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Table of Contents
CASE REPORT
Year : 2022  |  Volume : 9  |  Issue : 3  |  Page : 78-81

Autotransplantation for the correction of unfavorably impacted canines


1 Student, Department of Orthodontics and Dentofacial Orthopaedics, MES Dental College, Perinthalmanna, Kerala, India
2 Professor, Department of Orthodontics and Dentofacial Orthopaedics, MES Dental College, Perinthalmanna, Kerala, India
3 Private Practitioner, Department of Orthodontics and Dentofacial Orthopaedics, MES Dental College, Perinthalmanna, Kerala, India
4 Former Proffesor and HOD, Department of Orthodontics and Dentofacial Orthopaedics, MES Dental College, Perinthalmanna, Kerala, India

Date of Submission09-Aug-2022
Date of Acceptance25-Aug-2022
Date of Web Publication28-Sep-2022

Correspondence Address:
Dr. T Lishna Karalikkattil
Postgraduate Student, Department of Orthodontics and Dentofacial Orthopaedics, MES Dental College, Perinthalmanna, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpcdr.ijpcdr_17_22

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  Abstract 


The canine is diagnosed as impacted when its normal eruption time is significantly exceeded compared to the contralateral canine or the premolars. This case report presents, a female patient 14 years old with bilaterally impacted maxillary canines, retained maxillary deciduous canines, and proclination and spacing of the upper and lower anteriors and peg laterals. The treatment objective was to create a more ideal overjet and overbite relationship, place the impacted canines into position, and improve facial profile. Fixed orthodontic treatment was done with PEA “0.022 × 0.028” ORMCO, MBT prescription. After leveling, aligning, and space closure, extraction of bilaterally retained deciduous canines and autotransplantation of the unfavorably impacted canines were done. To enhance esthetics, composite restoration was done on the peg laterals. The total treatment time was 2 ½ years and the treatment objectives were achieved due to excellent patient cooperation. Facial harmony was good, and proclination and spacing were corrected.

Keywords: Autotransplantation, impacted canines, one-phase treatment


How to cite this article:
Karalikkattil T L, Shaloob M, Shebad A, Francis P G. Autotransplantation for the correction of unfavorably impacted canines. Int J Prev Clin Dent Res 2022;9:78-81

How to cite this URL:
Karalikkattil T L, Shaloob M, Shebad A, Francis P G. Autotransplantation for the correction of unfavorably impacted canines. Int J Prev Clin Dent Res [serial online] 2022 [cited 2022 Dec 7];9:78-81. Available from: https://www.ijpcdr.org/text.asp?2022/9/3/78/357306




  Introduction Top


Impacted teeth are those with a delayed eruption time or those which are not expected to erupt completely based on clinical and radiographic assessment.[1],[2],[3],[4],[5] Maxillary canines are the second-most frequently impacted teeth after third molars. Impaction of the maxillary canine has been reported as 1%–3%. Palatal impactions are reported to occur 2–3 times more frequently than buccal ones. The treatment plan for maxillary canine impaction should be decided among extraction, orthodontic traction, and autotransplantation according to several factors such as direction and position of the unerupted tooth, degree of developing root apex, eruption space, and existence of supernumerary tooth, odontoma, or cyst. Surgical exposure of impacted canines, often together with orthodontic traction, has long been advocated. Another treatment possibility is autotransplantation of the maxillary canine.[6],[7],[8],[9],[10] Autotransplantation is an alternative therapy that may be used in selected cases of severe impaction or when orthodontic repositioning is unsuccessful. In some cases, the position of the impacted tooth makes orthodontic traction too risky or even impossible. Autotransplantation can be a viable treatment option and has been proven to have an acceptable success rate. This case report describes the management of an unfavorably-impacted canine in a young female treated using autotransplantation together with orthodontic alignment.


  Case Report Top


A female patient 14-year-old reported to the Department of Orthodontics and Dentofacial Orthopedics, MES Dental College, Perinthalmanna, Kerala, with the chief complaint of spacing in the upper front teeth region. The patient had mesocephalic head, mesoprosopic facial form with orthognathic face, convex profile, acute nasolabial angle, incompetent lips, proclination of the upper and lower anteriors, retained 53, 63, impacted 13, 23, and peg laterals 12, 22. The patient had Angle's Class 1 molar relation [Figure 1] with bilaterally impacted maxillary canines, retained maxillary deciduous canines, and proclination and spacing of the upper and lower anteriors with peg laterals. Pretreatment radiographs are shown [Figure 2]. Cephalometric analysis indicated a bimaxillary protrusion with normal growth pattern.
Figure 1: Pretreatment extraoral and intraoral photographs

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Figure 2: Pretreatment OPG and lateral cephalogram radiographs. OPG: Orthopantomogram

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Treatment plan

Following a comprehensive clinical and database analysis, a treatment plan involving therapeutic extraction of 53.63 with autotransplantation of 13 and 23, corresponding midline, appropriate overjet, and adequate retraction of the proclined upper and lower anteriors were implemented.

Treatment progress

  • Banding of the upper and lower arch, TPA in the upper arch
  • Bonding of the upper and lower arch with Ormco Mini 2000
  • Leveling and alignment
  • Therapeutic extraction of 53 and 63
  • Autogenous transplantation of impacted 13,23 [Figure 3].
Figure 3: Autogenous transplantation of impacted 13, 23

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The bilateral greater palatine nerve block was given with buccal infiltration on the left and right quadrants (2% lignocaine with 1:80,000 epinephrine), a crevicular incision was taken from the upper first premolar region to the lateral incisor region on both sides, a full thickness mucoperiosteal flap was reflected, and the canines were exposed with round burs. Initially, the permanent canines were luxated, and then the new alveolus was prepared as completely as possible to a slightly wider socket. The over-retained primary canines were carefully luxated and extracted. Socket preparation was done in the region of 13 and 23. The permanent canines were extracted in one piece, and the surgical area was irrigated with saline solution. The transplant was kept in a dressing with physiological saline while adjusting the new alveolar site. Palatal flap closure was done with suture and then extracted permanent canines were placed in the socket with slight subocclusion without bony contact and stabilized with composite resin bonding. The postoperative period was uneventful. Follow-up revealed good healing and stabilization in the arch.

  • Retraction and space closure
  • Composite restoration of peg laterals
  • Retention using Hawley's appliance
  • The sequence of archwires used are:


  1. 0.016” nickel–titanium archwires
  2. 0.017 × 0.025” nickel–titanium archwires
  3. 0.019 × 0.025” nickel–titanium archwires
  4. 0.019 × 0.025” stainless steel archwires.


Atraumatic removal of donor's tooth during operation is prerequisite to an optimal clinical result. Due to a high possibility of pulp necrosis, endodontic treatment of fully developed transplanted teeth was undertaken.

Treatment results

The posttreatment results for the patients [Figure 4] showed excellent improvement in smile. Maxillary and mandibular anterior teeth proclination with the spacing was corrected with good maintenance of the buccal occlusion, and Class I molar relation was bilaterally maintained throughout the treatment with correction of the overjet and overbite. Posttreatment intraoral photographs and lateral cephalogram showed that the maxillary and mandibular incisors were inclined appropriately. Maxillary and mandibular anterior teeth protrusion were corrected, and a Class I molar relationship and overjet and overbite was maintained. The upper incisors to the NA plane had decreased from 31° to 22°, and the lower incisors to the NB plane decreased from 33° to 28°. The movement of the maxillary and mandibular incisors contributed to the correction of the soft-tissue profile and mental strain. The panoramic radiographs [Figure 5] showed adequate root parallelism in both upper and lower arches.
Figure 4: The posttreatment intraoral and extraoral photographs

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Figure 5: The posttreatment OPG and lateral cephalogram radiographs. OPG: Orthopantomogram

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  Discussion Top


Impacted maxillary canines are the most frequently impacted teeth after the third molars, with a prevalence ranging from approximately 1%–3%.[1],[2] More commonly observed in females.[3],[4] Although the alignment of maxillary canines plays an important role in maintaining esthetics and function of dentition, they are more difficult and time-consuming to treat. Autotransplantation can save time and less expensive than an orthodontic forced eruption. The recipient socket should be prepared to a size that is slightly larger than the root of the donor's tooth, and can be prepared with open or closed procedure; this depends on the root size of the donor tooth and buccolingual width at the transplantation site.[3],[4],[5],[6] An autotransplantation provides not only a biological replacement of a tooth which has the potential to induce alveolar bone growth but also supports proprioceptive function by maintaining a normal PDL.[7],[8],[9],[10] An autotransplanted tooth has the potential to erupt with neighboring teeth during continued facial growth. Autotransplanted tooth maintains a normal interdental papilla and shows desired movement with orthodontic treatment. The survival rate for autotransplantation of severely ectopic maxillary canines, as present in this case, has been reported to be as high as 83% with mean longevity of 14.5 years.[3]


  Conclusion Top


Autotransplantation is an alternative for replacing missing teeth. The success rate is approximately similar to implants, with proper technique applied.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
von der Heydt K. The surgical uncovering and orthodontic positioning of unerupted maxillary canines. Am J Orthod 1975;68:256-76.  Back to cited text no. 1
    
2.
Andreasen GF. A review of the approaches to treatment of impacted maxillary cuspids. Oral Surg Oral Med Oral Pathol 1971;31:479-84.  Back to cited text no. 2
    
3.
Patel S, Fanshawe T, Bister D, Cobourne MT. Survival and success of maxillary canine autotransplantation: A retrospective investigation. Eur J Orthod 2011;33:298-304.  Back to cited text no. 3
    
4.
Richardson G, Russell KA. A review of impacted permanent maxillary cuspids – Diagnosis and prevention. J Can Dent Assoc 2000;66:497-501.  Back to cited text no. 4
    
5.
Chaushu S, Chaushu G, Becker A. The use of panoramic radiographs to localize displaced maxillary canines. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:511-6.  Back to cited text no. 5
    
6.
Walker L, Enciso R, Mah J. Three-dimensional localization of maxillary canines with cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2005;128:418-23.  Back to cited text no. 6
    
7.
Mason C, Papadakou P, Roberts GJ. The radiographic localization of impacted maxillary canines: A comparison of methods. Eur J Orthod 2001;23:25-34.  Back to cited text no. 7
    
8.
Ericson S, Kurol PJ. Resorption of incisors after ectopic eruption of maxillary canines: A CT study. Angle Orthod 2000;70:415-23.  Back to cited text no. 8
    
9.
Kim E, Jung JY, Cha IH, Kum KY, Lee SJ. Evaluation of the prognosis and causes of failure in 182 cases of autogenous tooth transplantation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:112-9.  Back to cited text no. 9
    
10.
Zachrisson BU, Stenvik A, Haanaes HR. Management of missing maxillary anterior teeth with emphasis on autotransplantation. Am J Orthod Dentofacial Orthop 2004;126:284-8.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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