CASE REPORT

Forced eruption of a palatally impacted

and transposed canine with a temporary
skeletal anchorage device
Mi-Young Lee,a Jae Hyun Park,b Jin-Gon Jung,c and Jong-Moon Chaed
Seoul and Iksan, Korea, and Mesa and Tucson, Ariz

Treatment of palatally impacted and transposed canines is challenging for both orthodontists and oral surgeons.
To treat a maxillary canine impaction without risking damage to adjacent teeth, it is necessary to use cone-beam
computed tomography for proper localization and treatment planning. In this case report, a palatally impacted
canine was initially retracted distally with a microimplant inserted in the palatal slope and then was moved
buccally into its ideal position. The patient's occlusion and smile esthetics were significantly improved after
orthodontic treatment. (Am J Orthod Dentofacial Orthop 2017;151:1148-58)

M
axillary canine impaction is a fairly common
problem requiring surgical-orthodontic treat-
ment; it is more common in female patients
than in male patients and has a definite tendency toward
being unilateral rather than bilateral.1-3 Ranked after
third molar impaction, the maxillary canine is the
second most frequently impacted tooth with an
incidence of 0.92% to 1.7%, most often with a palatal
path of eruption. Although the cause of impacted
maxillary canines is not exactly known,4 it can be classi-
fied into 4 distinct groupings: local hard tissue obstruc-
tion, local pathology, departure from or disturbance of
the normal development of the incisors, and hereditary
or genetic factors.5
a
Department of Orthodontics, Gangnam Cha Hospital, Cha University School of
Medicine, Seoul, Korea.
b
Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health,
A. T. Still University, Mesa, Ariz; Graduate School of Dentistry, Kyung Hee Uni-
versity, Seoul, Korea.
c
Department of Orthodontics, School of Dentistry, University of Wonkwang, Ik-
san, Korea.
d
Department of Orthodontics, School of Dentistry, Wonkwang Dental Research
Institute, University of Wonkwang, Iksan, Korea; Postgraduate Orthodontic Pro-
gram, Arizona School of Dentistry and Oral Health, A. T. Still University, Mesa,
Ariz; Charles H. Tweed International Foundation, Tucson, Ariz.
All authors have completed and submitted the ICMJE Form for Disclosure of
Potential Conflicts of Interest, and none were reported.
Supported by Wonkwang University in 2015.
Address correspondence to: Jong-Moon Chae, Department of Orthodontics,
School of Dentistry, Wonkwang University, Daejeon Dental Hospital, 1268 Doon-
san–Dong, Seo-Gu, Daejeon, 302-120, Korea; e-mail, jongmoon@wonkwang.
ac.kr.
Submitted, March 2016; revised and accepted, June 2016.
0889-5406/$36.00
Ó 2017 by the American Association of Orthodontists. All rights reserved.
http://dx.doi.org/10.1016/j.ajodo.2016.06.051
1148
Tooth transposition is defined as a reversal of position
with adjacent teeth in the same quadrant, particularly at
the roots.6,7 Transposition of maxillary anterior teeth is
uncommon and is a special challenge diagnostically and
therapeutically. Maxillary tooth transpositions can be
classified into 5 types on the basis of anatomic factors.6
Maxillary canines are the most commonly involved
teeth,6,8,9 and maxillary canine-lateral incisor transposi-
tion is the second most common type. The most frequent
type of transposition is the reversal of a maxillary canine
and a first premolar.10-12 Although the etiology of
transposition is still speculative, some factors such as
trauma, heredity, transposition of the analog of the
teeth during odontogenesis, mechanical interferences,
migration of teeth away from their normal path of
eruption, and early loss or prolonged retention of
deciduous teeth have been related to tooth
transposition.6,8-12 The most common etiologic causes
for maxillary canine-lateral incisor transposition are envi-
ronmental factors such as dentofacial trauma in the de-
ciduous dentition rather than genetic factors.6,11
There are several potential treatment options for
impacted and transposed teeth: tooth extraction, surgical
repositioning, a surgical-orthodontic approach, and dental
implant replacement.4,10-20 The standard procedure is
surgical exposure and forced orthodontic eruption.21 If a
palatally impacted canine is transposed close to the incisor
roots, a buccally directed orthodontic force should be
changed to prevent root damage and move the canine
away from the root obstacle.22 Therefore, many techniques
have been proposed to move the impacted tooth in the
desired direction to prevent contact with other roots and
then move it buccally into occlusion.16-20,23,24
Lee et al
Fig 1. Pretreatment facial and intraoral photographs.
Assessing the actual position of an impacted canine is
an important factor affecting the total treatment time
and the final position of the canine in the oral cavity.25
Cone-beam computed tomography (CBCT) is essential
for determining the feasibility of and proper access for
a surgical procedure, as well as the best direction in
which to apply orthodontic forces.26-30 We present a
patient to demonstrate an impacted and transposed
maxillary left canine. It was diagnosed with CBCT and
treated with a temporary skeletal anchorage device to
accomplish the desired correction.
DIAGNOSIS AND ETIOLOGY
An 11-year-old girl came to the clinic at Wonkwang
University Daejeon Dental Hospital with the chief
complaint of delayed eruption of her maxillary left
canine. She was in good health with no history of dental
trauma. She had a well-balanced and symmetrical face,
but her appearance was degraded by spacing and malpo-
sitioned teeth upon smiling. Intraorally, she had a slight
Class II molar relationship on the left side with spacing
American Journal of Orthodontics and Dentofacial Orthopedics
1149
issues in both arches. Her maxillary dental midline was
shifted to the left of the facial midline. The maxillary
left central incisor tilted to the left side, and the maxillary
left lateral incisor showed evidence of gingival recession
because of thin attached gingivae (Figs 1 and 2).
The panoramic and periapical radiographs showed
transposition of the impacted maxillary left canine
with the maxillary left lateral incisor. The canine tipped
mesially, and the maxillary left central incisor tipped
distally. The mesial and distal alveolar process, especially
on the mesial side of the maxillary left lateral incisor re-
gion, had a deficiency in vertical development. The third
molars were present in the maxillary arch (Fig 3).
A lateral cephalometric assessment showed a Class I
hypodivergent skeletal pattern with normally inclined inci-
sors. Further CBCT findings (3-dimensional image analysis
software, Simplant; CEP Tech, Seoul, South Korea) showed
that the maxillary left canine was impacted on the palatal
side and transposed with the maxillary left lateral incisor.
The canine was mesially inclined and located between
the left central and lateral incisors (Figs 3 and 4; Table).
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1150 Lee et al

Fig 2. Pretreatment dental casts.

Fig 3. Pretreatment radiographs; A, lateral cephalogram; B, periapical radiograph; C, panoramic

radiograph.

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Lee et al 1151

Fig 4. Pretreatment 3-dimensional images generated by Simplant software.

TREATMENT OBJECTIVES
Table I. Cephalometric measurements
The treatment objectives were to transpose the
Measurement Norm Pretreatment Posttreatment
maxillary canines into an ideal position without causing
SNA ( ) 82.0 82.8 82.3
detrimental effects on the adjacent incisors, to make
SNB ( ) 79.9 78.9 80.0
Class I molar and canine relationships, to correct the ANB ( ) 2.1 3.9 2.3
maxillary dental midline, and to make an esthetic smile Wits (mm) 1.1 1.9 2.3
with minimal profile change. SN-MP ( ) 34.0 32.6 29.8
FH-MP ( ) 28.2 22.7 20.6
LFH (ANS-Me/N-Me) (%) 55.0 52.0 53.0
TREATMENT ALTERNATIVES U1-SN ( ) 104.0 102.4 104.6
U1-NA ( ) 22.0 19.6 22.3
The first alternative was to align the impacted canine
IMPA ( ) 90.0 93.8 92.0
in its position without resolution of the transposition L1-NB ( ) 25.0 25.2 21.8
followed by periodontal surgery, prosthetic restoration, U1/L1 ( ) 124.0 131.3 133.6
and occlusal adjustment. Upper lip (mm) 1.2 3.4 5.7
The second alternative was to reposition the trans- Lower lip (mm) 2.0 1.4 2.8
posed canine in its correct anatomic position with no
root interference using proper mechanics. However,
this option had some disadvantages such as a long treat-
ment time and possible root resorption of the adjacent TREATMENT PROGRESS
teeth during traction of the canine. Because the patient had a thin gingival biotype and
The patient and her parents did not want postortho- an unesthetic maxillary anterior gingival margin, she
dontic restoration, so they selected the second treatment was referred to her periodontist before orthodontic
plan, understanding the risk of root resorption and ac- treatment. A standard 0.022 3 0.028-in edgewise appli-
cepting the long treatment time. ance was placed in the maxillary arch, and leveling began

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1152 Lee et al

Fig 5. Three-dimensional images generated by Simplant software and intraoral photos; A, at the time
of surgery and lingual button bonding; B, 14 months after starting retraction of canine; C, 27 months
after starting retraction of canine and labial button bonding.

with 0.018-in and 0.017 3 0.025-in stainless steel arch-
wires and a maxillary posterior microimplant (1.3-
1.2 mm in diameter, 8 mm in length; Absoanchor
SH1312-08; Dentos, Taegu, South Korea) that was
installed in the palatal alveolar bone between the maxil-
lary second premolars and first molars to distalize the
impacted canine (Fig 5).
The impacted canine was surgically exposed under
local anesthesia, and a button was bonded on the
lingual surface for forced eruption. Direct buccal trac-
tion of the canine would apply pressure on the root of
the lateral incisor distobuccally, so the transposed
canine was initially retracted posteriorly using a micro-
implant inserted in the palatal slope, and the incisors
were not ligated until a sufficient distance was created
to prevent root interference (Fig 5, A), and then the
canine was moved buccally into its ideal position. Trac-
tion of the impacted canine was started on the day of
surgery with elastic thread that was changed every
4 weeks (Fig 5).
After 10 months of treatment, a 0.019 3 0.025-in
titanium-molybdenum alloy archwire was inserted for
torque control of the lateral incisor, and an open coil
was inserted to make space for forced eruption of the
canine (Fig 5, B). After 19 months of treatment, a
standard 0.022 3 0.028-in edgewise appliance was
placed in the mandibular arch, and leveling began
with an 0.018-in stainless steel archwire. The
impacted canine was surgically uncovered again and
bonded with a button on the labial surface when
the canine had been positioned in the middle of the
lateral incisor and the first premolar. Then the canine
was moved buccally to the main wire with elastic
thread (Fig 5, C).
After 36 months of treatment, a bracket was bonded
on the labial surface of the canine, and an overlay wire
was positioned for leveling. Lingual crown torque was
applied to the canine after engaging it into the main
archwire. A final, lengthy period of treatment was used
to effect as much lingual crown torque on the canine
as possible to balance the inclination of the opposite
canine for an esthetic smile.
After 53 months of treatment, the torque control of
the canine was completed, and debonding was done
after detailing. A fixed lingual retainer and circumferen-
tial clear retainer were used for retention.

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Lee et al
Fig 6. Posttreatment facial and intraoral photographs.
TREATMENT RESULTS
The posttreatment facial and intraoral photo-
graphs showed that alignment, leveling, dental
midline correction, and torque control of the maxil-
lary anterior teeth had improved the patient's smile.
Unfortunately, there was gingival recession on the
maxillary left lateral incisor (Fig 6), but the patient
refused to have periodontal surgery to solve it. Post-
treatment casts demonstrated proper interdigitation
of the teeth and acceptable overjet and overbite rela-
tionships (Fig 7).
Posttreatment panoramic and periapical radiographs
showed the optimal positioning of the maxillary left
canine with proper root parallelism and no significant
American Journal of Orthodontics and Dentofacial Orthopedics
1153
signs of bone or root resorption. A posttreatment lateral
cephalometric radiograph showed a well-balanced and
harmonious facial profile (Fig 8). As shown on the ceph-
alometric superimposition, there were no significant
changes in the skeletal measurements except for a 1.8
reduction of ANB due to strong mandibular growth,
and a good facial profile was maintained after treatment
(Fig 9; Table). There was no significant evidence of
relapse or complication 6 months after treatment
(Figs 10 and 11).
DISCUSSION
Maxillary canines are important keystones for
facial appearance, dental esthetics, arch development,
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1154 Lee et al

Fig 7. Posttreatment dental casts.

Fig 8. Posttreatment radiographs; A, lateral cephalogram; B, periapical radiograph; C, panoramic

radiograph.

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Lee et al
Fig 9. Cephalometric superimposition. Black, pretreatment; red, posttreatment.
and functional occlusion. However, a disturbance in
the eruption of the maxillary canine is relatively com-
mon because the tooth can be deflected from its long
and normal eruptive path by various sources of
interference. A number of mechanics have been
devised to recover impacted maxillary canines into
occlusion.6-20,23,24
This patient had simultaneous impaction of the
maxillary left canine with unilateral transposition of
the maxillary left lateral incisor and canine. Transpo-
sition may be classified as incomplete if the crowns
overlap each other but the root apices are in their
normal relative positions, or it may be considered
complete when both the crowns and roots are parallel
in their transposed malpositions.31 In this patient,
because the canine root apex was at the same level
as the lateral incisor root apex, we could not define
it as a complete or an incomplete transposition. The
canine root apex was far from the normal position,
and the transposed canine was moved a substantial
distance from its original position. Therefore, treat-
ment was performed with great difficulty and over a
long treatment time.
Treatment options for transpositioned teeth include
alignment of the teeth in their transposed positions or
orthodontic movement to their correct positions in the
arch. Alignment in their transposed positions together
with a reshaping of their incisal or occlusal surfaces
may be an acceptable solution. If this is possible, there
is a reduced risk of root interference during alignment,
American Journal of Orthodontics and Dentofacial Orthopedics
1155
and the treatment time is shorter, but this option is not
acceptable if anterior esthetics and occlusion are
important objectives. In this patient, it was better to
reposition the teeth to their correct positions in the
dental arch, but doing so required considerable care
and time to prevent possible damage to the teeth
and supporting structures. Therefore, when making
treatment decisions, several factors should be consid-
ered such as the position of the root apices, esthetic
and acceptable occlusion, patient compliance, and
treatment time.31,32
CBCT is the best way to make an accurate assess-
ment of the relative position of the affected teeth
since panoramic and periapical radiographs cannot
provide the exact relative positions of the affected
teeth.33-38 With our patient, CBCT images were
taken before and during treatment to determine the
feasibility of and proper access for a surgical
procedure, as well as the best direction of the
orthodontic recovery forces.
In this patient, the impacted canine was trans-
posed with the lateral incisor. The canine was located
between the central and lateral incisors, but there
was no root resorption on the adjacent roots, so a
challenging approach was chosen to align the
completely transposed canine into its normal posi-
tion in the dental arch for esthetic and functional
considerations.
The treatment plan required patient compliance and
tolerance of protracted treatment. Proper treatment
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1156 Lee et al

Fig 10. Six-month posttreatment facial and intraoral photographs.

results were observed, although the treatment time was
long to achieve 3-dimensional control (repositioning,
uprighting, and torque control) of the roots of the
canine and incisors. The periodontal consequences of
surgical and orthodontic treatment of the palatally
impacted canine were minimal compared with the
contralateral side, where gingival recession was observed
on the adjacent lateral incisor due to the narrow width of
the keratinized gingiva.39,40
To prevent potential root interferences during
reversion of the transposition, a microimplant was in-
serted in the palatal slope, and a properly extended
ligature wire was used for absolute anchorage and
proper direction of the orthodontic force. The pala-
tally impacted canine was initially retracted distally
and then moved buccally into its ideal position
without any adverse effect on the maxillary arch. After
aligning, lingual crown or labial root torque was given
on the canine through the titanium-molybdenum
archwire bending to produce an esthetic smile and
functional occlusion.
Several factors are related to the length of orthodon-
tic treatment.41-43 Stewart et al41 reported that treat-
ment duration for patients with palatally impacted
maxillary canines is influenced by the patient's age at
the start of treatment, distance from the occlusal plane,

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Lee et al
Fig 11. Six-month posttreatment radiographs; A, lateral cephalogram; B, periapical radiograph; C,
panoramic radiograph.
angulation, and horizontal distance from the midline.
Once the root apex of the impacted tooth has closed,
it loses its potential to erupt naturally.44,45 In our
patient, considering her age, her maxillary canine root
formation had been fast and was almost completed
when she was 11 years old. Therefore, the impacted
tooth showed delayed eruption during the forced
eruption procedure. The long distance from her canine
cusp tip to the occlusal plane, medial location of the
canine to the axis of the lateral incisor, and less
inclination of the canine were important factors that
influenced the long treatment duration. To shorten the
treatment time and accelerate tooth movement, micro-
osteoperforations should be considered as an augmen-
tation to the treatment.46
CONCLUSIONS
The treatment of impacted and transposed teeth is a
unique challenge for clinicians. Accurate assessment of
the relative position of the transposed tooth will mini-
mize the risk of negative effects (root resorption and
periodontal problem). In this patient, esthetic and func-
tional treatment results were achieved with proper
American Journal of Orthodontics and Dentofacial Orthopedics
1157
direction of orthodontic force with the use of CBCT
and a microimplant.
REFERENCES
1. Dachi SF, Howell FV. A survey of 3,874 routine full mouth radio-
graphs. Oral Surg Oral Med Oral Pathol 1961;14:1165-9.
2. Ericson S, Kurol J. Radiographic assessment of maxillary canine
eruption in children with clinical signs of eruption disturbances.
Eur J Orthod 1986;8:133-40.
3. Cooke J, Wang HL. Canine impactions: incidence and manage-
ment. Int J Periodontics Restorative Dent 2006;26:483-91.
4. Kokich VG, Mathews DP. Surgical and orthodontic management of
impacted teeth. Dent Clin North Am 1993;37:181-204.
5. Becker A, Chaushu S. Etiology of maxillary canine impaction: a re-
view. Am J Orthod Dentofacial Orthop 2015;148:557-67.
6. Peck S, Peck L. Classification of maxillary tooth transpositions. Am
J Orthod Dentofacial Orthop 1995;107:505-17.
7. Shapira Y, Kuftinec MM. Tooth transpositions—a review of the
literature and treatment considerations. Angle Orthod 1989;59:
271-6.
8. Chattopadhyay A, Srinivas K. Transposition of teeth and genetic
etiology. Angle Orthod 1996;66:147-52.
9. Papadopoulos MA, Chatzoudi M, Kaklamanos EG. Prevalence of
tooth transposition. A meta-analysis. Angle Orthod 2010;80:275-85.
10. Pair J. Transposition of a maxillary canine and a lateral incisor and
use of cone-beam computed tomography for treatment planning.
Am J Orthod Dentofacial Orthop 2011;139:834-44.
June 2017  Vol 151  Issue 6
1158
11. Maia FA. Orthodontic correction of a transposed maxillary canine
and lateral incisor. Angle Orthod 2000;70:339-48.
12. Shapira Y, Kuftinec MM. Maxillary tooth transpositions: character-
istic features and accompanying dental anomalies. Am J Orthod
Dentofacial Orthop 2001;119:127-34.
13. Nagaraj K, Upadhyay M, Yadav S. Impacted maxillary central incisor,
canine, and second molar with 2 supernumerary teeth and an odon-
toma. Am J Orthod Dentofacial Orthop 2009;135:390-9.
14. Pinho T. Impaction of both maxillary central incisors and a canine.
Am J Orthod Dentofacial Orthop 2012;142:374-83.
15. Kuroda S, Yanagita T, Kyung HM, Takano-Yamamoto T. Titanium
screw anchorage for traction of many impacted teeth in a patient
with cleidocranial dysplasia. Am J Orthod Dentofacial Orthop
2007;131:666-9.
16. Fischer TJ, Ziegler F, Lundberg C. Cantilever mechanics for treat-
ment of impacted canines. J Clin Orthod 2000;34:647-50.
17. Kalra V. The K-9 spring for alignment of impacted canines. J Clin
Orthod 2000;34:606-10.
18. Kim SH, Choo H, Hwang YS, Chung KR. Double-archwire me-
chanics using temporary anchorage devices to relocate ectopically
impacted maxillary canines. World J Orthod 2008;9:255-66.
19. Schubert M. A new technique for forced eruption of impacted
teeth. J Clin Orthod 2008;42:175-9.
20. Tausche E, Harzer W. Treatment of a patient with Class II maloc-
clusion, impacted maxillary canine with a dilacerated root, and
peg-shaped lateral incisors. Am J Orthod Dentofacial Orthop
2008;133:762-70.
21. Caminiti MF, Sandor GK, Giambattistini C, Tompson B. Outcomes
of the surgical exposure, bonding and eruption of 82 impacted
maxillary canines. J Can Dent Assoc 1998;64:572-9.
22. Brin I, Becker A, Zilberman Y. Resorbed lateral incisors adjacent to
impacted canines have normal crown size. Am J Orthod Dentofa-
cial Orthop 1993;104:60-6.
23. Kornhauser S, Abed Y, Harari D, Becker A. The resolution of pala-
tally impacted canines using palatal-occlusal force from a buccal
auxiliary. Am J Orthod Dentofacial Orthop 1996;110:528-34.
24. Park HS, Kwon OW, Sung JH. Micro-implant anchorage for forced
eruption of impacted canines. J Clin Orthod 2004;38:297-302.
25. Yadav S, Chen J, Upadhyay M, Jiang F, Roberts WE. Comparison of
the force systems of 3 appliances on palatally impacted canines.
Am J Orthod Dentofacial Orthop 2011;139:206-13.
26. Bedoya MM, Park JH. A review of the diagnosis and management of
impacted maxillary canines. J Am Dent Assoc 2009;140:1485-93.
27. Maverna R, Gracco A. Different diagnostic tools for the localization
of impacted maxillary canines: clinical considerations. Prog Orthod
2007;8:28-44.
28. Walker L, Enciso R, Mah J. Three-dimensional localization of
maxillary canines with cone-beam computed tomography. Am J
Orthod Dentofacial Orthop 2005;128:418-23.
29. Holberg C, Steinhauser S, Geis P, Rudzki-Janson I. Cone-beam
computed tomography in orthodontics: benefits and limitations.
J Orofac Orthop 2005;66:434-44.
30. Caprioglio A, Siani L, Caprioglio C. Guided eruption of palatally
impacted canines through combined use of 3-dimensional
computerized tomography scans and the easy cuspid device. World
J Orthod 2007;8:109-21.
June 2017  Vol 151  Issue 6 American Journal of Orthodontics and Dentofacial Orthopedics
Lee et al
31. Shapira Y, Kuftinec MM. Maxillary canine-lateral incisor transpo-
sition—orthodontic management. Am J Orthod Dentofacial Orthop
1989;95:439-44.
32. Tai K, Park JH, Tanino M, Sato Y. Orthodontic treatment of a bilat-
eral cleft lip and palate patient with bilateral tooth transpositions
and congenitally missing teeth. J Clin Pediatr Dent 2010;35:
225-32.
33. Haney E, Gansky SA, Lee JS, Johnson E, Maki K, Miller AJ, et al.
Comparative analysis of traditional radiographs and cone-beam
computed tomography volumetric images in the diagnosis and
treatment planning of maxillary impacted canines. Am J Orthod
Dentofacial Orthop 2010;137:590-7.
34. Alqerban A, Jacobs R, Fieuws S, Willems G. Radiographic predictors
for maxillary canine impaction. Am J Orthod Dentofacial Orthop
2015;147:345-54.
35. Bjerklin K, Ericson S. How a computerized tomography examina-
tion changed the treatment plans of 80 children with retained
and ectopically positioned maxillary canines. Angle Orthod
2006;76:43-51.
36. Smith B, Stewart K, Liu S, Eckert G, Kula K. Prediction of orthodon-
tic treatment of surgically exposed unilateral maxillary impacted
canine patients. Angle Orthod 2012;82:723-31.
37. Becker A, Chaushu G, Chaushu S. Analysis of failure in the treat-
ment of impacted maxillary canines. Am J Orthod Dentofacial Or-
thop 2010;137:743-54.
38. Wriedt S, Jaklin J, Al-Nawas B, Wehrbein H. Impacted upper ca-
nines: examination and treatment proposal based on 3D versus
2D diagnosis. J Orofac Orthop 2011;73:28-40.
39. Nguyen-Hieu T, Ha Thi BD, Do Thu H, Tran Giao H. Gingival reces-
sion associated with predisposing factors in young Vietnamese: a
pilot study. Oral Health Dent Manag 2012;11:134-44.
40. Maroso FB, Gaio EJ, R€osing CK, Fernandes MI. Correlation be-
tween gingival thickness and gingival recession in humans. Acta
Odontol Latinoam 2015;28:162-6.
41. Stewart JA, Heo G, Glover KE, Williamson PC, Lam EW, Major PW.
Factors that relate to treatment duration for patients with palatally
impacted maxillary canines. Am J Orthod Dentofacial Orthop
2001;119:216-25.
42. Becker A, Chaushu S. Success rate and duration of orthodon-
tic treatment for adult patients with palatally impacted maxil-
lary canines. Am J Orthod Dentofacial Orthop 2003;124:
509-14.
43. Zuccati G, Ghobadlu J, Nieri M, Clauser C. Factors associated with
the duration of forced eruption of impacted maxillary canines: a
retrospective study. Am J Orthod Dentofacial Orthop 2006;130:
349-56.
44. Kokich VG. Surgical and orthodontic management of impacted
maxillary canines. Am J Orthod Dentofacial Orthop 2004;126:
278-83.
45. Park JH, Tai K, Iida S. Unilateral delayed eruption of a mandibular
permanent canine and the maxillary first and second molars, and
agenesis of the maxillary third molar. Am J Orthod Dentofacial Or-
thop 2013;143:134-9.
46. Alikhani M, Raptis M, Zoldan B, Sangsuwon C, Lee YB, Alyami B,
et al. Effect of micro-osteoperforations on the rate of tooth move-
ment. Am J Orthod Dentofacial Orthop 2013;144:639-48.