| Abstract|| |
Objective: To estimate the incidence of maxillary canine impaction, its location, and mean impaction angle to the occlusal plane. Introduction: The canine teeth are important both aesthetically and functional occlusion. The maxillary canine impaction is genetically linked. Hence, the knowledge of prevalence in the local population is essential. Understanding the location of cuspid impaction is critical to initiate a preventive and therapeutic surgical or orthodontics interventions. Along with other clinical examinations, the impaction angle can also be used to differentiate the impaction location. Material and Methods: A total of 8517 patient's radiographs at the Dental Department of King Abdul Aziz Medical City, Riyadh, were retrospectively evaluated. The age group of the patient included in the study was between 18 and 45 years. The patient's records and radiographs were evaluated to register the impacted maxillary canines, location, and angulation to the occlusal plane. The obtained data were evaluated with SPSS 19 software to analyze the incidence and difference between the genders. Results: Total of 291 patients had the impacted maxillary cuspid. The additional radiograph was available with 44 patient records to further analyze the location of impaction. Among 44 patients, 17(38.64%) were males and 27(61.36%) female subjects. The seven (15.9%) of the cuspids were labially impacted, whereas 37(84.1%) were palatally impacted. The mean impaction angles for labial and palatal impactions were 57.65 and 65.4 degrees, respectively. Conclusions: The majority of canine impaction were palatally placed in comparison to labial impaction. The mean impaction angle of labial impaction is lesser than that of palatal impactions.
Keywords: Canine impaction prevalence, labial impaction, palatal impactions
|How to cite this article:|
Haralur SB, Al Shahrani S, Alqahtani F, Nusair Y, Alshammari O, Alshenqety O. Incidence of impacted maxillary canine teeth in Saudi Arabian subpopulation at central Saudi Arabian region. Ann Trop Med Public Health 2017;10:558-62
|How to cite this URL:|
Haralur SB, Al Shahrani S, Alqahtani F, Nusair Y, Alshammari O, Alshenqety O. Incidence of impacted maxillary canine teeth in Saudi Arabian subpopulation at central Saudi Arabian region. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Jul 21];10:558-62. Available from: http://www.atmph.org/text.asp?2017/10/3/558/213175
| Introduction|| |
Impacted teeth are described as teeth with a delayed eruption time or that are not expected to erupt completely based on the clinical and radiographic assessment. The impaction of maxillary canines is a frequent occurrence. They are the second most commonly impacted teeth in the dental arch after the third molar. The increased incidence of impaction in canine teeth is mainly attributed to their high developmental position in the maxilla and long, complicated path of eruption to the occlusal plane., The cuspids are important teeth in the dental arch, and they play a significant role in functional occlusion, esthetics, and arch development. Accurately positioned canines and the resultant canine guidance control the mandibular lateral excursive movements. The canine guidance disengages posterior teeth in the mandibular lateral excursive movement, thereby eliminating the lateral forces from posterior teeth and preventing fracture or excessive wear. The dental literature suggests the canine protected occlusion to reduce the chances of temporomandibular disorders and muscular dysfunction. The early diagnosis and initiation of appropriate surgical and orthodontic treatment are extremely helpful for an eruption and guiding the tooth to its proper location. The timely intervention will prevent the consequent aesthetic, functional, and pathological complications arising from impacted canines. Both clinical and radiological methods are employed to investigate and locate the impacted canines. The treatment plan and management of impacted maxillary canine are considerably influenced by its location and position in the dental arch. The researchers have espoused the genetic and guidance theories for tooth impaction. The genetic theory suggests the canine impaction is predominantly due to the genetic origin, and impaction is accompanied by other tooth anomalies in size, shape, and numbers. The studies indicate the association of the palatally impacted teeth with lateral incisor anomalies, hypoplastic enamel, and infra-occlusal primary molars. The guidance theory proposes the missing lateral incisors, odontomas, supernumerary teeth, and other mechanical determinants interfere with the path of eruption of canine. The researchers suggest that the labial impaction is essentially due to lack of eruption space, whereas the palatal impaction is the mainly owing to a genetic origin. The accurate determination of impaction location will enable the dentist to understand the possible etiologies and design the optimum preventive and interceptive treatment plans. Various studies explored the correlations of morphological features of impacted teeth with the impaction location. The literature on the association of impaction angle with positions of canine impaction is few and contradictory. Hence, it requires being examined further to understand the correlation. The reported incidence of maxillary canine impaction across different ethnic groups is in the range of 1.5%–2% of the population.,, Genetic and hereditary influence on canine impaction is reported to be strong. Therefore, it is important to ascertain the incidence of canine impaction in the local population. The data will help the dentist and health planners to understand the required preventive and interceptive treatment protocols. The objectives of the study were to estimate the incidence of maxillary canine impaction and their location at the dental arch in the Saudi Arabian subpopulation in the Riyadh region of Saudi Arabia. The purpose of the study also included the evaluation of the difference in the impacted cuspid angulation to the occlusal plane between palatal and buccal impacted cuspids.
| Material and Methods|| |
This study comprised the retrospective radiographic evaluation of the 8517 patients who attended the Dental Department of King Abdul Aziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia between 2010 and 2014. The age group of the patients included in the study was between 18 and 45 years. The patients' records were de-identified through a masking method to replace direct identifiers with randomly chosen values. The patient records were examined to identify any evidence of impacted maxillary canines, including clinical findings and associated radiographs. A tooth was designated as being impacted if there was a physical barrier or an improper orientation that prevented eruption of the tooth. Patient files with panoramic radiographs were used for recording the incidence of canine impaction. Since not all patient records included the required radiographs to locate the position of impacted canines accurately, only those patients with additional cone-beam computed tomography (CBCT) images and anterior occlusal radiographs were used to register buccal or palatal impaction. The relative position of the canine crown to adjacent teeth was taken into consideration for classification of location. CBCT images estimated the labio-palatal position of impacted canines in static cross-sectional reformatted images.
The maxillary occlusal plane was determined by drawing a straight line between the mesiobuccal cusps of the right and left maxillary first molars on the panoramic radiograph [Figure 1]. The long axis of the impacted canine was determined by tracing a straight line between its root apex and incisal tip. The angle resulting from the intersection of these two lines established the angulation of the impacted canine to the occlusal plane. All radiographs were examined diligently by a single skilled dentist, and the data were entered into a spreadsheet (Excel 2000; Microsoft, USA). The data were analyzed using SPSS version 19 (IBM Corporation, New York, USA) with the Pearson Chi-square test.
| Results|| |
The study included the examination of 8517 patients' records and panoramic radiographic images. A total of 291 patients' records revealed the presence of impacted maxillary canines; of these, 113 (38.83%) were male, and 178 (61.16%) were female. The incidence of maxillary canine impaction among the investigated group was 3.41%. [Table 1] shows the impacted maxillary cuspid distribution between the genders according to percentage and position. Among the sample of 291 maxillary canine impacted patients, CBCT or anterior occlusal radiographs were available for 44 subjects to analyze the labial or palatal position of impaction. Between these 44 patients [Table 2], seven cases (15.91%) had labially placed impaction, of which two (28.57%) were in males, and five (71.43%) were in females. A total of 37 (84.1%) subjects had palatally positioned impacted canines. The distribution of palatal impaction among male patients was 15 (40.54%) and 22 (59.46%) among female patients. The difference between labial and palatal impaction [Table 3] was statistically significant with a p-value of < 0.0001.
|Table 1: Incidence of maxillary canine impaction among the investigated group|
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|Table 2: Distribution of maxillary canine impaction location according to gender|
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|Table 3: Pearson Chi-square evaluation for between labial and palatal impactions|
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[Graph 1] displays the mean angle between the vertical axis of canine and occlusal plane among labially and palatally impacted maxillary canines. In the palatally impacted group, the mean angle was 65.4 ( ± 7.17) degrees, whereas the labially impacted group had a mean angle of 57.65 ( ± 2.80) degrees. The mean angle of the impacted cuspid did not differ significantly between the labial and palatal locations.
| Discussion|| |
The maxillary canines are critical for both esthetic and functional occlusion. The literature suggests that unerupted maxillary canines are associated with an increased incidence of temporomandibular disorders. The other sequelae of unerupted canines include malposition of impacted teeth, migration and resorption of adjacent teeth, external root resorption of impacted/adjacent teeth, dentigerous cyst formation, infection with partial eruption, and referred pain. The maxillary canines are the second-most impacted teeth in the dental arch, after third molars. The development of the maxillary canines starts very early, at four to five months of age, and initiation of crown calcification begins at six to seven years. The cuspids appear in the mouth at 11-12 years of age. The frequent impaction incidence in canine teeth is ascribed to the high developmental position, development of a crown at an early age, and a long eruption distance. Patients in the present study among the selected Saudi Arabian population of 8517 patients, for a total of 291 patients, had maxillary canine impaction. The impaction incidence within the studied group was 3.41%. The results of previous studies showed the average canine impaction incidence in the various ethnic groups to be between 0.92% and 2.2%. Thilander and Myrberg  found cuspid impaction in Swedish school children aged between 7 and 13 years at a rate of 2.2%, whereas, Ericson et al. reported that 1.7% of the canines showed eruption disturbances. Dachi and Howell  observed 0.92% incidence of maxillary canine displacement among 3874 subjects. The results of the study also noted the gender distribution among the 291 patients with impacted canines: 113 (38.83%) were males, and 178 (61.16%) female. Earlier study observations  of almost twice the rate of cuspid impaction among females were reinforced by this study (with the ratio being 1:1.57). Regarding impaction location, the results of the study showed palatal impaction in 37 patients (84.1%). Impaction in the labial aspect was witnessed only in seven patients (15.9%). Palatal side impaction was substantially higher than labial surface impaction in the studied group. Jacoby et al. found that 85% of palatally displaced teeth had adequate space in the dental arch for a normal eruption, whereas barely 17% labially placed canines had eruption space. Langberg BJ et al. supported the earlier observation; according to them, palatally displaced cuspids were smaller in size in comparison to labially placed canines. The researchers consider the lack of sufficient jaw space to be the primary etiological factor for buccal surface canine impaction. Hence, they may erupt without surgical or orthodontic interventions. The thick palatal cortical bone and dense mucosal tissue are viewed as impediments for the eruption of palatally placed canines. Consequently, surgical and orthodontic interventions are suggested to enable eruption in these teeth. The most commonly used surgical methods for palatally displaced canines are surgical exposure and the placement of auxiliary attachments. Canine impaction on the palatal surface was recorded in 15 (40.54%) male patients and 22 (59.46%) female patients. Labial side impaction was recorded for a total of two (28.57%) male and five (71.43%) female patients. The overall picture indicates the predilection of canine impaction in females both in palatal and buccal locations. The cuspid impaction position and its angulation to the adjacent lateral incisor strongly influence the outcome of interceptive treatment. Power et al. reported that angles of more than 31° from the vertical axis significantly reduce the normal eruption process of canine teeth. An increased mesial position of a cuspid to the midline of a lateral incisor also jeopardizes the eruption of a canine. The previous studies suggest the horizontal/oblique inclination of palatally impacted cuspids to be more in comparison to labially impacted canines. Katsnelson et al. reported that the labio-palatal position of the impacted maxillary canine could be predicted from its angulation to the occlusal plane. The results of the present study showed that the position of palatal impaction had a greater mean impaction angle of 65.4 ( ± 7.17) degrees, whereas it was at 57.65 ( ± 2.80) for labial impactions. Future studies with larger samples are required to understand the tendencies and locations of canine impaction further.
| Conclusion|| |
Within in the limitations of the study, the following inferences were drawn.
- The maxillary canine impaction incidence among studied Saudi Arabian population was at was at 3.41%.
- The female subjects had higher maxillary impaction tendencies in comparison with male at the ratio of 1:1.57
- The palatal position impactions were considerably higher at 84.1% as compared to 15.8% of labial side impactions.
- The angulation of palatally impacted canine (65.4°) was greater than labial impactions (57.65°).
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| References|| |
Richardson G, Russell KA. A review of impacted permanent maxillary cuspids-diagnosis and prevention. J Can Dent Assoc 2000;66:497-501.
Litsas G. A review of early displaced maxillary canines: Etiology, diagnosis and interceptive treatment. Open Dent J 2011;5:39-47.
Alqerban A, Jacobs R, Fieuws S, Willems G. Comparison of two cone beam computed tomographic systems versus panoramic imaging for localization of impacted maxillary canines and detection of root resorption. Eur J Orthod 2011;33:93-102.
Bjerklin K, Ericson S. How a computerized tomography examination changed the treatment plans of 80 children with retained and ectopically positioned maxillary canines. Angle Orthod 2006;76:43-51.
Kerstein RB. Disocclusion time-reduction therapy with immediate complete anterior guidance development to treat chronic myofascial pain-dysfunction syndrome. Quintessence Int 1992;23:735-47.
Bishara SE, Ortho D. Impacted maxillary canines: A review. Am J Orthod Dentofacial Orthop 101:159-71.
Eve T, Winfried H. Treatment of a patient with Class II malocclusion, impacted maxillary canine with a dilacerated root, and peg-shaped lateral incisors. Am J Orthod Dentofacial Orthop 2008;133:762-70.
Rayne J. The unerupted maxillary canine. Dent Pract Dent Rec 1969;19:194-204.
McKay C. The unerupted maxillary canine. An assessment of the role of surgery in 2,500 treated cases. Br Dent J 1978;145:207-10.
Pirinen S, Arte S, Apajalahti S. Palatal displacement of canine is genetic and related to congenital absence of teeth. J Dent Res 1996;75:1742-6.
Shafer WG, Hine MK, Levy BM. A textbook or oral pathology. 2nd ed. Philadelphia: WB Saunders. 1963;2-75.
Dewel BF. The upper cuspid: Its development and impaction. Angle Orthod 1949;19:79-90.
Bishara SE, Kommer DD, McNeil MH, et al.
Management of impacted canines. Am J Og'mot 1976;80:173-90.
Thilander B, Myrberg N. The prevalence of malocclusion in Swedish school children. Scand J Dent Res 1973;81:12-20.
Ericson S, Kurol J. Radiographic assessment of maxillary canine eruption in children with clinical signs of eruption disturbances. Eur J Orthod 1986;8:133-40.
Dachi SF, Howell FV. A survey of 3,874 routine full mouth radiographs. Oral Surg Oral Med Oral Path 1961;14:1165-9.
Jacoby H. The etiology of maxillary canine impactions. Am J Orthod 1983;84:125-32.
Langberg BJ, Peck S. Tooth-size reduction associated with occurrence of palatal displacement of canines. Angle Orthod 2000;70:126-8.
Clark D. The management of impacted canines: Free physiologic eruption. J Am Dent Assoc 1971;82:836-40.
Power SM, Short MB. An investigation into the response of palatally displaced canines to the removal of deciduous canines and an assessment of factors contributing to favourable eruption. Br J Orthod 1993;20:217-23.
Katsnelson A, Flick WG. Use of panoramic x-ray to determine position of impacted maxillary canines. J Oral Maxillofac Surg 2010;68:996-1000.
Satheesh B Haralur
College of Dentistry, King Khalid University
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3]