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Apicotomy: a root apical fracture for surgical treatment of impacted upper canines

DOI: 10.1186/1746-160x-3-33

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Abstract:

Canines guide the teeth into proper bite, and have therefore specific functions in chewing and in excursive movements of the mandible. According to Fiedler and Alling in 1968 [1] and Mead and Monsen in 1965 [2], canines present proprioceptive and reflexive fibres which protect and stabilize occlusion. Due to their position, they provide an aesthetic and harmonious transition between the anterior and posterior segments of the dental arch. Canines have the longest roots and are the most resistant teeth [3,4] and thus are often displaced or impacted [5]. The prevalence of maxillary canine impaction seems to be related to the ethnic origin [6]. The lowest frequency (0.27%) is seen among Japanese individuals [7], while the highest (1.8%) is observed in Iceland [8]. Impacted canines occur more frequently in females than males, with a proportion of 2.5:1 [9].Maxillary canines travel a long, tortuous path before they erupt, and the long axis may adopt an inclined or horizontal position related to the occlusal plane. Impaction might occur due to general or local factors. The etiopathological investigation of impaction may reveal the existence of systemic diseases such as cleidocranial dysplasia, or Gardner and Gorlin-Goltz syndromes. However, many local problems may be involved, particularly those related to alterations in bone or dental structures and volumes. Bone condensation, alveolar ridge, dental arch length discrepancy, ankylosis and root dilaceration are among the local causes of impaction. Dentoalveolar or oral maxillofacial traumas are among the possible local causes of impaction, in variable combinations involving factors such as the kind of trauma or the age of the patient at diagnosis [10].Surgical intervention for impacted canines can be classified as: exposure for spontaneous eruption, exposure for orthodontic traction with bonding devices and extraction [11-16]. Planning the adequate surgical strategy depends on radiographic analyses or computed tomography (C

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