Partial maxillary osteotomy following an unsuccessful forced eruption of an impacted maxillary canine: 10 year follow-up. Review and case report

Abstract

The maxillary canines are amongst the most frequently impacted teeth, second only to the third molars. Several conservative orthodontic and surgical techniques are available to position the teeth properly in the dental arch, even in severe cases. However, when an extraction is necessary, it often leaves a critical alveolar defect of difficult management. The authors present the technique of partial maxillary osteotomy, in which a dento-alveolar segment is moved mesially, hence closing the remaining space, allowing for the formation of healthy periodontium and resulting in an adequate functional and aesthetic outcome. A case report is presented with a 10 year follow-up, proving the technique's stability in the long term.

Figure 1

A. Preoperatory aspect. Orthodontic appliance was used to open space for the right maxillary canine traction. B. Oclusion in 30 days postoperative control. Tooth 14 substitutes the lost canine, with closure of the space, in the horizontal immobilization stage, prior to orthodontic alignment. C. Clinical control of 10 years and 10 months postoperatively. Orthodontic appliances were removed for 10 years and 3 months. Patient's occlusion maintains excellent functional and esthetic result

Figure 2

Palatal view. A. Preoperatory. Tooth 13 partially erupted in a transalveolar position with the crown mesially inclined. Note the presence of three orthodontic traction devices. B. Clinical control of 10 years and 10 months postoperatively, with orthodontic appliance removed for 10 years and 3 months, thus confirming stability. Vestibular and palatal gingival contour is maintained. C. Extracted maxillary right canine. Severe apical dilaceration is observed, along with areas compatible with periodontal alterations, possibly related to root ankylosis

Figure 3

Panoramic radiographic sequence. A. Preoperative aspect dating from January 14, 2001. Alveolar bone loss is noticeable along the misaligned impacted canine’s crown. B. Control of October, 2010. The osteosynthesis titanium miniplate is still present. Alveolar bone neoformation and remodeling are completed with the mobilization and approximation of the posterior segment. C. Following removal of the fixation, panoramic radiographic control of January, 17, 2012

Figure 4

Periapical radiographic sequence. A. Preoperatory image of January 14, 2001. The root apex is perfectly identifiable situated between the nasal and sinusal cortical, area named the Ennis inverted Y. In this image, root dilaceration is not noticeable. B. Periapical radiography of September 10, 2001, corresponding to 4 months and 7 days following surgery. Alveolar bone height may be observed between teeth 12 and 14 with the distal dental-alveolar segment approximation. C. Periapical radiography of January 17, 2001, corresponding to 10 years and 10 months following surgery. Space closure and complete bone neoformation and remodeling are apparent, typifying normal physiology of the area. All involved teeth maintain pulpar vitality