Buccally Malposed Mesially Angulated Maxillary Canine Management Suhad. H. Manhal,* Summery: Maxillary canine is an important tooth in all fields of dentistry. However, malposed upper canine is seemed to be a common problem in Sebha and the neighbored villages. Treatment of this condition is mostly simple and effective using removable appliances. Few cases need treatment with fixed appliances, others extraction only is sufficient, therefor survices required from the general practitioners in solving this problem and greater attention in our teaching program in the dental school on this vital subject. Introduction: Various values of the maxillary canine from esthetic or functional point of view it is the longest tooth with the longest root, it is situated in the corner of the mouth, it supports the incisors and premolars, well anchored to the maxilla, with low susceptibilities to caries. 1 Bishara et al stated that Most clinicians agrees that permanent canines are important for both esthetic and functional point of view therefore, it should be preserved wherever possible. 2 The maxillary permanent canine receives a greater care other than any other tooth forward to the upper permanent first molar. Foster stated that the permanent upper canine is probably the tooth which most commonly develops in a wrong position. 3 The author has carried out a study on the ways of retracting a canine only and calculates about (36) method of retracting it. 4 Further investigations are needed in this field especially in Sebha because it is a popular problem, this is the first study carried in, So research s are needed to know exactly the percentages of this problem. This is the first paper that deals with the Buccally malposed mesially angulated canines with dental arches CL I in Sebha, also their management s were discussed. But CL II or Class III, arch relationships were excluded because other factors were involved. Also palatally erupted or impacted canines were not involved because they need other ways of management s. Materials and Method: Seventy-two patients with one or both Buccally malposed upper canines have been treated. 54 were females and 18 were males the No. of teeth were 100.The age ranged between 12 and 35 ys. All cases associated with CL 1 dental arch relationship in an antero posterior direction. Three types of orthodontic management were used in this paper these are: the use of removable appliance, fixed appliance, and canine extraction. I. Removable appliance: The removable appliance can do only tipping movement i.e. crown moves in an opposite direction in relation to its root, so it do little root movement, that s why the Buccally malposed, mesially Angulated maxillary canines were treated with a removable appliance. It was constructed of a modified buccal canine retractor (0.7 mm hard stainless Steel wire). On one or both sides if affected, this type of spring moves the canine in a distal and / or palatal direction. Adam s clasps were used (0.7mm H.S.S. wire) on molars and or premolars to retain the appliance intraorally. Fitted labial arch on the centrals (0.7mm H.S.S.Wire) to retain the appliance anteriorly and finally simple acrylic were used (fig 1). Spaces should be available, naturally, orthodontically created or by extraction mainly an upper first permanent premolar was chosen. II. Fixed appliance: This is a more complicated appliance and can be used only by orthodontists that s why it is beyond the level of general dental practitioner it was used when root movement was needed specially in vertically or distally Angulated canines with the use of full arch multibands or brackets or by sectional arch wires the alignment was accomplished (fig 4). *) College of dentistry, Sebha University, Libya. 75 Sebha University Journal of Medical Sciences, 2005, Vol. 4(2).
III. Extractions: This option was taken when the canine was completely excluded out of the arch and there was contact between the first permanent premolar and the upper lateral incisor with good occlusion with the lower arch (Fig.3.). Results: Table 1: shows the main results of this research. Discussion: So many designs have been proposed and used for canine retraction as recommended by many authors. 5-14 Comparing the mechanical properties of three main springs in common use, these were, the standard buccal canine retractor, the modified buccal canine retractor and the reversed loop retractor, the modified B.C.R. had the best mechanical properties, most of other springs had poor stability, in this study a slightly different design was used, that s by adding a U-loop on the mesial aspect of the canine for better gripping and also adding C clasp labially for palatal tooth movement (fig 1). Tipping movement of the canine is done, the root will move around fulcrum of 40% of its length from the apex. 13 Fixed Appliances: This is mainly used when root movement is needed either in vertically or distally Angulated canines. (Fig.2). That s why a multibanded appliance is used using edgewise or Roth technique. Too many techniques had been used, which are beyond the scope of this Paper; thus principles are described in many orthod. Books. 15-18 Manhal compared different methods for canine alignment using edgewise technique, which is only one type of many fixed appliances. 4 The upper Canine has a long strong, root, which us well anchored to the maxilla 1 therefore it has great resistance to orthodontic movement. The root movement has relatively much greater resistance than tipping (crown) movement; longer duration of treatment, and movements requires much greater anchorage. Issacson and Williams stated that, Such tooth movement requires a considerable amount of anchorage. 15 In addition to the general disadvantages of F.A. Houston reported that, it is unsightly, requires special facilities and highly trained person (orthodontist). 9 Therefore, it is advisable to use this technique when it is not possible to use the removable type. Canine extraction: The upper canine is an important tooth with implications in almost every field of dentistry. 19 Bishara et al stated that most clinicians agree that permanent canines are important from both esthetic and functional point of view, and therefore should be preserve whenever possible. 2 However many authors agree on extracting the canine in certain 3,6,,7,11,14, 16. conditions. The suggested indications are: When a lateral incisor is in contact with the first premolar, and the canine excluded Buccally or with an unfavorable apex position in an otherwise good upper arch. In such condition it is advisable to extract the canine and avoid an unnecessary orthodontic treatment. This study confirms that a great number of Buccally malposed upper canines can be treated by relatively simple removable appliance or by its extractions. Therefore the general dental practitioners should be trained on this technique in order to control a very common malocclusion problem in Sebha. % Males 25 Females 75 One malpos. canine 35 Both canine 65 Removable appliance 68 Fixed appliance 25 Canine extraction 7 Extraction required to provide space for 60 treatment Table (1): main results of the research. 76 Sebha University Journal of Medical Sciences, 2005, Vol. 4(2).
Fig. 1: 1. The design of the upper removable appliance. 2. A dam s clasp. 3. Fitted labial arch. 4. Acrylic plate. A. Occlusal view. B. Facial view. (1) Modified buccal canine retractor. Fig. 2: cases requiring multibanded appliance to move the root A. Vertical canine. B. Distally inclined canine, which requires root movement than crown movement 77 Sebha University Journal of Medical Sciences, 2005, Vol. 4(2).
Fig.3: Mesially drifted buccal segment, with the upper canine completely excluded Buccally. Canine extraction will leave an acceptable dental arch alignment. Fig.4. Fixed appliance used for treatment. References: 1. Wheeler R.C., Dental anatomy, physiology and occlusion, W.B. Saunders Co. 1974. 2. Bishara, et al. management of impacted canines, Am. J. Orth. 1976, 69:371-387. 3. Foster T.D., A textbooks of orthodontics, Black Well. Scientific publication London, 1975. 4. Manhal S.H. Accepted for publication in Iraqi Dent. J. 1997. 5. Adam s, F.A., The design and construction of removable orthodontic appliances.john Wright & Sons, Bristol, 1970. 6. Tulley W.J. & Cryer B.S. Orthodontic treatment for the adults, John wright & Sons Ltd. Bristol, 1969. 7. Tulley, W.J. &Campbell A.C., A manual of practical Orthodontics, Third edition reprint, John Wright & Sons. Ltd. Bristol, 1970. 78 Sebha University Journal of Medical Sciences, 2005, Vol. 4(2).
8. Kinaan B.K., Management of Buccally malposed canine, Iraqi dental J. 1983, 10:15-23. 9. Houston, W.J.B. and Walther, orthodontic notes, third edition, 1976. 10. Houston, W.J.B. and Issacson, K.J., orthodontic treatment with removable appliances. Wright & Sons Ltd.-Bristol, 1977. 11. Houston, W.J.B. and Walther, orthodontic notes, fifth edition, 1977. 12. Adam s,c.p. and Keer, W.J., The design, construction and use of removable orthodontic appliances, Butterworth Heinemann Ltd, 1990. 13. Walther and Houston, Orthodontic notes Fifth edition, 1997. 14. White T.C. Gardiner, J.H. and Lighten B., orthodontics for dental student, Third edition, The Macmillan press Ltd. 1976. 15. Issacson, K.G. and Williams J.K., An introduction to fixed app. Second edition, John Wright and Sons Ltd. Bristol, 1978. 16. Houston, W.J.B. and Waters, N.W., The design of buccal canine retraction springs for removable orthodontic appliances, Brit. J. Ortho. 1977, 4:191-195. 17. William R.P. and Henry W.F., Contemporary orthodontics, Second Edition, Mosby yearbook. press Ltd. 1992. 18. Farrant S.D., An evaluation of different methods of canines retraction Brit. J. Ortho. 1997, 4:5-15. 19. Rayns, J., the unerupted maxillary canine, Dental Practitioner, 1969, 194-203. 79 Sebha University Journal of Medical Sciences, 2005, Vol. 4(2).