Schmidt Article
Schmidt Article
Schmidt Article
nines not previously impacted.2 In addition, posttreatment differences in root length, attachment level, and
crestal bone height were found on lateral incisors and
premolars adjacent to the impacted canines when compared with contralateral control lateral incisors and
premolars.2
The studies involving open exposure with autonomous eruption focused mainly on the success of the
surgical procedures. Pearson et al5 compared simple
exposure and eruption with closed exposure, bracketing, and early traction in 104 consecutively treated
patients with palatally impacted canines; they found
that a second surgical intervention was needed in
15.3% of the open exposure patients and 30.7% of all
patients exposed and bracketed. Ferguson and Parvizi6
studied the open exposure of 85 palatally impacted
canines in 72 consecutive patients. They found that
84.6% of the exposures were successful, 10.4% were
partially successful, and 5.1% of the canines required a
second exposure.
Open exposure of a palatally impacted canine with
natural eruption has several potential advantages, in449
Fig 1. A, Patient had palatally impacted maxillary right canine. To permit impacted canine to erupt
autonomously and reduce time in orthodontic appliances, impacted tooth was uncovered before
orthodontic treatment. B, Mucoperiosteal flap was elevated, and it was determined that crown was
still covered in bone. C, All palatal bone down to CEJ was removed so that the tooth could erupt
unimpeded. D, Hole was made in flap, and it was repositioned and sutured over crown of impacted
canine. E and F, Canine erupted without orthodontic forces. G, When cusp tip was at level of
occlusal plane, bracket was placed on crown, and root was moved labially. H and I, Final alignment
after appliance removal.
cluding fewer subsequent re-exposures,5,6 shorter treatment time,7 and improved hygiene during treatment. To
date, no studies have examined the posttreatment effects of palatally impacted canines that were surgically
exposed and allowed to erupt freely into the palate
before placing traction. The purpose of this study was
to evaluate periodontal, root length, and visual assessment differences between impacted canines treated in
this matter and nonimpacted control teeth.
Records from a sample patient demonstrate the
surgical and orthodontic treatment of a palatally impacted maxillary canine with surgical exposure and
autonomous eruption (Fig 1). This patient had a Class I
uncrowded malocclusion with a palatally impacted
maxillary right cainine. The impacted canine was sur-
Table I.
17
2
2
23
y
y
y
y
7.2 mo
9 mo
11.5 mo
6.8 mo
Range
12
1
1
16
y 8 mo-59 y 6 mo
y 4 mo-5 y 2 mo
day-9 y 6 mo
y 1 mo-67 y
Table II.
GBI measurements
Lateral incisor
Canine
Premolar
VPI measurements
Lateral incisor
Canine
Premolar
Score 0
Score 1
Score 2
Score 0
Score 1
Score 2
56%
56%
56%
44%
44%
44%
0%
6%
0%
50%
63%
56%
50%
37%
44%
0%
0%
0%
94%
88%
94%
6%
12%
6%
0%
0%
0%
100%
94%
94%
0%
6%
6%
0%
0%
0%
Table III.
Mean differences in probing attachment level between previously impacted canines and adjacent lateral
incisors and premolars (impacted side) and contralateral control teeth (nonimpacted side) (n 16)
Impacted side
Lateral incisor
Canine
Premolar
MB
B
DB
DL
L
ML
MB
B
DB
DL
L
ML
MB
B
DB
DL
L
Nonimpacted side
Mean (mm)
SD
Mean (mm)
SD
Mean difference
P value
0.53
0.60
0.51
0.73
0.45
0.35
0.64
0.40
0.53
0.65
0.67
0.41
0.60
0.50
0.63
0.04
0.22
0.50
0.47
0.60
0.59
0.61
0.49
0.64
0.45
0.82
0.71
0.92
1.17
0.47
0.42
0.66
0.55
0.46
0.58
0.49
0.51
0.28
0.59
0.43
0.63
0.40
0.28
0.63
0.65
0.56
0.60
0.37
0.35
0.38
0.48
0.61
0.40
0.41
0.55
0.60
0.48
0.28
0.46
0.37
0.48
0.53
0.43
0.53
0.47
0.64
0.52
0.54
0.05
0.11
0
0.45
0.14
0.08
0.01
0
0.25
0.02
0.02
0.15
0
0.13
0.28
0.34
0.26
NS
NS
NS
.012
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
.045
NS
NS
MB, Mesiobuccal; B, buccal; DB, distobuccal; DL, distolingual; L, lingual; ML, mesiolingual; NS, Not significant.
3
2.5
2
mm 1.5
Nonimpacted side
(NI)
Difference (I-NI)
1
0.5
0
Distal
Canine
Mesial
Canine
*Distal
Lateral
(p<.01)
*Mesial
Lateral
(P<.05)
Fig 2. Mean differences in crestal bone height of experimental teeth (impacted side) compared with control
side (nonimpacted side).
20
18
16
14
Impacted side (I)
12
Nonimpacted side
(NI)
Difference (I-NI)
10
8
6
4
2
0
Premolar
*Canine
(p=.025)
*Lateral
(p=.01)
Table IV.
% of reasons given
Torque
Gingiva
Alignment
Crown length/wear
Recession
Color
Other
28%
27%
17%
13%
6%
5%
3%
to
to
to
to
to
to