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Orthodontic treatment of an unerupted mandibular canine tooth in a patient with mixed dentition: a case report
© The Author(s). 2016
Received: 31 March 2015
Accepted: 3 May 2016
Published: 10 June 2016
The aim of this case report was to describe the surgical–orthodontic treatment of an unerupted mandibular canine tooth in a 9-year-old girl.
A 9-year-old white girl presented with an unerupted right mandibular canine tooth. Combined surgical–orthodontic treatment was performed to correct dental impaction and to achieve good aesthetic and functional results.
Orthodontic treatment achieved all of the required objectives.
Dental eruption is a dynamic and complex biological and physiological process that occurs over several years. The process includes the formation of teeth and their migration in the jaws until their eruption in their final functional position in the dental arches. The age at which the temporary and permanent teeth appear varies markedly among individuals and can be related to several factors, including gender, dentition, socioeconomic status, and height.
Under certain anatomical conditions, trauma or infective processes involving the deciduous teeth can cause alterations of their eruptive process, preventing the permanent tooth from appearing in the oral cavity within the physiological eruption timeframe or causing ectopic positioning. A tooth is considered “impacted” when it fails to erupt in the dental arch within the expected developmental window. Teeth may become impacted because of adjacent teeth, dense overlying bone, excessive soft tissue, or genetic abnormalities. The reported incidence of dental impaction varies between 5.6 and 18.8 %, with a higher frequency among women . The third molars are most frequently impacted (20 to 30 %) because they are the last teeth to erupt in the oral cavity, followed by the maxillary canines (85 % with palatal dislocation), mandibular second premolars (0.3 %), and central maxillary incisors (0.1 %) [2–5].
Several classifications can be used to evaluate the degree of tooth impaction. These classifications are based on different factors, such as duration of impaction (that is, temporary versus permanent), number of impacted teeth (that is, single versus multiple) , the degree of impaction (that is, total versus partial) , and cause of impaction (that is, primary versus secondary). Primary impaction is caused by intrinsic factors, such as tooth anatomy and tilt, whereas secondary impaction is caused by external factors, such as cystic lesions, supernumerary teeth, and neoplasms .
The etiopathogenesis of dental impaction is vast. Causes of dental impaction can be classified as general, local, structural, and systemic. General causes include genetics, endocrine hypofunction or hyperfunction, metabolic dysfunction, and infectious diseases . Local causes include obstructed eruption, lack of space, ankylosis of primary or permanent teeth, ectopic position of the tooth bud, dilacerations of the roots, soft tissue or bony lesions, fibrosis, and habits . Structural causes include maxillary hypoplasia, severe hyperdivergence, skeletal open bite, and congenital pathologies of the maxillofacial system . Systemic factors include prenatal causes (heredity), postnatal tuberculosis, anemia, malnutrition, and endocrine disorders of the thyroid or parathyroid gland.
Several therapies are possible for impacted teeth, including classic orthodontic treatment, combined surgical–orthodontic treatment, conservative surgery, and radical surgical treatment . In the simplest cases of tooth retention, conventional orthodontic treatment should be chosen. When the impacted tooth has anomalies of location and inclination or a particular coronoradicular morphology, combined surgical–orthodontic treatment should be chosen. When tooth eruption is hampered by a pathological condition, such as a cyst or odontoma, and the tooth’s position in the arch depends on removal of the obstacle, conservative surgical treatment should be selected. In the case of serious anomalies in tooth anatomy or location, or at the patient’s request, radical surgical treatment (extraction) may be chosen. Maintaining the teeth in the arch is important, to ensure that the patient will have adequate functionality and good aesthetics.
At her age, functional treatment is generally advisable. However, considering the canine ectopia, surgical–orthodontic treatment was chosen to move the canine into her arch. This case shows that it is important to act early, during the mixed dentition phase, to prevent worsening impaction of ectopic teeth, which could require tooth extraction at a later stage. The treatment involved creating a surgical incision next to her unerupted canine, applying traction on the tooth toward her arch with an anchoring device and bonding of her lower arch, followed by a phase of functional orthodontics to improve the shape of her arches.
The purpose of this case report was to describe the combined surgical–orthodontic treatment of an unerupted mandibular canine tooth in a 9-year-old girl. Given her age, functional treatment would generally be advisable to expand her arches. In this case we preferred to immediately implement fixed treatment to bring the canine into her arch and to avoid the risk of the tooth requiring extraction with delayed treatment. The treatment was successful, with recovery of the impacted canine. Good aesthetic and functional results were achieved.
MTD conceived of the study, participated in its design and coordination, and helped to draft the manuscript. EM conceived of the study, participated in its design and coordination, and helped to draft the manuscript. SM conceived of the study, participated in its design and coordination, and helped to draft the manuscript. SC conceived of the study, participated in its design and coordination, and helped to draft the manuscript. GM and UG conceived of the study, participated in its design and coordination, and helped to draft the manuscript. All authors read and approved the final manuscript.
The authors declare that they have no competing interests.
Written informed consent was obtained from the patient’s legal guardian for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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