Severity and Treatment Difficulty of Impacted Maxillary Canine among Orthodontic Patients in Riyadh, Saudi Arabia

Abstract

Background: The current study aimed to evaluate the severity and treatment difficulty of impacted maxillary canines and their relationship with gender, age group, and bucco-palatal position.

Methods: A retrospective cross-sectional study was conducted from 2017 to 2021. Patients' data and panoramic radiography were obtained from the orthodontic clinic at King Saud University's Dental University Hospital in Riyadh, Saudi Arabia. The severity factors and treatment difficulty index were used to assess the impacted maxillary canines. Statistical analyses were performed utilizing a chi-square test for categorical variables and an independent t-test for numerical variables, and a p-value of ≤0.05.

Results: There were 171 impacted maxillary canines in total, with a female-to-male subject ratio (11:8) and a mean age (18.7 years). Overall, 77.2% of impacted upper canines were found to be palatal. The severity of canine impaction parameters showed no significant sex or age group predilection. Buccally impacted maxillary canines were characterized by a preferable angulation to the midline, compared to the palatally impacted maxillary canines (p = 0.012). The horizontal overlap of the impacted maxillary canine cusp tip revealed a significant association with the bucco-palatal position of the impacted canine (p < 0.001). Palatal impaction was located more frequently in sectors 3 and 4. Male patients were found to have a higher total score in terms of the treatment difficulty index relative to females (p = 0.046).

Conclusion: Despite the severity parameters having revealed no significant gender predilection, males were found to have higher treatment difficulty in maxillary canine impaction than females. The severity of the palatally impacted canine is greater than that of buccal impaction in terms of angulation to the midline and horizontal overlap.

Keywords: difficulty index; impaction; maxillary canines; severity.

Figure 1

Angulation of the impacted canine to the midsagittal plane: (A) Score 1—less than 30 degrees, (B) Score 2—between 30 and 45 degrees, (C) Score 3—more than 45 degrees.

Figure 2

Horizontal position of the impacted canine: (A) Sector 1—canine overlapping less than half the width of the lateral incisor, (B) Sector 2—canine overlapping half the width of the lateral incisor, (C) Sector 3—canine completely overlapping the lateral incisor, (D) Sector 4—enclosing all areas mesial to Sector 3.

Figure 2

Horizontal position of the impacted canine: (A) Sector 1—canine overlapping less than half the width of the lateral incisor, (B) Sector 2—canine overlapping half the width of the lateral incisor, (C) Sector 3—canine completely overlapping the lateral incisor, (D) Sector 4—enclosing all areas mesial to Sector 3.

Figure 3

Apex position: (A) score 1—in the area of canine apex, (B) score 2—in the area of the first premolar apex, (C) score 3—in the area of the second premolar apex.

Figure 4

Vertical position of the impacted canine: (A) Score 1—canine cusp tip at the level of the cementoenamel junction of the adjacent incisor, (B) Score 2—canine cusp tip at the middle of the root of the adjacent incisor, (C) Score 3—canine cusp tip within the apical third of the root of the adjacent incisor, (D) Score 4—canine cusp tip above the apical third of the root of the adjacent incisor.

Figure 5

Comparison between buccal–palatal canine impaction and the canine angulation to the midline using the chi-square test (X² = 40.7, df = 3, p < 0.001 *). * Statistically significant at p ≤ 0.05.

Figure 6

Comparison between buccal–palatal canine impaction and the horizontal overlap of the impacted canine crown tip with adjacent teeth using the chi-square test (X² = 40.7, df = 3, p < 0.001 *). * Statistically significant at p ≤ 0.05.