Join me for a summary of the management of impacted canines, the latest evidence regarding different techniques for alignment. This podcast is based on an excellent lecture by Julia Naoumova delivered at last year’s British Orthodontic Conference. 

Part 1 will focus on recent findings of a modified open exposure technique Vs closed exposure, in terms of duration but also other key outcomes, health, pain, use of analgesics,  time absent from school and costs. The next episode, part 2, will look at the prognosis of resorbed incisors related to impacted canines long term. 

Previous research  no difference between closed Vs open exposure for alignment, aesthetics, treatment time, surgical success, treatment times. Limited to 2D views Parkin 2017, Sampaziotis 2018, Cassina 2018. 

Questionnaire of current decision making of open Vs closed: n=48 orthodontists = current clinical decision making by orthodontists based on preference Naoumova 2018

Multicentre RCT Margitha Björksved 2018, 2021

• Modified open exposure with Glass ionomer OPen Exposure, first described by Nordenval 1999

• 6/12 of spontaneous eruption

• Traction with orthodontic appliances

Results

• Total time: no difference 26 months (95% CI −3.2 to 2.9, P = 0.93)

• Canine eruption time: Open exposure quicker by 3 months 8.5 months Vs 11.5 months (95% CI 1.1 to 4.9, P = 0.002). With no traction in open exposure group 

• No difference in periodontal status, root resorption, surgery time, complications, 

• Pain:  greater in closed group

• Greater pain with bilateral open exposure

• Closed exposure more painful applying traction 

• Analgesics use (preliminary data):

• Day 1 nearly all patients use

• Day 5 drops to less than 50% of patients use

• Day 10 most have stopped taking analgesics

• Costs: – no difference 

• €3,400  healthcare costs

• €6,300 including patient costs

• Missed days of school (preliminary data)

• Day 1 -  76% open Vs 65% closed exposure 

• Day 2 -  3% open Vs 6% closed exposure

Open exposure with GOPEX Not appropriate for:

• Close to adjacent tooth, to avoid material on adjacent teeth

• Very high canine position 

• Older patient – start traction straight away, probability of ankylosis increases Cernochova 2024

• 1% at age 15

• 4% at age 20

• 14% at age 25

• 97% at age 45

Conclusion:

• Both open and closed techniques are viable, however with open exposure of GOPEX technique the canine erupts spontaneously and quicker

• Less pain with open exposure unless bilateral

• Most patient will miss 1-2 days from school 

• Pain relief common for the first 5 days, but maybe used until day 10

Papers

Open vs closed surgical exposure of palatally displaced canines: a comparison of clinical and patient-reported outcomes—a multicentre, randomized controlled trial 

Margitha Björksved

Open and closed surgical exposure of palatally displaced canines: a cost-minimization analysis of a multicentre, randomized controlled trial 

Margitha Björksved