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Title Early Prediction of Maxillary Canine Impaction is Possible in Panoramic Radiographs by Using Geometric Measurements and Sectors
Clinical Question In young patients, can panoramic imaging reliably predict whether maxillary canines will become impacted or erupt normally?
Clinical Bottom Line Using panoramic images can reliably predict whether maxillary canines will become impacted in younger patients. Three retrospective studies confirm that maxillary canine impaction can be predicted by utilizing a combination of angular measurements, distances and sector locations. By identifying possible maxillary canine impaction early, a practitioner can intervene and prevent future complications that may result from impaction.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26683426Alqerban, A/201630 subjects with unilateral canine impaction Retrospective
Key resultsThree parameters were found to be best for predicting canine impaction: canine to first premolar angle, canine cusp to midline angle and canine cusp to maxillary plane distance. When these three parameters were combined in a regression model, an AUC (area under the curve) of 0.97 (CI: 95%) resulted, with a sensitivity of 90% and a specificity of 94%. This final prediction model using these three parameters might be used to determine whether follow-up or early intervention is necessary.
#2) 22748989Sajnani, AK/2012384 panoramic radiographs of 111 patients with unilateral canine impactionRetrospective
Key resultsAfter the age of 5 years, there was a statistically significant difference in the mean difference in distance between the cusp tip and occlusal plane of impacted and unaffected canines (P=0.01). At age 8 years, there was a clinically discernible difference of 4mm in the mean location of impacted cusp tips versus unaffected canine cusp tips from the occlusal plane (P<0.05). At the age of 9 years, a mean angulation of 28.4 degrees was found in impacted canines (measured from midline to long axis of impacted canine). There were no changes in the stages of root formation between impacted and unaffected canines.
#3) 14666077Warford, JH/200382 patientsRetrospective
Key resultsBicondylar line was used for horizontal reference of canine angulation. Unerupted canine tip located and categorized by sector. Angulation was higher for non-impacted teeth (mean of 75.12) compared to impacted teeth (mean of 63.2) but was not statistically significant for probability of impaction. 82% of impacted canines were located in sectors II, III and IV. If the cusp tip was located in sector III, the prediction of impaction was 87%
Evidence Search (("Cuspid"[Mesh]) AND "Tooth, Impacted"[Mesh]) AND "Radiography, Panoramic"[Mesh] early prediction
Comments on
The Evidence
Validity: All evidence cited are retrospective studies that were not tested for validity. No Randomized Controlled Trials ( RCTs) or meta-analysis’ were found during literature search on this subject at time of publication. Perspective: Due to a lack of higher evidence it is recommended that further study take place on this subject, focusing on RCT and reduced bias. However, all three of these studies confirm that prediction of maxillary canine impaction can be predicted using a variety of diagnostic measurements and parameters when viewing panoramic radiographs.
Applicability The subjects included in the evidence are representative of patients that most orthodontists and/or pediatric dentists would see in their practice. Utilizing the measurements and parameters described in these studies, it is feasible for practitioners to reasonably predict the likelihood of maxillary canine impaction. Having the ability to predict canine impaction can reduce future treatment time and the possible negative effects that result from tooth impaction.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Orthodontics) (Pediatric Dentistry)
Keywords Canine impaction, Panoramic radiographs, Ectopic eruption
ID# 3297
Date of submission: 12/11/2017spacer
E-mail cliftonc@livemail.uthscsa.edu
Author Corbin Clifton, D.D.S
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