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Introduction: In this research project, we aimed to compare the effectiveness of single (1 deciduous canine) and
double (deciduous canine and rst molar) extractions in subjects with retained maxillary permanent canines
positioned palatally or centrally in the alveolar crest, at risk for root resorption of adjacent permanent teeth.
Methods: Subjects at risk for canine impaction or resorptive situations were randomly assigned to 1 of 2 treatment modalities: single extraction (17 patients, 28 canines) or double extraction (20 patients, 37 canines).
Thirty-one patients with 53 canines judged to be not at risk constituted the untreated control group.
Panoramic radiographs were taken at the initial observation and after 18 months on average. Between-group
statistical comparisons were carried out on the changes in canine inclination and sector location (measured
on panoramic radiographs) and on the percentages of successful permanent canine eruptions. Results: The
double-extraction group showed signicant improvements in the success rate and the intrabony position of
the permanent canine, in terms of uprighting the canines long axis with a crown movement in a distal
direction. Conclusions: Concomitant deciduous canine and rst molar extractions proved to be more effective
as a preventive approach to promote eruption of retained maxillary permanent canines positioned palatally or
centrally. (Am J Orthod Dentofacial Orthop 2011;139:316-23)
316
Alessandri Bonetti et al
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Fig 1. CONSORT ow chart of participants of the ECG and the ECMG through each stage of the trial
(n, number of patients).
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ECG
17
9
8
9.8
ECMG
20
9
11
10.2
CG
31
16
15
9.0
Total
68
34
34
On the basis of the results obtained in a pilot sampling of canines, a normal distribution of the main
Alessandri Bonetti et al
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Fig 3. Sector of mesiodistal crown position of the maxillary permanent canine (s1-s5) was located in accordance
with the sector designation used by Ericson and Kurol.7
ECG
28
17
11
ECMG
37
20
17
CG
53
15
38
To evaluate the method error, an intraobserver reliability check was carried out for both angular values
and sectors. Fifteen randomly selected panoramic radiographs (15 subjects; 30 canines) were measured by the
same operator (S.I.P.) twice, on 2 days, with 15 days
separating the measurement sessions. The intraclass
correlation coefcient (ICC)22 was 0.968 (95% CI,
0.934-0.985; P 5 0.0001) for angulation of the canines,
thus conrming high intraobserver reliability for the
method used. The ICC was 1.00 for the sector designation, indicating no differences between measurement
sessions. To evaluate whether clinical experience affects
the accuracy of the measurements, 20 randomly selected
panoramic radiographs (20 subjects; 20 right and 20 left
canines) were independently measured by 5 orthodontists. The ICC values were 0.955 for the angular measurements and 1.000 for the sector designation for both
right and left canines. These coefcients show high interobserver reliability of the measurement method, which
has proved not to be inuenced by clinical experience.
RESULTS
The T0-T1 changes in the radiographic measurements relative to the canines intraosseous position on
the panoramic radiographs are shown in Table III. The
variable a-angle exhibited statistically signicant
changes between T0 and T1 in the ECMG when compared with both the ECG (P 5 0.0001) and the CG
(P 5 0.0001). The variable sectors (s1-s5) showed
a statistically signicant change between T0 and T1 in
the ECMG when compared with both the ECG (P 5
0.0009) and the CG (P 5 0.003). Neither the a-angle
nor the sectors (s1-s5) showed signicant differences
in T0-T1 changes in the ECG compared with the CG.
Positive values (11, 12) relative to the T0-T1 changes
in the sectorsie, signicant improvement in the mesiodistal canine crown positionprevailed in the ECMG. In
the ECMG, 51% of the canines (19 of 37) showed
improvement by 1 sector, and 13% of the canines
(5 of 37) had improvement by 2 sectors. In the ECG,
32% of the canines (9 of 28) exhibited improvement
by 1 sector, but no canines improved by 2 sectors.
No signicant inuence of the stage of root development of the permanent canines was seen. A statistically
signicant difference (P 5 0.036) was observed in the
Alessandri Bonetti et al
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Table III. Comparison of the changes between T0 (initial observation) and T1 (18 months after T0) for canine inclination (a-angle) and sector location (s1-s5) on the panoramic radiographs
ECG (28 canines)
a-angle ( )
s1-s5
Mean Interval
5.7
40.9
0.0
1.0
CG (53 canines)
Signicance
Fig 4. Patient in the ECMG who underwent bilateral concomitant extraction of the maxillary deciduous canines
and rst molars (before and after extractions).
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Fig 5. Patient in the ECMG who underwent bilateral concomitant extraction of the maxillary deciduous canines
and rst molars (before and after extractions).
Alessandri Bonetti et al
322
CONCLUSIONS
2.
3.
4.
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