DENTOALVEOLAR SURGERY
APICOECTOMY TREATMENT OF AN IMPACTED MAXILLARY CANINE THAT RESISTED ORTHODONTICALLY FORCED ERUPTION
Constantinus Politis 1a *, Jimoh Olubanwo Agbaje 1b, Yi Sun 1c, Harry Stamatakis 2d, Luc Daems 3e, Ivo Lambrichts 4f
1
KU Leuven Department of Imaging and Pathology, Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium
2
DFaculty of Dentistry, Department of Orthodontics, Groningen, The Netherlands
3
Department of Oral and Maxillofacial Surgery, Middelheim Ziekenhuis ZNA, Antwerp, Belgium
4
Faculty of Medicine, Hasselt University, Diepenbeek, Belgium a
MD, DDS, MHA, MM, PhD, Professor and Head of Department OMFS b
BDS, DMD, FMCDS, MMI, PhD, Post doctoral fellow c
MSc, PhD, Post doctoral fellow d
DDS, resident doctor orthodontics e
MD, DDS, Professor and Senior Lecturer f
DDS, PhD, Professor and Senior Lecturer
Cite this article: Politis C, Agbaje JO, Sun Y, Stamatakis H, Daems L, Lambrichts I. Apicoectomy treatment of an impacted maxillary canine that resisted orthodontically forced eruption. Stoma Edu J. 2016; 3( 1): 22-27.
ABSTRACT
Received: September 7, 2015 Received in revised form: December 7, 2015
Accepted: December 10, 2015 Published online: February 09, 2016
Aim: This case study describes a palatally impacted maxillary canine that was successfully brought into occlusion after initial resistance to orthodontically-induced forces. Summary: Clinical and radiographic examinations of the impacted canine revealed a dilaceration of the apical portion of the root, which was bent, and hooked into the dense cortical bone of the nasal cavity floor. Ankylosis was excluded as the main cause of immobility. Finally, the canine was endodontically treated and an apicoectomy was performed to remove the bent tip. Results: During the follow-up period, orthodontic force was applied to encourage canine movement. Fourteen months after the operation, the canine had descended to a functional occluding position. Twenty-six months after the operation, no signs of apical lesion or root resorption were observed. The dentition and occlusion remained stable. Key learning point: Apical dilaceration through the cortical bone may cause immobility of an impacted canine. Apicoectomy of the bent tip following endodontic treatment of the tooth led to successful exposure and eruption of the canine, with a favorable prognosis. Keywords: apicoectomy, impacted tooth, canine guidance.
1. Introduction
Maxillary canine impaction occurs with a reported prevalence of 0.8-3.3 %, as opposed to impacted mandibular canines, which occur less frequently. 1-4 Specifically, impacted canines with palatal displacements occur at a ratio of 1:3 compared to those with labial displacements. 5 Several etiologies have been identified that may potentially lead to impaction of a canine. For example, canine impaction may be due to failed resorption of the deciduous tooth root; early loss of the deciduous teeth, followed by lack of space in the arch; dislocation of the impacted canine and an abnormal eruption path; blockage of the eruption, due to the presence of a pathological entity in close proximity to the tooth( e. g., cysts, odontomas or supernumerary teeth); dental crowding; root dilacerations; or even failure of the eruption mechanism. Also, an eruption may be obstructed by mucosa thickening after trauma or extraction. 5 It is important to identify the cause of impaction before treatment, to ensure the proper counteractive measure is included in a suitable treatment plan. Although lack of sufficient space is the most frequent etiologic factor for impaction of a maxillary canine, it has been found that palatally impacted canines are most often associated with sufficient space in the arch. 6 Therefore, another cause or combination of causes should also be considered, when determining the etiology. The present report presents a case of a maxillary impacted canine that resisted an orthodontically forced eruption. Here, the treatment sequence is described, with a 1-year postoperative follow-up.
* Corresponding author: Constantinus Politis, MD, DDS, MM, MHA, PhD, Professor & Chairperson Oral & Maxillofacial Surgery University Hospitals Leuven UZ Leuven, Campus Sint-Rafaël Kapucijnenvoer 33 3000 Leuven, Belgium Tel: + 32 16 3 32462, Fax: + 32 16 3 32437, e-mail: constantinus. politis @ uzleuven. be
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