The management of impacted canines is important in terms of esthetics and function. Clinicians must formulate treatment plans that are in the best interest of the patient and they must be knowledgeable about the variety of treatment options. When patients are evaluated and treated properly, clinicians can reduce the frequency of ectopic eruption and subsequent impaction of the maxillary canine. The simplest interceptive procedure that can be used to prevent impaction of permanent canines is the timely extraction of the primary canines. This procedure usually allows the permanent canines to become upright and erupt properly into the dental arch, provided sufficient space is available to accommodate them. In the present article, an overview of the incidence and sequelae, as well as the surgical, periodontal, and orthodontic considerations in the management of impacted canines is presented.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals
who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry,
Periodontics and General Dentistry.
Cybernetic theory of craniofacial growth /certified fixed orthodontic courses...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Interdisciplinary Literacy - Social StudiesEMichWP
Presentation of the Social Studies Interdisciplinary Study Group - EMWP - Andrea Gilles, Michelle McLemore , Judy Wycoff, Dawn Putnam, and John Stauton
An Interdisciplinary Perspective on Global Health and the SDGs - Prof. Sir An...LIDC
It is rare that you find an outstanding leader in a particular discipline who has also become as well an international figure in interdisciplinary thinking. Prof Sir Andy Haines is just such a figure.
A former Director of the London School of Hygiene and Tropical Medicine and one of the designers and founders of LIDC about a decade ago, Andy has in recent years developed an international reputation and programme linking our development agenda for global health with the much bigger challenge of sustainability and the threat posed to that by climate change and environmental degradation.
His work has revealed the threats posed to health and well being by environmental change, but has emphasized and identified the positive opportunities, and the co-benefits they can generate.
1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals
who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry,
Periodontics and General Dentistry.
Cybernetic theory of craniofacial growth /certified fixed orthodontic courses...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Interdisciplinary Literacy - Social StudiesEMichWP
Presentation of the Social Studies Interdisciplinary Study Group - EMWP - Andrea Gilles, Michelle McLemore , Judy Wycoff, Dawn Putnam, and John Stauton
An Interdisciplinary Perspective on Global Health and the SDGs - Prof. Sir An...LIDC
It is rare that you find an outstanding leader in a particular discipline who has also become as well an international figure in interdisciplinary thinking. Prof Sir Andy Haines is just such a figure.
A former Director of the London School of Hygiene and Tropical Medicine and one of the designers and founders of LIDC about a decade ago, Andy has in recent years developed an international reputation and programme linking our development agenda for global health with the much bigger challenge of sustainability and the threat posed to that by climate change and environmental degradation.
His work has revealed the threats posed to health and well being by environmental change, but has emphasized and identified the positive opportunities, and the co-benefits they can generate.
Pursuing a Curriculum of Interdisciplinary StudiesGraham Garner
The pursuit of interdisciplinary studies in modern curricula represents the continued effort to design an education that gives students the knowledge about the world around them, the ability to critically think about it and then act to the advancement of knowledge and betterment of mankind. The traditional division of disciplines has raised barriers, and techniques from interdisciplinary studies can replace those with bridges. Educators must be committed to overcoming interdisciplinary studies’ unique challenges to make a difference in the future of curriculum.
The management of impacted canines is important in terms of esthetics and function. Clinicians must formulate treatment plans that are in the best interest of the patient and they must be knowledgeable about the variety of treatment options. When patients are evaluated and treated properly, clinicians can reduce the frequency of ectopic eruption and subsequent impaction of the maxillary canine. The simplest interceptive procedure that can be used to prevent impaction of permanent canines is the timely extraction of the primary canines. This procedure usually allows the permanent canines to become upright and erupt properly into the dental arch, provided sufficient space is available to accommodate them. In the present article, an overview of the incidence and sequelae, as well as the surgical, periodontal, and orthodontic considerations in the management of impacted canines is presented.
Titanium Button With Chain by Watted For Orthodontic Traction of Impacted Ma...Abu-Hussein Muhamad
Abstract: Advances in bonding techniques and materials allow for reliable bracket placement on ectopically positioned teeth. This prospective study evaluates the outcome of forced orthodontic eruption of impacted canine teeth in both palatal and labial positions. Eighty-two impacted maxillary canines in 2200patients were included in the study and were observed for 2006 to 2013 ,in Center for Dentistry research and Aesthetics, Jatt/Israel after exposure. Following exposure by means of a palatal flap or an apically repositioned buccal flap, an orthodontic traction hook, with a Titanium Button with chain by Watted (Dentaurum) attached, was bonded to each impacted tooth using a light cured orthodontic resin cement. A periodontal dressing was placed over the surgical site for a period of time. All teeth were successfully erupted. Complications consisted of: failure of initial bond, at the time of surgery, which required rebonding; premature debonding at the time of pack removal and; debonding of brackets during orthodontic eruption. There was no infection, eruption failure, ankylosis, resorption or periodontal defect (pocket greater than 3 mm) associated with any of the exposed teeth. Forced orthodontic eruption of impacted maxillary canines with a well bonded orthodontic traction hook and ligation chain, used in conjunction with a palatal flap or an apically repositioned labial flap, results in predictable orthodontic eruption with few complications. Key Words: cuspid/surgery; orthodontics, corrective; tooth, impacted/therapy
Introduction: Impaction of maxillary canines is a frequently encountered clinical problem in orthodontic therapy. When a preventive approach fails, treatment involves surgical exposure of the impacted tooth, followed by orthodontic traction to guide and align it into the dental arch. The aim of the present report was to demonstrate by case reports of an adult patient with bilateral impacted maxillary canines treated with surgical exposure and orthodontic treatment
Introduction: Impaction of maxillary canines is a frequently encountered clinical problem in orthodontic therapy. When a preventive approach fails, treatment involves surgical exposure of the impacted tooth, followed by orthodontic traction to guide and align it into the dental arch. The aim of the present report was to demonstrate by case reports of an adult patient with bilateral impacted maxillary canines treated with surgical exposure and orthodontic treatment.
Clinical Management of Bilateral Impacted Maxillary CaninesAbu-Hussein Muhamad
Introduction: Impaction of maxillary canines is a frequently encountered clinical problem in orthodontic therapy. When a preventive
approach fails, treatment involves surgical exposure of the impacted tooth, followed by orthodontic traction to guide and align it into the
dental arch. The aim of the present report was to demonstrate by case reports of an adult patient with bilateral impacted maxillary canines
treated with surgical exposure and orthodontic treatment.
Material and Methods: A 15year-old female with various degrees of bilateral palatal impaction of maxillary canines were managed
by the described technique.
Results and Discussion: Autonomous eruption of the impacted canines after surgical uncovering was witnessed in all patients
without the need for application of a vertical orthodontic force for their extrusion.
Conclusion: The described method of surgical uncovering and autonomous eruption created conditions for biological eruption of the
palatally impacted canines into the oral cavity and facilitated considerably the subsequent orthodontic treatment for their proper alignment
in the dental arch.
Keywords: Impacted canines; Surgical; Tooth exposure; Orthodontic treatment
Surgery of Labially Impacted Canine & Orthodontic Management – A Case ReportAbu-Hussein Muhamad
Maxillary canines are one of the most common teeth that are impacted among patients seeking orthodontic treatment. Depending on the position of these impacted teeth, various surgical techniques have been employed for their exposure. His primary goal of surgical phase is to provide the means for correct position of orthodontic anchorage. Additionally, the technique used must ensure favorable tissue anatomy that will permit long-term maintenance of periodontal health. In the present case, a labially impacted maxillary left canine was surgically exposed using an apically po
Esthetic Management of Congenitally Missing Lateral Incisors With Single Toot...Abu-Hussein Muhamad
Congenitally missing teeth are frequently presented to the dentist. Interdisciplinary approach may be needed for the proper treatment plan. Several treatment options exist for the replacement of congenitally missing lateral incisors.This case report addresses the fundamental considerations related to replacement of a congenitally missing lateral incisor by a team approach.
Esthetic Management of Congenitally Missing Lateral Incisors With Single Toot...Abu-Hussein Muhamad
Congenitally missing teeth are frequently presented to the dentist. Interdisciplinary approach may be needed for the proper treatment plan. Several treatment options exist for the replacement of congenitally missing lateral incisors.This case report addresses the fundamental considerations related to replacement of a congenitally missing lateral incisor by a team approach.
Two Treatment Approaches for Missing Maxillary Lateral Incisors: A CaseAbu-Hussein Muhamad
Missing maxillary lateral incisors create an esthetic problem with specific orthodontic and prosthetic considerations. The aim of the present study is to evaluate the clinical success of the transmucosal flapless implant placement and immediate loading of the implants to restore the agenic lateral incisors after completing the orthodontic treatment and during the retention period.
Surgery of Labially Impacted Canine & Orthodontic Management – A Case ReportAbu-Hussein Muhamad
Maxillary canines are one of the most common teeth that are impacted among patients seeking orthodontic treatment. Depending on the position of these impacted teeth, various surgical techniques have been employed for their exposure. His primary goal of surgical phase is to provide the means for correct position of orthodontic anchorage. Additionally, the technique used must ensure favorable tissue anatomy that will permit long-term maintenance of periodontal health. In the present case, a labially impacted maxillary left canine was surgically exposed using an apically positioned flap. Orthodontic extrusion was carried out further.
ORTHODONTIC TREATMENT OF AN IMPACTED MAXILLARY CENTRAL INCISOR COMBINED WI...Abu-Hussein Muhamad
Impaction of maxillary permanent incisors is not a frequent case in dental practice, but its treatment is challenging because of these teeth importance to facial esthetics Management by a combination of orthodontics and surgery produces a satisfactory result. The surgical exposure and orthodontic traction of impacted central incisor after surgical exposure of impacted maxillary central incisor teeth is presented in this case report.
Key words: Impacted tooth, Maxillary incisors orthodontics, tooth movement
Aim: Dental impaction is a very frequent problem and the canine tooth is one of the most affected. Impacted canines result
in many complications and their early diagnosis by radiographic evaluation is imperative. The aim of the present study was
to determine the prevalence of impacted canines in the Arab population in Israel(48Arabs). Materials and Methods: The
panoramic radiographic records of 2200patients attending the Center for Dentistry Research and Aesthetics, Jatt/Israel ,
between June 2006 and December 2013 were examined for the study. The age of the patients ranged from 10.5 to
39,5years, with a mean of 16,2years. Results: The prevalence of canine impaction in males was 1,6% and 2,1% in
females.in maxillary,and 0,6%mandibular The overall prevalence was 4,3 %. Maxillary left canines were the most
frequently impacted Only 13 cases showed impaction of the mandibular canine. Unilateral impaction was seen in 0,5% of
the patients. Conclusion: Canines play a vital role in facial appearance, dental esthetics, arch development, and functional
occlusion. If signs of ectopic eruption are detected early, every effort should be made to prevent impaction and its
consequences. Early intervention eliminates the need for surgical intervention and complex treatment.
Clinical study of impacted maxillary canine in the Arab population in IsraelAbu-Hussein Muhamad
The objective of the present study was to determine the prevalence of impacted maxillary canine in patients in Arabs
Community in Israel (ARAB48,Israel) visiting our Center For Dentistry,Research & Aesthetics,Jatt,Almothalath,Israel,
4250 patients . This study comprises data from patients who attended the O.P.D.2200 patients between Jun. 2006 to Dec
2013. Patients were examined in order to detect the impacted maxillary canines by intraoral examination, palpation, dental
records and followed by radiographs. It was found that the prevalence of canine impaction was 0,8 % (N=4250), 1,6
(N=2200), 43,9 (N-82) in males and 1,1% (N=4250), 2,1 (N=2200), 56,1 (N-82) in females suggesting that prevalence of
impacted maxillary canines is more in females than males and it is statistically significant. The overall prevalence for
maxillary impacted canines was found to be 3,7 % (N=2200) which suggested that it is much higher than previous studies.
The results of this study were slightly different than other studies, while the dissimilarities may be attributed to the sample
selection, method of the study and area of patient selection, which suggest racial and genetic differences.
Congenital absence of maxillary lateral incisors is a frequent clinical challenge which must be solved by a multidisciplinary approach in order to obtain an
esthetic and functional restorative treatment. . Fixed prosthodontic and removable prostheses, resin bonded retainers, orthodontic movement of maxillary
canine to the lateral incisor site and single tooth implants represent the available treatment modalities to replace congenitally missing teeth. This case report
demonstrates the team approach in prosthetic and surgical considerations and techniques for managing the lack of lateral incisors. The aims of this case
report of replacement of bilaterally congenitally missing maxillary lateral incisors with dental implants.
Aesthetic Management of Fractured Anteriors: A Case ReportAbu-Hussein Muhamad
Introduction: Coronal fracture of anterior teeth is an important topic for esthetic dentistry. Such fractures may jeopardize esthetics, function, tissue biology
and occlusal physiology, thus endangering tooth vitality and integrity. Coronal fractures resulting from dental trauma most frequently occur to the maxillary
anterior teeth of adolescents and less frequently to mandibular teeth. Adult teeth may also suffer traumatic fracture, although less frequently than for
adolescents.
Case Report: In our case, an economical and time-saving novel technique has been described for direct composite restoration in a young patient with
uncomplicated fractured maxillary anterior tooth.
Conclusion: As restoring a fractured tooth is a complex procedure, this technique can prove as a simple, effective and appropriate technique that will fulfill all
the requirements of dental personnel. This technique can also prove to be easy for inexperienced beginner clinicians without requiring special skills in
providing the patients with direct composite restorations.
Impacted Maxillary Central Incisors: Surgical Exposure and Orthodontic Treat...Abu-Hussein Muhamad
The maxillary permanent central incisor develops early in life and forms part of an aesthetic smile. Disruption of the formation or eruption of the permanent
central incisor has multiple etiological factors. Treatment options depend to some extent on the cause of failure of eruption of the central incisor. Generally,
the earlier treatment is provided, the higher the likelihood of success and the less the complexity. Our results suggest that close monitoring and interdisciplinary
cooperation during the treatment phases led to a successful esthetic result, with good periodontal health and functional occlusion.
Excess of space in the dental arch is diagnosed as a
generalised spacing or a local divergence, often
observed in the maxillary anterior region, as a median
diastema, traumatic loss of central incisors, or
congenital absence of lateral incisors. Furthermore,
spacing is observed in aging individuals, due to
pathological migration of teeth caused by
periodontitis. Finally, adult individuals with partial
edentulous jaws demand pre-prosthetic orthodontic
treatment from functional aspects. Thus, indication for
orthodontic treatment in subjects with spacing of teeth
exists for aesthetic reasons, but also for facilitating
prosthetic restorations with optimal occlusalstability.
Dental implants represent one of the most successful treatment modalities in dentistry.
However, failures do occur in the range from 5 to 8% for routine procedures and up to 20% in major grafting
cases after at least 5 years of function . The majority of implant losses may be explained as biomechanically
induced failures, since low primary implant stability, low bone density, short implants and overload have been
identified as risk factors . Hence, achievement and maintenance of implant stability are pre-conditions for a
successful clinical outcome with dental implants.
The review focuses on different methods used to assess implant stability and recent advances in this field.
Aesthetic Management of Fractured Anteriors: A Case ReportAbu-Hussein Muhamad
Introduction: Coronal fracture of anterior teeth is an important topic for esthetic dentistry. Such fractures may jeopardize esthetics, function, tissue biology
and occlusal physiology, thus endangering tooth vitality and integrity. Coronal fractures resulting from dental trauma most frequently occur to the maxillary
anterior teeth of adolescents and less frequently to mandibular teeth. Adult teeth may also suffer traumatic fracture, although less frequently than for
adolescents.
Case Report: In our case, an economical and time-saving novel technique has been described for direct composite restoration in a young patient with
uncomplicated fractured maxillary anterior tooth.
Conclusion: As restoring a fractured tooth is a complex procedure, this technique can prove as a simple, effective and appropriate technique that will fulfill all
the requirements of dental personnel. This technique can also prove to be easy for inexperienced beginner clinicians without requiring special skills in
providing the patients with direct composite restorations
Orthodontic tooth movement is basically a biologic response towards a mechanical force. Osteoclast and osteoblast cells mediate bone resorption and apposition, which eventually produces tooth movement. Researches showed that the rate of orthodontic tooth movement can be altered by certain drugs locally or systemically. The Objective of this article is to discuss the current data concerning the effect of drugs on orthodontic tooth movement.
Multidisciplinary Approach in the Rehabilitation of Congenitally Maxillary C...Abu-Hussein Muhamad
Objective: This case report describes the multidisciplinary
approach to treat a congenitally missed maxillary canine, how to
improve patient’s smile using orthodontic fixed appliance, endosseous
dental implant, and porcelain veneer to achieve the treatment results of
function and esthetic.
Materials and procedures: Unilateral agenesis of the permanent
maxillary canines in healthy individuals is extremely rare. This
paper presents the case of a female patient diagnosed with congenital
unilateral agenesis of the permanent maxillary canines as well as
occlusal abnormalities in the form of left-side crossbite. To restore the
proper aesthetics and function, interdisciplinary therapeutic treatment
was implemented. In the case presented in this paper, the aim of
oral rehabilitation was to restore a functional balance by obtaining
proper skeletal relationships, creating optimal occlusal conditions and
obtaining arch continuity.
Conclusion: Interdisciplinary treatment combined of orthodontics,
implant surgery, and prosthodontics was useful to treat a nonsyndromic
oligodontia patient. Especially, with the new strategy, implantanchored
orthodontics, which can facilitate the treatmentand make it
more simply with greater predictability.
The multifactorial factors influenc cleft Lip-literature review Abu-Hussein Muhamad
Congenital cleft-Lip and cleft palate have been the subject of many genetic
studies, but until recently there has been no consensus as to their modes of
inheritance. In fact, claims have been made for just about every genetic
mechanism one can think of. Recently, however, evidence has been
accumulating that favors a multifactorial basis for these malformations. The
purpose of the present paper is to present the etiology of cleft lip and cleft palate
both the genetic and the environmental factors. It is suggested that the genetic
basis for diverse kinds of common or uncommon congenital malformations may
very well be homogeneous, whilst, at the same, the environmental basis is
heterogeneous.
Dental implants represent one of the most successful treatment modalities in dentistry.
However, failures do occur in the range from 5 to 8% for routine procedures and up to 20% in major grafting cases after at least 5 years of function . The majority of implant losses may be explained as biomechanically induced failures, since low primary implant stability, low bone density, short implants and overload have been identified as risk factors . Hence, achievement and maintenance of implant stability are pre-conditions for a successful clinical outcome with dental implants.
The review focuses on different methods used to assess implant stability and recent advances in this field
Over time, progressively shorter implants have been placed such that short implants are now available that are less than 6 mm in length. The viability and high success rates seen with short implants can be explained by osseointegration, the macro geometric design of the implant, as well as physics and the distribution of forces. This paper was aimed to review the stability and survival rate of short implants under functional loads. Numerical and clinical studies were reviewed. Keywords: Short dental implants, sinus augmentation, factors affecting bone regeneration in dental implantology
Porcelain laminate veneers are among the most esthetic means of creating a more pleasing and beautiful smile. Porcelain veneers within reason allow for the alteration of tooth position, shape, size and color. They require a minimal amount of tooth preparation, approximately 0.5 mm to 0.7mm of surface enamel reduction. This study describes the use of ceramic veneers without tooth wear, reinforcing the concept that minimally invasive porcelain laminate veneers could become versatile and conservative allies in the fi eld of esthetic dentistry. Keywords: Ceramics, dentin-bonding agents, esthetics
Immediate Restoration of Single Implants Replacing Lateral Incisor Compromis...Abu-Hussein Muhamad
Today, the diagnosis of internal root resorption is significantly improved by the three-dimensional imaging. Furthermore, the CBCT’s superior diagnosis accuracy resulted in an improved management of the resorptive defects and a better outcome of Implant therapy of teeth with internal resorption.Implant has become a wide option to maintain periodontal architecture. Diagnosis and treatment planning is the key factors in achieving the successful outcomes after placing and restoring implants placed immediately after tooth extraction. The purpose of this clinical update is to report on the success and survival of Immediate restoration of single implants replacing right lateral incisor compromised by internal resorption.
Immediate Implant Placement And Restoration With Natural Tooth In The Maxilla...Abu-Hussein Muhamad
Anterior tooth loss and restoration in the esthetic zone is a common challenge in dentistry today. The prominent visibility of the area can be especially distressing to the patient and requires a timely and esthetically pleasing solution. Immediate single-tooth implantation followed by immediate provisionalization is becoming an increasingly desirable treatment that offers numerous benefits over conventional delayed loading. Provisionalization for immediately-placed implants using the patient’s existing tooth can enhance the final aesthetic outcome if certain steps are
followed. If the natural tooth is intact and can be used as a provisional, the emergence profile can be very similar to the preoperative condition. This article outlines a technique to use the patient’s natural tooth after extraction to provisionalize an implant.
“One-Piece” Immediate-Load Post-Extraction Implant In Maxillary Central IncisorAbu-Hussein Muhamad
Abstract: This case report describes extraction of a fractured left maxillary central incisor tooth, followed by immediate placement of an one-piece implant in the prepared socket and temporization by a bonded restoration.
Materials And Methods: The tooth was extracted with minimal hard and soft tissue trauma and without flap reflection. The socket was prepared to the required depth and a Implant was inserted.
Results: The atraumatic operating technique and the immediate insertion of the one-piece Implant resulted in the preservation of the hard and soft tissues at the extraction site.
Conclusion: The “One-piece” dental implant and provisional restoration provided the patient with immediate esthetics, function, comfort and most importantly preservation of tissues. The one-piece implant design resulted in a high cumulative implant survival rate and beneficial marginal bone levels.
Single Visit Replacement of Central Maxillary Using Fiber-Reinforced Composi...Abu-Hussein Muhamad
Fiber reinforced composites are high strength filling materials composed of conventional composites and glass fibres. They exhibit extensive applications in different fields of dentistry. This clinical report present a case where FRC technology was successfully used to restore central maxillary incisor edentulous area in terms of esthetic-cosmetic values and functionality.
Zirconium Dental Implants And Crown for Congenitally Missing Maxillary Latera...Abu-Hussein Muhamad
Zirconia implants were familiarized into dental implantology. Zirconia appears
to be an appropriate implant material due to its low plaque affinity, tooth like color, biocompatibility and mechanical properties. The following a case presentations will show how the acid-etched zirconia Implant can be used to functionally and aesthetically replace congenitally missing left lateral incisor tooth germ in the maxilla, and achieve optimal soft tissues and health.
Taurodontism is a rare dental anomaly in which the involved tooth has an enlarged and elongated body and pulp chamber
with apical displacement of the pulpal floor. Endodontic treatment of a taurodont tooth is challenge to a clinician and
requires special handling because of the proximity and apical displacement of the roots. The present article describes the
diagnosis and management of hypertaurodontism by endodontic treatment in a left mandibular second molar.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
1. INTERNATIONAL JOURNAL OF MAXILLOFACIAL RESEARCH VOLUME 1 ISSUE 2 2015 116
Interdisciplinary Approach in the
Treatment of Impacted Canines – Review
Péter Borbély1
, Nezar Watted2
, Ivana Dubovská3
, Viktória Hegedűs 4
,Abu-Hussein
Muhamad5
The management of impacted canines is important in terms of esthetics and function.
Clinicians must formulate treatment plans that are in the best interest of the patient and they
must be knowledgeable about the variety of treatment options. When patients are evaluated
and treated properly, clinicians can reduce the frequency of ectopic eruption and subsequent
impaction of the maxillary canine. The simplest interceptive procedure that can be used to
prevent impaction of permanent canines is the timely extraction of the primary canines. This
procedure usually allows the permanent canines to become upright and erupt properly into
the dental arch, provided sufficient space is available to accommodate them. In the present
article, an overview of the incidence and sequelae, as well as the surgical, periodontal, and
orthodontic considerations in the management of impacted canines is presented.
Keywords: Diagnosis, etiology, impacted canines, orthodontic techniques, prevention,
surgical techniques
INTRODUCTION
Impaction is a pathological condition
defined by the lack of eruption of a tooth
in to the oral cavity within the time and
physiological limits of the normal eruption
process.1
Impacted teeth are those with a
delayed eruption time or that are not
expected to erupt completely based on
clinical and radiographic assessment.
Permanent maxillary canines are the
second most frequently impacted teeth; the
prevalence of their impaction is 1-2% in
the general population. 1, 2
This is most
likely due to an extended development
period and the long, tortuous path of
eruption before the canine emerges into
full occlusion. Methods of diagnosis that
may allow for early detection and
prevention should include a family history,
visual and tactile clinical examinations by
the age of 9-10 years and a thorough
radiographic assessment. Because there is
a high probability that
palatally impacted maxillary canines may
occur with other dental anomalies, the
clinician should be alert to this possibility.
When the condition is identified early,
extraction of the maxillary deciduous
R
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2. INTERNATIONAL JOURNAL OF MAXILLOFACIAL RESEARCH VOLUME 1 ISSUE 2 2015 117
canines may, in some cases, allow
the impacted canines to correct their paths
of eruption and erupt into the mouth in
relatively good alignment. This
interceptive treatment may further reduce
complications associated with
palatally impacted canines including root
resorption of the lateral incisors and the
need for more complex surgical and
orthodontic intervention.1,2,4,5
(Fig. 01)
Fig. 01: Root resorptions of adjacent teeth
Clinicians have various definitions of
“impaction.” Canine impaction can be
defined as an unerupted tooth after its root
development is complete; or a tooth still
unerupted when the corresponding tooth
on the other side of the arch has been
erupted for at least 6 months and has a
complete root formation; or a condition in
which a tooth is embedded in the alveolus
and is locked in by bone, adjacent teeth, or
other obstacles and cannot properly erupt
into the oral cavity. This includes teeth in
which eruption is significantly delayed and
there is no clinical or radiographic
evidence that further eruption is likely to
happen.1,3,4,6,7
Maxillary canine has the longest period of
development and the most devious
eruption path. Its final position in the
occlusion is essential to complete the arch
form, a functional occlusion and symmetry
and harmony of the dentition. The
maxillary canine is the most frequently
impacted tooth except from third molars.
The reported incidence of canine
impaction varies from 0.8 to 5.2 percent in
normal populations. Bilateral impaction is
seen in 17 to 45 percent of the cases, and
impacted canines are more common in
females than males. The reported
percentages of palatally impacted canines,
varies between 41 percent and 93 percent
among studies. Most of the palatally
impacted canines (85 percent), have
sufficient space for eruption into the dental
arch.4,5,7,8(Fig. 02a-c)
3. INTERNATIONAL JOURNAL OF MAXILLOFACIAL RESEARCH VOLUME 1 ISSUE 2 2015 118
Fig.02a-c: The cyst is the cause of the
displacement in the maxilla and mandible
Two common theories may explain the
phenomenon of the palatally impacted
canine, but the exact etiology of impacted
maxillary canines is not yet known. The
guidance theory of palatal canine
displacement suggests that palatal
displacement is a result of local factors
such as lack of guidance along the root of
the lateral incisor due to congenitally
missing lateral incisors, supernumerary
teeth, odontomas, transposition of teeth, or
other mechanical destining factors that
influence the eruption path of the canine.
The second theory for canine impaction is
known as the genetic theory‖. In this
theory palatal impaction of canines has
been found to be related to congenital
absence of teeth, and is suggested to be of
the same genetic origin. In addition, there
are some factors that are thought to cause
canine impaction such as obstacles,
abnormal position of tooth bud, dental
crowding, long and complicated path of
eruption, late eruption date, early loss of
deciduous canine, prolonged retention of
the deciduous teeth, and systemic disease .
Palatally impacted maxillary canines are
often present along with other dental
abnormalities including tooth size, shape,
number, and structure; hypoplastic enamel,
infra-occluded primary molars and aplastic
second bicuspids. 2,3,4,8
In general, the causes for retarded eruption
of teeth may be either generalized or
localized. Generalized causes include
endocrine deficiencies, febrile diseases,
and irradiation. The most common causes
for canine impactions are usually localized
and are the result of any one, or
combination of the following factors:
(a) tooth size-arch length discrepancies,
(b) prolonged retention or early loss of the
deciduous canine,
(c) abnormal position of the tooth bud,
(d) the presence of an alveolarcleft,
(e) ankylosis,
(f) cystic or neoplastic formation,
(g) dilaceration of the root,
(h) iatrogenic origin (discussed earlier),
and (i)idiopathic condition with no
apparent cause . (Fig. 03a, b)
4. INTERNATIONAL JOURNAL OF MAXILLOFACIAL RESEARCH VOLUME 1 ISSUE 2 2015 119
Fig. 03a, b: OPG shows the resorption at
the lateral incisors. In CT, the extent of
resorption at the central incisors is also
clearly seen.
If orthodontic treatment is not provided
for impacted canine, complications such as
root resorption of the neighbouring lateral
incisor and first premolar, and
development of cyst may occur.7,8,9
(Fig.
04a, b).
Fig. 04a, b: dilaceration of the root and
displacement of the canine
A genetic predisposition was shown in
some studies; the relatives of patients with
palatal canines are likely to exhibit
palatally displaced canines and anomalous
lateral incisors. Peck et al concluded that
palatally displaced canines appear to be a
product of polygenic multifactorial
inheritance. 10
Also Prinin et al found that
palatally impacted canines are genetic and
related to incisor premolar hypodontia and
peg shaped lateral incisors.11
This article discusses the etiology,
diagnosis, and clinical management of
impacted maxillary canine teeth.
Prevalence and Etiology
Eighty-five per cent of impacted maxillary
permanent cuspids are palatal impactions,
and 15% are labial impactions. Inadequate
arch space and a vertical developmental
position are often associated with
5. INTERNATIONAL JOURNAL OF MAXILLOFACIAL RESEARCH VOLUME 1 ISSUE 2 2015 120
buccal canine impactions. If buccally
impacted cuspids erupt they do so
vertically, buccally and higher in the
alveolus. Due to denser palatal bone and
thicker palatal mucosa, as well as a more
horizontal position, palatally displaced
cuspids rarely erupt without requiring
complex orthodontic treatment. Palatally
erupting or impacted maxillary canines
occur twice as often in females than males,
have a high family association and are 5
times more common in Caucasians than
Asians. It is not unusual for
maxillary canine impaction to occur
bilaterally, although unilateral ectopic
eruptions are more frequent.5
Although Impacted canines can be seen
intooth size arch length discrepancy, early
loss of deciduous teeth, craniofacial
syndromes like Crouzon syndrome,
cliedocranial dysostosis etc, The exact
etiology of palatally impacted maxillary
cuspids is unknown; however, two
common theories may explain the
phenomenon: the guidance theory and the
genetic theory.6,7
The “guidance theory of
palatal canine displacement” proposes that
this anomaly is a result of local
predisposing causes including congenitally
missing lateral incisors, supernumerary
teeth, odontomas, transposition of teeth
and other mechanical determinants that all
interfere with the path of eruption of the
canine. Maxillary canines develop high in
the maxilla, are among the last teeth to
develop and travel a long path before they
erupt into the dental arch. These factors
increase the potential for mechanical
disturbances resulting in displacement and,
thus, impaction. The second theory focuses
on a genetic cause for impacted cuspids.7,12
Palatally impacted maxillary cuspids often
present with other dental abnormalities,
including tooth size, shape, number and
structure, which Baccetti reported to be
linked genetically. Several abnormalities
are believed to have a common hereditary
link, manifested as a developmental
disturbance during embryonic growth.
Research demonstrates that up to 33% of
patients with palatally impacted cuspids
also have congenitally missing teeth, a
frequency that is 4-9 times that of the
general population.12
Studies also show that up to 47.7% of
patients with palatally impacted cuspids
have small, peg-shaped or missing lateral
incisors. 12
In patients with congenitally absent
maxillary lateral incisors, the co-
occurrence of palatally impacted canines is
2.4 times that of the general population.
Palatally impacted maxillary canines are
also associated with such anomalies as
hypoplastic enamel, infra-occluded
primary molars and aplastic second
6. INTERNATIONAL JOURNAL OF MAXILLOFACIAL RESEARCH VOLUME 1 ISSUE 2 2015 121
bicuspids.12
However, it remains uncertain whether the
anomalous lateral incisor is a local causal
factor for palatally displaced canines or an
associated genetic developmental
influence. Diagnosis and Early detection
of impacted maxillary canines may reduce
treatment time, complexity, complications
and cost. Ideally, patients should be
examined by the age of 8 or 9 years to
determine whether the canine is displaced
from a normal position in the alveolus and
assess the potential for impaction. The
clinician can investigate the presence and
position of the cuspid using 3 simple
methods: visual inspection, palpation and
radiography.5,6,7,12
DIAGNOSIS
When dealing with impacted maxillary
canines, an accurate diagnosis is critical
for the success of the proposed treatment.
Unlike impacted mandibular third molars,
unerupted permanent maxillary canines
cause patients relatively few problems. A
retained primary canine may have a
relatively poor appearance compared with
a properly aligned permanent canine, but
many patients are often unaware of the
presence of and do not seek treatment for a
retained primary canine. Consequently, the
discovery of an impacted canine is
frequently made at the time of a routine
radiographic examination.4,5,6,7
Jacobs gave the four reasons why it is
important to localize an impacted
maxillary canine. Firstly, it is a sound
principle not to extract a well-placed tooth
in order to make space for a poorly
positioned one. If a well-placed tooth is
preserved, the treatment time may be
shortened considerably, and the result is
predictable. The converse is also true. If a
poorly placed canine is kept and a well-
aligned tooth extracted, then the treatment
time will be prolonged and the result is
unpredictable.13
Secondly, an error in the
localization process can result in a surgical
flap being raised in the wrong area.
Thirdly, the clinician must be estimate the
degree of difficulty involved in uncovering
a displaced canine. Uncovering a
malpositioned canine may be more
hazardous to the adjacent teeth than
extracting the
canine14,15
. And, fourthly, if suitable
clinical conditions exist, a palatally
impacted maxillary canine may be induced
to spontaneously erupt into the line of the
arch, simply by extraction of the primary
canine. As extraction of the primary canine
is often successful in allowing the palatally
impacted canine to erupt spontaneously,
the necessity for surgery and orthodontics
with all their associated discomforts,
hazards, and costs are avoided. This
procedure may also reduce the incidence
of resorption of the roots of an adjacent
incisor by an impacted canine.[14,15,16]
7. INTERNATIONAL JOURNAL OF MAXILLOFACIAL RESEARCH VOLUME 1 ISSUE 2 2015 122
Clinical signs that may indicate ectopic
or impacted succedaneous cuspids include
lack of a canine bulge in the buccal sulcus
by the age of 10 years, overretained
primary cuspids, delayed eruption of their
permanent successor and asymmetry in the
exfoliation and eruption of the right and
left canines. Primary cuspids that are
retained beyond the age of 13 years and
have no significant mobility strongly
indicate displacement and impaction of
permanent canines. Although Power and
Short assert that the maxillary canine is
late in its eruption sequence if it has not
emerged by the age of 12.3 years in
females and 13.1 years in males,
correlation between chronological and
dental ages is poor and overall dental
development must be considered when
investigating delayed canine eruption.17
Although distal crown tip on the maxillary
lateral incisors is common in the mixed
dentition stage before eruption of the
maxillary canines, an exaggerated distally
tipped incisor should increase suspicion of
a mesially deflected and palatally
impacted canine.18
In these cases, the lateral incisor crown
may be tipped distally because
the impacted cuspid is exerting force on
the distal aspect of the lateral incisor root.
Such palatal impactions can cause the
lateral incisor to rotate as well. Retroclined
lateral incisors can also occur when
buccally directed forces cause the root to
tip labially and the crown to tip palatally.19
In severe cases, the central incisor may
also be affected, and its crown may
become malpositioned.17,18,19
Palpation of the buccal and lingual
mucosa, using the index fingers of both
hands simultaneously, is recommended to
assess the position of the erupting
maxillary canines. Eruption time of a
maxillary canine varies from 9.3 to 13.1
years. Because canines are palpable from 1
to 1.5 years before they emerge, the
absence of the canine bulge after the age of
10 years is a good indication that the tooth
is displaced from its normal position, and
ectopic eruption or impaction of the
maxillary cuspids is possible.
Asymmetries in the alveolar process are
not considered significant in children
younger than 10 years, and differences in
bilateral palpation could be due to vertical
differences in eruption rates at young ages.
However, in patients older than 10 years,
an obvious palpable bilateral asymmetry
could indicate that one of the permanent
cuspids is impacted or erupting
ectopically.20,21,22
In contrast, examination of intrabony
movement of the canines between the
dental age of 8 to 10 years was advised by
Williams . If permanent canine bulges are
not palpable, he offered to examine lateral
8. INTERNATIONAL JOURNAL OF MAXILLOFACIAL RESEARCH VOLUME 1 ISSUE 2 2015 123
and frontal radiographs specifically for
Class I malocclusions, even with minimal
arch length loss. He suggested removing
the deciduous canine when a position
apparently lingual to the anterior teeth on
the lateral radiograph and a medial tilt of
the long axis of the canine in relation to
the lateral wall of the nasal cavity on the
frontal radiograph are observed.23
Radiographs are indicated
when canine bulges are not present; right
and left canine development and eruption
is asymmetrical occlusal development is
advanced and there are no palpable bulges
indicating the presence of the cuspids in
the alveolar process; and the lateral incisor
is delayed in eruption, malpositioned, or
has a pronounced labial or palatal
inclination in relation to the adjacent
central incisor. Accurate radiographs are
critical for determining the position of
impacted canines and their relation to
adjacent teeth, assessing the health of the
neighbouring roots and determining the
prognosis and best mode of treatment. 24,25
(Fig 05 )
Fig. 05 : radiographic Diagnosis, parallax
method
A panoramic radiograph taken in
conjunction with 2 periapical views
obtained using Clarke’s Rule (Buccal
Object Rule) or a 60% maxillary occlusal
film allows the impacted teeth to be
located either palatally or buccally relative
to adjacent teeth. Ericson and Kurol found
that periapical radiographs allowed
accurate location of the teeth in 92% of the
cases they evaluated.24
(Fig 06 )
Fig. 06 maxillary occlusal film
Although periapical films are diagnostic
for transverse position, occlusal
radiographs are more accurate for
determining the positions of the canines
relative to the midline. Lateral
cephalometric radiographs are also helpful
in assessing the anterior–posterior position
of the displaced tooth, as well as its
inclination and vertical location in the
alveolus.24,25,26
Although conventional dental radiographs
provide satisfactory diagnostic images,
they lack the accuracy necessary for
assessing palatal or buccal root resorption
of the lateral incisor especially with mild
9. INTERNATIONAL JOURNAL OF MAXILLOFACIAL RESEARCH VOLUME 1 ISSUE 2 2015 124
or early resorption. Computed tomography
(CT) is more accurate in terms of locating
the impacted cuspid in 3 dimensions and
for diagnosing associated lesions such as
root resorption of adjacent teeth.
However, although CT is an asset in cases
where root resorption is suspected, cost,
time and increased radiation exposure
restrict its routine use. More recently cone
beam CT has been recommended for
visualizing impacted teeth, as the radiation
dose is less and it gives 3D picture of
impacted tooth, path to be followed for
orthodontic movement. 26,27,28
(Fig 07)
Fig. 07: cephalogram can be used to
discern the position of the impaction
As may be seen in OPG, it is not clear
whether canines and premolars are labial
or palatal and mesial or distal. When we
look at the pictures developed from CBCT
scan, it is clear that the canines are
erupting labially whereas the premolars are
palatally erupting. 27, 29
Medical computerized tomography (CT)
was an improvement which overcomes the
limitations of conventional two-
dimensional (2D) imaging however,
radiation exposure of CT scans limits its
clinical utility. 30
The advent of 3D cone
beam computed tomography (CBCT) has
reduced the radiation dose, making it an
advantageous tool in dentistry.31
CBCT
images have been proven to be useful for
the accurate diagnosis of the impacted
canines, treatment planning and the
identification of associated complications,
such as root resorption in adjacent incisors.
In addition it was found that CBCT
reduces the treatment duration and
increases the success of treatment in
difficult cases to a similar level of simpler
cases.32
Small volume CBCT may be
indicated as a supplement to a routine
panoramic X-ray in the following cases if:
32
• canine inclination in the panoramic X-ray
exceeds 30°
• root resorption of adjacent teeth is
suspected
• the canine apex is not clearly discernible
in the panoramic X-ray, implying
dilaceration of the canine root.
The association of
palatally impacted maxillary cuspids with
other dental anomalies regardless of
whether there is a true genetic relation is
clinically significant for the general
practitioner. When an associated
abnormality is suspected or diagnosed,
further clinical and radiographic
examinations are indicated to investigate
10. INTERNATIONAL JOURNAL OF MAXILLOFACIAL RESEARCH VOLUME 1 ISSUE 2 2015 125
the possibility of
maxillary canine displacement. If palatally
displaced canines are identified early
during mixed dentition, interceptive
treatment may prevent future
complications and more extensive
orthodontic treatment. 4,8,21,28,29
Management of Impacted Canines
Before surgical intervention, it is necessary
to consider the need to create adequate
space to facilitate movement of the
impacted tooth. For management of the
impacted maxillary canine, all of the teeth
in the maxillary arch should be bracketed
to allow for proper positioning of the
canine and to avoid canting of the occlusal
plane. 33
Bracketing of all the teeth
provides adequate anchorage for extrusion
of the
impacted canine. The other option is to use
a mini-implant or micromini-implant as
anchorage to move the impacted canine.
Pre-surgical orthodontic treatment should
be performed until adequate space is made
for the canine. This usually takes between
2 and 4 months 33
.
In principle, there are five treatment
options for impacted maxillary canines:4,21
(i) no active treatment except monitoring,
(ii) interceptive removal of the primary
canine,
(iii) surgical removal of the impacted
canine,
(iv) surgical exposure with orthodontic
traction and alignment, and;
(v) auto-transplantation of the impacted
canine.
When the permanent maxillary canine is
impacted or erupting buccally or palatally
to the arch, the preventive treatment of
choice is extraction of the primary canine;
when the patient is 10-13 years old. 13,14,26
However, if any root resorption is evident
before this age and there is suspicion of
impaction, the primary canine should be
extracted and appropriate treatment
implemented, such as monitoring of the
eruption path or orthodontic alignment.
When a canine is impacted buccally, the
retained primary canine should be
extracted to create a pathway and space for
the permanent canine to erupt into the
arch. This is especially important if both
the permanent and primary canines are
simultaneously visible in the arch. 9
In Class I noncrowded situations where the
permanent maxillary canine is impacted or
erupting buccally or palatally , preventive
treatment of choice is extraction of the
primary cuspids when the patient is 10-13
years old. However, if any root resorption
is visible before this age and there is
suspicion of impaction, the primary
cuspids should be extracted and
appropriate treatment implemented, i.e.,
monitoring the eruption path or
orthodontic alignment. When canines
are impacted buccally, overretained
11. INTERNATIONAL JOURNAL OF MAXILLOFACIAL RESEARCH VOLUME 1 ISSUE 2 2015 126
primary cuspids should be extracted to
create a path and space for the permanent
cuspids to erupt into the arch. This is
especially important if both the permanent
and primary cuspids are visible in the arch
at the same time.5
Power and Short showed that interceptive
extraction of the
primary canine completely resolves
permanent canine impaction in 62% of
cases; another 17% show some
improvement in terms of more
favourable canine positioning.6
Ericson
and Kurol found that, in 78% of palatally
erupting cuspids, the eruption paths
normalize within 12 months. However,
extraction of the primary cuspid does
not guarantee correction or elimination of
the problem. If there is no radiographic
evidence of improvement one year after
treatment, more aggressive treatment, such
as surgical exposure and orthodontic
eruption, is indicated.24, 25
The success of
early interceptive treatment for impacted
maxillary cuspids is influenced by the
degree of impaction and age at diagnosis.
As a general rule, when the degree of
overlap between the permanent maxillary
cuspid and the neighbouring lateral incisor
exceeds half the width of the incisor root,
the chances for complete recovery are
poor.24,25,26
The surgical removal of impacted canines
although seldom considered might be a
viable option in the following situations;
patient declines active treatment and/or is
happy with appearance:4
• there is evidence of early resorption of
adjacent teeth.
• the patient is too old for interseption.
• there is a good contact for lateral incisor
and first premolar or the patient is willing
to undergo orthodontic treatment to
substitute first premolar for the canine
• if the impacted canine is ankylosed and
cannot be transplanted
• if the root of impacted canine is severely
dilacerated
• if the impaction is severe and the degree
of malocclusion is too great for surgical
repositioning/ transplantation.
Especially extraction of the labially
erupting and crowded canine is
contraindicated. Such an extraction might
temporarily improve the aesthetics
however may complicate and compromise
the orthodontic treatment results.
The success rate drops to 64% if the cuspid
crown is positioned mesial to the midline
of the lateral incisor before interceptive
treatment. Other factors influencing
prognosis include canine angulation and
crowding. The chance of successful
eruption of an impacted canine following
extraction of the primary canine is less
than favourable as the angle from the
vertical increases. Power and Short found
that an angle exceeding 31% from the
vertical significantly reduces the chance of
12. INTERNATIONAL JOURNAL OF MAXILLOFACIAL RESEARCH VOLUME 1 ISSUE 2 2015 127
normal eruption following an extraction.
However, the degree of horizontal overlap
with the adjacent lateral incisor has been
found to have more influence on prognosis
than angulation.7, 8
(Fig 08a-c)
Fig. 08a-c: As an example, the pendulum
can be used for space gain
Ericson and Kurol found that more
mesially positioned canine cusp tips are
associated with greater resorption of lateral
incisor roots. Arch crowding can also have
a significant influence; moderate to severe
crowding indicates the need for complex
orthodontic treatment to resolve the
impaction and the malocclusion. Sequelae
from Maxillary Canine Impactions The
permanent canines are the foundation of an
esthetic smile and functional occlusion,
and any factors that interfere with their
development and eruption can have serious
consequences. Although extraction of
primary cuspids can be beneficial in
specific cases, inappropriate extraction of
primary maxillary cuspids must be
avoided, due to the increased potential for
arch collapse and arch crowding, which
could lead to a buccal impaction.
Abnormal eruption paths within the
dentoalveolar process may result in
impactions and serious clinical
ramifications. Unerupted or partly erupted
cuspids may increase the risk of infection
and cystic follicular lesions and
compromise the lifespan of neighbouring
lateral incisors due to root resorption.
8,9,10,21,28,20
Clinical studies have
determined that 12% of lateral incisors that
are adjacent to ectopically erupted canines
have some degree of external root
resorption, while the prevalence of lateral
incisor root resorption in 10-13 year olds is
0.7%. A mesial-horizontal eruption path
has also been shown to be more
devastating to the adjacent lateral incisor,
as is advanced root formation of the
palatally displaced maxillary canine.4,21,29
Corrective Treatment
Corrective treatment is performed in
13. INTERNATIONAL JOURNAL OF MAXILLOFACIAL RESEARCH VOLUME 1 ISSUE 2 2015 128
situations where orthodontists cannot
render preventive or interceptive treatment
for some reason, or patients present
beyond the point of prevention. There
should be an attempt to bring impacted
maxillary canines down to occlusion if
possible, because permanent canines are
important for both functional and aesthetic
reasons. There are numerous surgical
methods for exposing the impacted canine
and bringing it to the line of occlusion.
Two of the most commonly used methods
are (I) surgical exposure, allowing natural
eruption and surgical exposure with
placement of an auxiliary attachment. 34
Orthodontic forces are subsequently
applied to the attachment to move the
impacted tooth . (Fig 09a-g).
Fig. 9a, b: Formation of a Mucoperiosteal
flap and expose the crown of an impacted
canine with substantial protection of the
bone.
Fig. 9c: titanium chain by Watted
(DENTAURUM).
Fig. 9d Fixation of the attachment by
means of ligh tcuring resin after etching
technique.
Figure 9e: repositioned and stitched cloth
(closed elongation).
14. INTERNATIONAL JOURNAL OF MAXILLOFACIAL RESEARCH VOLUME 1 ISSUE 2 2015 129
Fig. 9f: formation of a symmetric
mucoperiosteal flap under incision around
the incisive foramen-parametric marginal
incision, fix the attachments
Fig. 9g: repositioned and stitched cloth.
Three techniques have been proposed by
Kokich for uncovering a labially unerupted
maxillary canine (gingivectomy, apically
positioned flap, and closed eruption
technique).He also suggested that
orthodontists should evaluate 4 criteria to
determine the correct method for uncover
uncovering the tooth so the outcome
achievesthe optimum periodontal
health.33,35
These criteria include the distance between
the canine cusp and the mucogingival
junction; the labiolingual position; the
mesiodistal position; and the amount of
gingiva in the area of the impacted canine.
In palatally impacted canines, the concern
about the lack of keratinized gingiva
disappears because palatal tis sue is a
dense connective tissue.
Bishara suggested 2 surgical methods for
exposing the impacted canines: surgical
exposure followed by allowing
spontaneous eruption; and
surgicalexposure with auxiliary attachment
for further orthodontic treatment. 4
The first method is useful when the canine
has a correct axial inclination and needs no
upright correction during its eruption, but
this method may increase treatment time
and be unable to control the path of
eruption.
Kokich suggested performing this method
before the beginning of orthodontic
treatment or during the late mixed
dentition because the tooth will erupt in a
more favorable location, which will
facilitate orthodontic movement without
dragging the crown through the palatal
gingival. 19
Schmidt and Kokich also reported that
this technique had minimal effects on the
periodontium and that the overall effects
on the impacted canine appeared better
than those from the closed exposure and
early traction techniques.33,35
The second method is used when there is
no eruption force left or the tooth does not
lie in a favorable direction and orthodontic
force is required to move the impacted
tooth away from the roots of the adjacent
teeth and bring it to the proper
15. INTERNATIONAL JOURNAL OF MAXILLOFACIAL RESEARCH VOLUME 1 ISSUE 2 2015 130
position.After sufficient space has been
created, surgical exposure is performed
and the attachment is placed. Light
orthodontic force (not to exceed 60 g, or 2
oz) is then applied to move the tooth to the
desired position by various orthodontic
techniques.36
(Fig. 10a-k)
Fig.10 a: a 16-year-old patient before the
treatment The OPG shows the
displacement and retention of tooth 13
and 23 with persistence of the tooth 53 and
63
Fig. 10b-e: Clinical situation in occlusion
and in the supervision of the upper dental
arch
Fig. 10 f: Status after initial mobilization
of the canine
Fig. 10 g: OPG at the end of treatment.
16. INTERNATIONAL JOURNAL OF MAXILLOFACIAL RESEARCH VOLUME 1 ISSUE 2 2015 131
Fig. 10 h-k: Clinical situation after the
treatment
Surgical exposure
The individually selected surgical
procedure for each of the canine position
in which the exposure the first step is to
secure periodontally and aesthetically
pleasing result. It is now generally
recommended, again to cover the palatal
displaced canines after adhesion of the
attachment with the mucoperiosteal flap
previously formed, to perform a closed
elongation. The Attachment with the best
chance of success, the titanium head with
titanium necklace is by Watted.mit the best
chance of success is the titanium head with
titanium chain by Watted. 36, 37,38
Exposure of palatal displaced canines
In the surgical exposure of impacted
palatal canines the cut is marginal (Fig. 9a)
or para marginal (Fig. 09f). Because of
better wound healing after adaptation of
the mucosa to mucosa the para marginal
incision is preferred. If the displacement
permits this, incision around the Incisive
foramen in an asymmetric (unilaterally
extended to canine) or symmetrical formed
(bilaterally extended to canine).39
After
careful mobilization of the mucoperiosteal
flap, only so much cortical bone is
removed until the crown portion of the
retained tooth is exposed enough to secure
fixation of attachments. Extensive milling
leads to a larger post-therapeutic bone loss.
To limit the bone loss after cessation of the
canine to a minimum, the cemento-enamel
border must not be exceeded. The dental
follicle is carefully debrided in the
immediate circumference of the exposed
crown area since often it emanates from
17. INTERNATIONAL JOURNAL OF MAXILLOFACIAL RESEARCH VOLUME 1 ISSUE 2 2015 132
the highly vascularized tissue and
frequently bleeds, which makes the
attachment difficult to be fixated (Fig.
09b). 36, 37
In general, the most reliable bonding
technique is the acid etching technology
without the usual pre-treatment of the
enamel with rubber cups and polishing
paste, since the post-eruptive enamel
maturation has not been yet taken place
and pre-eruptive enamel porosities
increase the composite adhesion. In
addition, the use of rotary instruments
would easily cause bleeding and thus the
Attachment fixation is difficult. A
sufficient flushing of the surface is
necessary to avoid gingival necrosis or
permanent fixation of the attachment that
is endangered by remaining etchant. 21,28,33
After careful hemostasis - often all it takes
is a short compression by means of a swab
soaked with H2O2 - the exposed tooth
surface is blown dry and slightly etched
for 30 seconds with phosphoric acid.
Following a copious lavage with isotonic
NaCl solution, the surface must be
carefully dried. An adequate flushing of
the surface is necessary to avoid the result
of gingival necrosis or permanent fixation
of the attachment that is endangered by
remaining etchant. The attachments with
fine clinical prospects are for example the
Eyelet and Pressing with the gold chain.
21,36,37
The new attachment with the best
Chance of success in terms of stability and
biocompatibility is the titanium head with
titanium chain by Dr .Watted (titanium
head with chain DENTAURUM) (Fig
09c). The knobs base was treated with the
laser, that significantly increases detention
accuracy. The attachment with the best
resistance to the liability of knobs or eyelet
is substantially larger than that of a
brackets.38,39,40
Due to the bracket size and
base, it is not suitable to be glued on the
palatal surface (Fig. 09d). The fixation of
gold or titanium chains to the attachment
ensures secure transmission of orthodontic
forces in one to three days after the applied
surgical exposure for the first time.40
After
hardening the composite, the operation
field is finally rinsed with ISO toner NaCl
solution. The repositioned mucoperiosteal
flap is fixed by sutures and covering the
entire surgical field (Fig. 9e and g). After
the exposure of palatally impacted tooth, if
the exposed area is open or is it only
covered by a surgical dressing, according
to Becker et al. the following
complications can occur: soft tissue
overgrowth and plaque accumulation
which lead as soon as the adjustment has
been completed in association with the
secondary healing to a chronic infection
and to compromise- afflicted periodontal
conditions21,29
. The fixed knobs of
titanium chain project at the desired
breakdown location at the alveolar ridge
level several millimeters above the seam
18. INTERNATIONAL JOURNAL OF MAXILLOFACIAL RESEARCH VOLUME 1 ISSUE 2 2015 133
area. The passage point must be
necessarily determined in consultation
with the orthodontist, since otherwise the
soft tissue may undergo unnecessary
trauma during orthodontic setting. If
necessary, a maxillary association board
can be incorporated. Several days after the
surgical exposure of the impacted tooth, it
was moved by the action of suitable
orthodontic appliances with the mucous
membrane in the desired position. In
palatal displaced canines, the closed
elongation is carried out in the rule. If the
canine is moved directly under the palatal
mucosa, a fenestration is possible and
sufficient 40
.
CONCLUSION
The prevalence of
maxillary canine impaction is significant
and the frequency increases with other
genetically associated dental anomalies.
Multidisciplinary approach for guiding
the impacted canine gives predictable
results. Careful diagnosis is critical and it
is crucial that every patient should be
managed with tailor-made treatment plan
with sound scientific backing as there is no
‘cook book’ approach for all cases. The
development of treatment and mechanical
plans must be based on the careful analysis
of the clinical situation and identification
of the correct force system is necessary to
obtain the desired tooth movement.
The management of an impacted canine is
a complex procedure requiring a
multidisciplinary approach. The clinicians
should communicate with each other to
provide the patient with an optimal
treatment plan based on a scientific
rationale.
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22. INTERNATIONAL JOURNAL OF MAXILLOFACIAL RESEARCH VOLUME 1 ISSUE 2 2015 137
1. Péter Borbély1
Fogszabályozási Stúdió, Budapest,
Hungary
2. Nezar Watted2
Clinics and Policlinics for Dental, Oral and
Maxillofacial Diseases of the Bavarian
Julius-Maximilian- University Wuerzburg,
Germany
3. Ivana Dubovská3
Institute of Dentistry and Oral Sciences
Faculty of Medicine and Dentistry
Palacký University, Olomouc, Czech
Republic
4. Viktória Hegedűs 4
Department of Pediatric Dentistry and
Orthodontics, University of Debrecen,
Debrecen, Hungary
5. Abu-Hussein Muhamad5
University of Naples Federic II, Naples,
Italy, Department of Pediatric Dentistry,
University of Athens,Athens, Greece
Corresponding Author:
Dr.Abu-Hussein Muhamad
DDS, MScD, MSc, Ped.Cert,FICD
123 ARGUS STREET
10441 ATHENS
GREECE
Email;abuhusseinmuhamad@gmail.com