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Objectives: The objective of this article is to establish a large sample-based prediction model for maxillary canine impaction based on linear and angular measurements on panoramic radiographs and to validate this model., Materials and Methods: All patients with at least two panoramic radiographs taken between the ages of 7 and 14 years with an interval of minimum 1 year and maximum 3 years (T1 and T2) were selected from the Department of Oral Health Sciences, University Hospital Leuven database. Linear and angular measurements were performed at T1. From 2361 records, 572 patients with unilateral or bilateral canine impaction were selected at T1. Of those, 306 patients were still untreated at T2 and were used as study sample. To construct the prediction model, logistic regression analysis was used., Results: The parameters analyzed through backward selection procedure were canine to midline angle, canine to first premolar angle, canine cusp to midline distance, canine cusp to maxillary plane distance, sector, quadratic trends for continuous predictors, and all pairwise interactions. The final model was applied to calculate the likelihood of impaction and yielded an area under the curve equal to 0.783 (95% CI [0.742-0.823]). The cut-off point was fixed on 0.342 with a sensitivity of 0.800 and a specificity of 0.598. The cross-validated area under the curve was equal to 0.750 (95% CI [0.700, 0.799])., Conclusion: The prediction model based on the above mentioned parameters measured on panoramic radiographs is a valuable tool to decide between early intervention and regular follow-up of impacted canines., (© 2019 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Background and Objectives: Impacted third molars (ITM) are the most commonly-impacted teeth. There is a risk for ITM to cause a number of pathological conditions, and external root resorption (ERR) of adjacent teeth is one of the most prevalent. Retaining or prophylactic extraction of ITM is a polemic topic. External root resorption of adjacent teeth is one of possible indications for prophylactic removal of ITM. The aim of this study was to assess the relationship between external root resorption (ERR) on the distal aspect of second molars' roots and positional parameters of ITM. Methods : Cone beam computed tomography scans of 109 patients (41 males, 68 females; mean age 26.4 ± 7.9 years) with 254 ITM (131 in the maxilla and 123 in the mandible) were retrospectively analyzed. Positional parameters of ITM (mesio-distal position, angulation, impaction depth, and available eruption space) were evaluated. The presence, location, and depth of ERR of adjacent second molars were assessed. Results: Analysis showed a relationship between ITM impaction depth, mesial inclination angle, and the presence of ERR. Mesial inclination angle of more than 13.6° increased the odds of ERR occurrence by 5.439 (95% CI, 2.97-9.98). ITM presence at the level of ½ of roots of the adjacent second molar or more apically increased the odds of ERR occurrence by 2.218 (95% CI, 1.215-4.048). No significant correlation was detected between the occurrence of ERR and patient age, gender, or the available eruption space in the mandible. Depth of ERR did not depend on its location. Conclusions: Incidence of ERR in second molars is significantly associated with mesial inclination and a deep position of ITM.

Background: Even though periodontal health was suggested to be not related to the traction technique, some other variables might influence the esthetic outcome of palatally displaced canines (PDC) when aligned, such as the initial position and impaction rate of the canine before treatment. The purpose of the present study was therefore to evaluate the existing correlations between periodontal health outcome of PDC after their exposure and alignment and their initial position identified according to the different rates of impaction severity., Materials and Methods: The final sample enrolled 293 PDC which satisfied inclusion and exclusion criteria. All the canines were exposed using CT by the same oral surgeon and orthodontic traction was applied using the easy cuspid device followed by fixed appliance treatment. Image analysis and periodontal status evaluation were performed for all PDCs., Results: α-Angle and d-distance showed no significant differences in the periodontal outcome of PDCs after treatment. The only tested variable showing significant differences was S, since canines with CEJ visible at the end of the treatment presented sectors with a mean score of 1.67, which was significantly different (P < 0.05) when compared to the S-sector for the canines that showed PD < 2 mm at the end of the treatment., Conclusions: Radiographic variables as α-Angle and d-distance seem to not influence the periodontal outcome of the treated impacted canine regardless of the amount of gravity. On the contrary, S-sector might play a significant role when higher rates of gravity are present suggesting the possibility in few cases for periodontal damage at the end of treatment.

Introduction: This study aimed to assess the eruption of impacted teeth in cleft lip and/or palate (CLP) after alveolar bone graft., Materials and Methods: Research was carried out through a cross-sectional study at the Craniofacial Rehabilitation Center of the University General Hospital of the University of Cuiabá, Mato Grosso, Brazil. Variables related to cleft, cleft side, gender, age, laterality of cleft, impacted teeth, and orthodontic traction were analyzed., Results: Forty-two patients treated at the institution from 2004 to 2011 had their charts retrospectively reviewed. They were 54.7% male and 45.2% female. The group aged 9 to 11 years was most affected, representing 59.5% of cases. A unilateral cleft was the most prevalent craniofacial anomaly (85.7%). A total of 57 impacted teeth were observed. Maxillary canines were the most commonly impacted teeth (97.6%) and the most frequently identified in patients with a transforamen incisor cleft (TIC) (76.3%). Orthodontic traction was required for both impacted maxillary canines and impacted lateral incisors (64.3 and 35.7% respectively). The orthodontic traction was required only in patients with a TIC (p = 0.0101)., Conclusion: The canine teeth were the most commonly impacted teeth, found mainly in patients with a TIC. After placement of the alveolar bone graft in patients with a preforamen incisor cleft (PIC), all impacted teeth erupted spontaneously., Clinical Significance: An impacted tooth can have negative consequences on a patient's quality of life. Thus, a survey evaluating the incidence and prognosis of impacted teeth after an alveolar bone graft for CLP was important.

Food impaction after impacted mandibular third molar extraction is a serious problem that should not be ignored. Incomplete suturing of the distal incision in the conventional method is the main cause of food impaction and delayed wound healing. The present study introduces a novel suture and drainage technology that requires hermetic suturing of the distal incision and rubber drainage for buccal drainage. 76 patients with horizontally/mesially impacted third molars (bilateral) were enrolled in this prospective study. An impacted tooth on one side of each patient was extracted by occlusal drainage using the conventional method, whereas the other side tooth was extracted by buccal drainage using the novel method. The differences in wound healing, facial swelling, bleeding and dry socket between the two sides of each patient were compared postoperatively, and the trends for patient selection of the surgical method were also compared. The results indicated that buccal drainage had obvious advantages in wound healing and reduced the risk of postoperative bleeding, and most patients preferred this technique; there were no significant differences in postoperative facial swelling or pain. Thus, buccal drainage can solve the problem of long-term food impaction induced by traditional incision postoperatively and is worthy of clinical promotion.

Objectives: To assess the relationship between dental follicle width and maxillary impacted canines' descriptive and resorptive features with three-dimensional (3D) cone-beam computed tomography (CBCT)., Methods: The study comprised 102 patients with cone-beam computed tomography 3D images and a total of 140 impacted canines. The association between maxillary impacted canine dental follicle width and the variables of gender, impaction side (right and left), localization of impacted canine (buccal, central, and palatal), and resorption of the adjacent laterals was compared. Measurements were analyzed with Student's t -test, Kruskal-Wallis test, and Mann-Whitney U statistical test., Results: According to gender, no statistically significant differences were found in the follicle size of the maxillary impacted canine between males and females ( p > 0.05). Widths of the follicles were determined for the right and left impaction sides, and no statistically significant relation was found ( p > 0.05). There were statistically significant differences between root resorption degrees of lateral incisors and maxillary impacted canine follicle width ( p < 0.05). Statistically significant higher follicle width values were present in degree 2 (mild) resorption than in degree 1 (no) and degree 3 (moderate) resorption samples ( p < 0.05)., Conclusions: No significant correlation was found between follicle width and the variables of gender, impaction side, and localization of maxillary impacted canines. Our study could not confirm that increased dental follicle width of the maxillary impacted canines exhibited more resorption risk for the adjacent lateral incisors.

Objectives: To assess the null hypothesis that there is no difference in the rate of dental development and the occurrence of selected developmental anomalies related to shape, number, structure, and position of teeth between subjects with impacted mandibular canines and those with normally erupted canines., Materials and Methods: Pretreatment records of 42 subjects diagnosed with mandibular canines impaction (impaction group: IG) were compared with those of 84 subjects serving as a control reference sample (control group: CG). Independent t-tests were used to compare mean dental ages between the groups. Intergroup differences in distribution of subjects based on the rate of dental development and occurrence of selected dental anomalies were assessed using χ(2) tests. Odds of late, normal, and early developers and various categories of developmental anomalies between the IG and the CG were evaluated in terms of odds ratios., Results: Mean dental age for the IG was lower than that for the CG in general. Specifically, this was true for girls (P < .05). Differences in the distribution of the subjects based on the rate of dental development and occurrence of positional anomalies also reached statistical significance (P < .05). The IG showed a higher frequency of late developers and positional anomalies compared with controls (odds ratios 3.00 and 2.82, respectively; P < .05)., Conclusions: The null hypothesis was rejected. We identified close association of female subjects in the IG with retarded dental development compared with the female orthodontic patients. Increased frequency of positional developmental anomalies was also remarkable in the IG.

Objective: To evaluate the clinical manifestation of and treatment modalities for this severe phenotype of infraocclusion and to examine relationships between deep submersion and the occurrence of other dental anomalies., Materials and Methods: The experimental sample consisted of 25 orthodontic patients with at least one deciduous molar in infraocclusion greater than 5 mm. Dental records were used to assess severity of infraocclusion, treatment modality, and presence of other dental anomalies (tooth agenesis, small maxillary lateral incisors, palatally displaced canines, and distal angulation of mandibular second premolars)., Results: The sample included 14 females and 11 males, age 7 to 14 years (mean age 10.1 years). The mean infraocclusion depth was 9 mm, with a range of 5-18 mm. The crowns of the adjacent teeth were severely tilted toward the infraoccluded tooth, space was lost in the dental arch, and the successor premolars were impacted in all cases. Treatment consisted of space regaining, surgical extraction of the deciduous molar, and space maintenance. The impacted premolar erupted spontaneously in 95% of the cases. There was a significant increase in prevalence of dental anomalies in the deep-submersion sample compared with that of reference values (P < .001)., Conclusions: The treatment modality used in this sample resulted in spontaneous eruption of the impacted premolar in most cases. Markers for early diagnosis of deep submersion include other dental anomalies, severe tilt of adjacent teeth, and local space loss. The increased prevalence of other dental anomalies supports a shared genetic etiology.

Objective: To compare the root development and the growth rate of the mandibular third molar (M3 inf) in individuals where the M3 inf erupted vs individuals exhibiting M3 inf impaction., Materials and Methods: Serial standardized intraoral radiographs (Eggen technique) were taken annually of the mandibular third molar region from 132 subjects (71 male and 61 female) from 15 to 20 years of age. Based on the films, 264 lower third molars were classified into an eruption and an impaction group. Root development was recorded according to a quantitative method described by Haavikko (1970), and the eruption status was analyzed using logistic regression., Results: In total, 155 (59%) of the M3 inf erupted, and 109 (41%) were impacted at age 20. In 44 (33%) patients both M3 inf were impacted, in 21 (16%) patients one tooth was erupted and the contralateral tooth impacted, and in 67 (51%) patients both M3 inf were erupted. The more mature a tooth was at age 15, the higher was the probability of eruption (odds ratio: 3.89, P < .001). The growth rate of the root development stage was statistically significantly associated with the probability of eruption (odds ratio: 10.50, P  =  .041)., Conclusions: Delayed mandibular third molar root development is associated with impaction. Radiographs taken at age 15 may predict the risk of impaction and thereby guide decision making for the orthodontist or the oral and maxillofacial surgeon.

Aim: The purpose of the present study was to establish the relationship between the eruption of permanent maxillary canines and cervical vertebral maturation stages (CVMs) to assess an alternative method for determining time of canine eruption in the late mixed dentition., Materials and Methods: One hundred and twenty subjects with erupting permanent maxillary canines were observed both intraorally and radiographically with orthopantamograms. Lateral cephalograms were recorded to divide subjects according to CVM stage into prepeak (CS1 and CS2), peak (CS3 and CS4) and postpeak (CS5 and CS6) groups of puberty., Statistical Analysis: The differences between the prevalence rates of canine eruption in different groups of puberty were estimated using 'z test'., Results: Prepeak group comprised of forty six subjects, peak group sixty eight subjects and postpeak group six subjects. The differences in prevalence rates between peak and prepeak and between peak and postpeak groups were noticed highly significant (p<0.001), while prevalence rates between peak and postpeak was found less significant ( p0 <0.01)., Conclusion: Eruption of the permanent maxillary canine can occur at any CVM stage till end of the puberty or after puberty (CS1-CS6). Thus, an absence of maxillary canine during or after postpeak stage of puberty (CS5 or CS6) suggests delayed eruption and canine impaction.

Bone formation below the crown of mandibular horizontal incompletely impacted third molar is frequently seen in the middle-aged and elderly. The phenomenon shows lamina dura loss without radiolucency and we hypothesized the participation of mature enamel without any influence on the environmental oral status. In order to investigate the characteristics of the phenomenon based on the presence/absence of the lamina dura and radiolucency below the crown, we studied the relationship between 58 men and 43 women with a lamina dura without radiolucency, 12 men and 8 women without a lamina dura with radiolucency, 34 men and 16 women without a lamina dura without radiolucency, and the status of teeth in the ipsilateral mandible. Subjects without a lamina dura without radiolucency were significantly older than those with a lamina dura without radiolucency in both men (P < 0.0001) and women (P <0.01), indicating different chronological causes. Men without lamina dura with radiolucency showed significantly more tooth loss than those with a lamina dura without radiolucency (P < 0.00001) and those without a lamina dura without radiolucency (P < 0.0001), indicating the influence of poor oral health. Thus, the phenomenon without a lamina dura without radiolucency may show the clinical importance of bone formation in the elderly.

The ameloblastic fibro-odontoma (AFO) is a rare odontogenic tumor that occurs predominantly in children and is generally associated with unerupted teeth. The choice of treatment for this entity is conservative surgery with enucleation and its prognosis is excellent. However, preserving the associated impacted teeth may make complete removal of the lesion difficult and may explain some cases of recurrence. A case of AFO in a 6-year-old girl treated with enucleation and preservation of an impacted lower left first permanent molar is reported. After two years of follow-up, there were no signs of recurrence and complete spontaneous eruption of the preserved tooth was observed. The present report indicates that the degree of involvement of the impacted tooth by AFO is a fundamental aspect to be considered during radiological analysis and surgical assessment. We concluded that preservation of the impacted permanent teeth associated with this tumor should always be considered and carried out with caution, since they are clearly not included in the surgical cavity.

Presented here is a case of 7 years 6 month old child with an apically impacted mesiodens in relation to the developing root of right upper central incisor. The removal of mesiodens was deferred in order to avoid disturbance in the natural development of the upper central incisor. Serial X-rays are presented and case is discussed.

The aim of this study was to investigate the differences between two groups of patients with either erupted or impacted mandibular third molars before and after orthodontic treatment. All patients were treated with Begg appliances following extraction of the four first premolars. The erupted group consisted of 14 subjects and the impacted group 13 subjects. Lateral cephalometric films, peri-apical radiographs, orthopantomographs and orthodontic casts of each subject were taken before and after treatment. Thirteen measurements were carried out on the lateral cephalometric radiographs. The results revealed slightly more vertical growth and a smaller mandibular arc angle in the erupted group at pre-treatment, and also a more upright lower third molar position and slightly greater distance between the distal point of the lower second molars and the centre of ramus (Xi) in the same group. In the course of treatment, mandibular third molars seemed less likely to erupt when the condyle grew vertically. The lesser resorption on the anterior border of the ramus might have played a part in this finding. In addition, a greater mesial inclination of the mandibular third molars might be an indication of the tendency for these teeth to be impacted in the present study.

Panoramic radiographs of 1834 patients older than 21 years were evaluated for the prevalence of impacted teeth at different ages. The frequency of impacted teeth by age was constant, that is, the presence of completely impacted teeth could not be related to age. The interrelationship between the angulation of impacted teeth and the existence of adjacent teeth was studied in individuals older than 61 years. The angulation of most of the completely impacted teeth in the upper-third molar region was horizontal when adjacent teeth were not present, whereas impacted teeth in the upper-third molar region showed vertical angulation when adjacent teeth were present, suggesting that vertically impacted teeth may become exposed by bone resorption or infection and should be removed. The angulation of impacted lower third molars was horizontal irrespective of the presence of adjacent teeth. It appears that the interrelationship between the angulation of completely impacted teeth and the presence of adjacent teeth is different between the upper and lower third molar regions. The angulation of completely impacted teeth and the presence of adjacent teeth should be included in those criteria which determine whether or not completely impacted teeth should be removed.