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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