Biological parking concept: proposal of a modular approach for the prevention of upper impacted canine in paediatric patients

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ABSTRACT

Aim

The aim of this paper is to propose a new concept of “biological parking” for the prevention of upper impacted canine in the early mixed dentition, illustrating the management of palatal expansion, followed by serial extraction of first deciduous molar and than deciduous canine.

Results

This approach, applied in the early mixed dentition, can obtain an important improving of the infrabony path of the canines, either in case of vestibular or palatal risk of impaction, because it promotes a guided acceleration of the eruption of the first premolar avoiding o reducing the risk of its mesial eruption and frees up space for the eruption of the canine, improving its inclination, better if associated with an open root apex. If pretreatment variables regarding the possible success of treatment on the eruption of canine are more severe, this approach can make easier the next surgical-orthodontic threrapy.

Conclusion

Early maxillary expansion followed by the extraction first of the first milk molar and then of the deciduous canine, after the initial eruption of first premolars, in this exact sequence, can be effective in treating patients in early mixed dentition with risk of impacted canines.

Study Design

The risk of impacted canine is detected by clinical examination, analysis of the intraoral scans and the panorex, in association with the presence of family history or other dental anomalies. In patients aged between 6 to 8 years old with maxillary transverse deficiency the treatment plan starts from palatal expansion, that can be performed with different type of expander. After the expansion and retention (9 to 12 months) a new panoramic x-ray is performed, in order to define the maturation stage of the upper first premolar, that has to be at least 50%, to carry out the extraction of the first deciduous molars. Before the extraction, the palatal expander can be substituted by a transpalatal arch or a Nance plate, to maintain the space and first molar position. When the early eruption of the first premolars is observed, the extraction of the deciduous canines can be performed. All subjects are periodically observed till the eruption of the maxillary permanent canines is clinically or radiologically assessed.

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