Original article
Analysis of failure in the treatment of impacted maxillary canines

https://doi.org/10.1016/j.ajodo.2008.07.022Get rights and content

Introduction

In this study, we aimed to evaluate the reasons for failure of orthodontic treatment for impacted maxillary canines and to recommend measures to overcome them.

Methods

Twenty-eight patients (ages, 17.4 ± 4.3 years) with 37 maxillary impacted canines were referred after a failed attempt to resolve the impaction. Reasons for failure were analyzed, and corrective measures undertaken. The success rate of the revised treatments and the durations of both treatments were recorded.

Results

The mean duration of the failed treatments was 26.2 ± 17.2 months. The failed treatments were mostly based on plane radiographs, intra-arch dental anchorage, and elastic traction directly to the labial archwire. The major reasons for failure were inadequate anchorage (48.6%), mistaken location and directional traction (40.5%), and ankylosis (32.4%). In several patients, there was more than 1 possible reason for failure. The success rate of the revised treatments was 71.4%, and the mean duration was 14.4 ± 7.2 months. Repeat surgery was needed for 62.9% of the canines in which corrective treatment was started, mostly to redirect the ligature wires. The corrective measures included the use of 3-dimensional imaging and a change in the direction of traction. Anchorage was reinforced by dental and skeletal means.

Conclusions

Inaccurate 3-dimensional diagnosis of location and orientation of impacted teeth and failure to appreciate anchorage demands were the major reasons for failure in the treatment of impacted canines.

Section snippets

Material and methods

A sample of 28 patients (18 female, 10 male; ages, 17.4 ± 4.3 years) with 37 impacted canines was assembled from the private practices of the 3 authors. The patients' initial records showed that 26 impactions were palatal, 9 were buccal, and 2 were in the midalveolus. All patients had been treated elsewhere for a malocclusion that included at least 1 impacted maxillary canine that did not respond to treatment. They were referred by general practitioners or orthodontists and were taken

Results

The patients were referred by 26 clinicians. Twenty were specialists, including 15 who had over 10 years of experience, and 6 were general practitioners, including 3 with more than 10 years of experience. Most patients (26 of 28; 92.9%) were referred after surgery had been performed. In 2 (patients 11 and 22), space had been prepared for the impacted teeth without surgery. It had been optimistically expected that the teeth would erupt spontaneously, but that had not occurred. Twenty-five

Discussion

The prevalence of canine impaction in the general population of most Western countries has been variously described as between 0.92% and 2.4%.10, 11, 12, 13, 14 Since this problem is a local etiologic factor leading to malalignment and malocclusion of the teeth, it must be assumed that in any orthodontic practice there will be a disproportionately larger number of patients who suffer from this anomaly. Many will be treated successfully, but, as can be seen in this study, some clinicians will

Conclusions

There are many aspects and minutiae involved in the treatment of impacted maxillary canines that, singly or together, can lead to failure of the overall aim of the exercise. This study has shown that failure in this type of treatment is all too frequent for the following reasons.

  • 1.

    Diagnosis of the location of the tooth and its immediate relationship with the roots of the adjacent teeth is generally treated with cavalier and often negligent simplicity, even though modern technology has provided

References (39)

Cited by (72)

  • Treatment for critically impacted maxillary canines: Clinical versus scientific evidence – A systematic review

    2022, Journal of Stomatology, Oral and Maxillofacial Surgery
    Citation Excerpt :

    However, there are no studies reporting the outcome of this treatment strategy. When this fails, removal of the impacted canine is often the treatment of choice [6, 31]. Aside from the patient-related factors mentioned above, orthodontist or surgeon related factors can equally influence treatment prognosis.

View all citing articles on Scopus

The authors report no commercial, proprietary, or financial interest in the products or companies described in this article.

View full text