procedure. Maxillary teeth, particularly canines and premolars, were more likely to be treated conservatively. Conclusions: Economic factors, limited treatment access, and variations in patient preference influenced the observed patterns. Despite a national trend toward increased conservative treatments, disparities persisted based on age, gender, and tooth type. These findings emphasize the need for targeted prevention strategies and equitable access to advanced dental care. Full article

Background: The primary aim of this study was to evaluate, using conventional radiographic imaging, the height, angulation, and mesiodistal position of impacted maxillary canines to determine if these variables are significantly associated with the palatal or buccal positioning of the tooth. Methods: A retrospective analysis was conducted on all patients diagnosed and treated for at least one impacted maxillary canine over a 4-year period in the Principality of Asturias. The final sample included 159 impacted canines. The variables analyzed were age, gender, associated pathology, location, angulation, height, mesiodistal position, buccopalatal position, and treatment method. Follow-up periods ranged from 12 to 50 months. Results: The mean age of the patients was 21 years (range 10–41 years), with most cases occurring in patients aged 14 to 30 years. Females accounted for 66.1% of the sample, with a female-to-male ratio of 1.95:1. The type of treatment (extraction/traction, surgical–orthodontic approach) was significantly associated with patient age. Additionally, the proximity of the impacted canine crown to the palatal or buccal cortices was significantly related to the treatment choice. However, no significant relationship was observed between the palatal/buccal position of the canine crown and its height or angulation. Conclusions: In the present work, the upper canines included by the palatal did not have a greater height or angulation than the canines included by the vestibule. Full article