Association of impacted maxillary canines with root resorption of adjacent teeth. A Radiographic Retrospective Study

Association of impacted maxillary canines with root resorption of adjacent teeth. 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A Radiographic Retrospective Study Ebrahim Alshawy, Waleed Alharbi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3908492/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The study aims to record the grade of resorption in maxillary teeth in patients with impacted maxillary canines. Methods We collected a number of 4500 panoramic radiographs from the Radiographic Department at the dental clinics of the College of Dentistry, Qassim University. Patients ≥ 12 years old with good-quality panoramic radiographs were included. The root resorption severity was categorized into 4 groups (no, mild, moderate, and severe resorptions). The location of the impacted maxillary canine was divided into 5 sectors. Chi-squared test was used to identify any significant differences between genders. The Kappa test was used to assess the Intra-rater reliability for the severity of root resorption. The level of significance was set at P < 0.05. Results A number of 19 impacted maxillary canines caused mild to severe resorption of the lateral incisors (n = 17, 89.5%) and central incisors (n = 2, 10.5%). The prevalence of root resorption of adjacent teeth was 17.3%. There were 12 males (66.7%) and 6 females (33.3%) affected with root resorption, with a significant difference detected ( p = 0.01) between the two genders. Most of the root resorption occurred with impacted canines in sectors 1 and 2 (79%). Conclusion Impaction of maxillary canines occurred more in males than females. The root resorption occurred more frequently in male compared to female patients with highly significant differences. The most affected teeth were lateral incisors (89.5%). impacted resorption canines roots Figures Figure 1 Figure 2 Background Teeth are considered impacted when they stay embedded in the jaw and past their expected time of eruption [ 1 ]. Impacted maxillary canines are a common issue in dental practice with a prevalence of 1–3% [ 2 , 3 ]. The presence of impacted teeth in an orthodontic patient carries a great concern for orthodontists [ 4 ]. The clinical and radiographical diagnosis and localization of impacted canines are sometimes challenging. The effect of embedded teeth on the roots of the adjacent teeth should be examined carefully before attempting an orthodontic or surgical management [ 5 ]. The absence of good monitoring and a postponement in the impacted canine treatment can result in several complications, including teeth displacement, follicular cysts, loss of vitality in nearby teeth, recurrent infections and pain, canine ankyloses, shortening of the dental arch, internal and external resorption of the canine and the neighboring teeth, and a combination of these factors [ 6 – 8 ]. Such unwanted outcomes are probably avoidable with the help of an adequate diagnosis, precise analysis, and early action [ 9 ]. Loss of dental cementum and dentin linked to physiological and pathological activities of the tooth-resorbing cells is referred to as root resorption [ 10 , 11 ]. Impaction of the maxillary canine occurs frequently during the permanent dentition development. Root resorption of neighboring teeth is the most frequent and unfortunate consequence [ 12 , 13 ]. This resorption, often asymptomatic and gradually resorbing the roots of the incisors, usually goes unnoticed until detected on X-rays. Accurately assessing the root resorption is crucial, as numerous factors influence treatment options and prognosis. The best course of treatment depends on the extent of resorption, severity of impaction, and overall dental health. Knowing whether incisor resorption has occurred is particularly critical, as it significantly impacts tooth extraction strategies. When root resorption is discovered prior to the start of orthodontic therapy, a choice must be made regarding whether to extract the resorbed tooth or to move the impacted canine away from the resorbed tooth. Extraction of the resorbed tooth would be followed by orthodontic alignment of the impacted canine, closure of the gap, and reshaping [ 14 , 15 ]. Improper force application and direction during this process can cause further resorption [ 2 ]. Another crucial component to evaluate in a clinical case with root resorption is the severity of root resorption. The extent of root resorption was classified into four categories by Ericon and Kurol [ 16 ]. If the resorption is severe, extraction of the affected teeth and realignment might be the best choice of treatment; since the resorption is permanent. The proximity and cusp position of the impacted canine is also an important factor to evaluate [ 12 ]. Impacted canines in sectors 1 and 2 have a chance of self-correction, emerging on their own; while impacted canines in sectors 4 and 5 are difficult to align with orthodontic appliances. The current study aims to investigate the severity of root resorption on maxillary teeth in patients with impacted maxillary canines. The frequency and severity of root resorption in each sector will be documented. Methods Ethical approval was received from the Committee of Research Ethics, Deanship of Scientific Research, Qassim University (Date: 24 Nov 2021 – Number: 21-04-11). A number of 4500 (2500 males and 2000 females) panoramic radiographs were obtained from the Radiographic Department at the dental clinics of the College of Dentistry, Qassim University. Panoramic radiographs were taken with a Soredex CRANEX Novus machine (Soredex, Helsinki, Finland). Inclusion criteria involved patients ≥ 12 years old with good-quality panoramic radiographs. Patients with syndromes, such as cleft lip and palate, pathological conditions in the interested area, and previous history of fracture of the maxilla or orthodontic treatment, were excluded. To understand the relationship between impacted maxillary canines and root resorption, we gathered some key details from each participant, such as: date of X-ray, file number, age, gender, presence of hereditary diseases, local pathological conditions, presence of impacted maxillary canines, and the degree of root resorption. The severity of root resorption and position of impacted canines were classified according to Ericson and Kurol’s classification [ 16 ]. The root resorption was classified into four categories: the first category was no signs of root resorption (= 0), followed by mild resorption (= 1, where half of the dentin was resorbed), moderate resorption (= 2, where most of the dentin was resorbed, but the pulp is intact), and severe resorption (= 3, where the pulp was exposed). Ericson and Kurol, 1988, divided the position of impacted maxillary canines into 5 sectors [ 16 ]. Figure 1 illustrates the 5 different sectors introduced by Ericson and Kurol. An orthodontist examined the panoramic radiographs to assess the severity of root resorption. To assess the Intra-rater reliability, all samples were re-evaluated after a month of the initial evaluation [ 8 ]. Descriptive statistics, including the number of root resorption occurrences and percentages, were used to report the results. The Kappa test was used to assess the Intra-rater reliability for the severity of root resorption and the position of the canine tip (sector). To identify any significant differences between genders we used the Chi-squared test. The level of significance was set at P < 0.05. All statistical analyses were carried out using SPSS (IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp). Results We identified 82 cases of patients with impacted canines. The total number of impacted teeth was 110 with a prevalence of 2.4%. The included panoramic radiographs were taken between 2018 and 2022. The mean age of the study population was 25.9 (SD ± 12.3). Interestingly, we found a slightly higher number of impacted canines in males (56.1%) compared to females (43.9%) with a M:F ratio of 1.28:1. Although more males were affected, this difference was not statistically significant (df = 1, p = 0.238). A number of 19 impacted maxillary canines in 18 patients caused mild to severe resorption of the lateral incisors (n = 17, 89.5%) and central incisors (n = 2, 10.5%). The prevalence of root resorption of adjacent teeth was 17.3%. There were 12 males (66.7%) and 6 females (33.3%) affected with root resorption. There was a significant difference detected between males and females ( p = 0.01). Figure 2 shows an example of root resorption on the adjacent lateral incisor. Table 1 shows the frequency of impacted canines in the different sectors and the degree of resorption on adjacent teeth. The frequency and degree of root resorption in each sector are shown in Table 2 . The Intra-rater reliability for the degree of root resorption and location of the impacted canines were considered high, with percentages of 85% and 100%, respectively. Table 1 The overall frequency of sectors and degree of resorption. Sectors 1 2 3 4 5 Total Number (%) 36 (32.7) 26 (23.6) 19 (17.3) 15 (13.6) 14 (12.8) 110 (100) Degree of resorption No resorption Mild Moderate Severe Total Number (%) 91 (82.7) 12 (10.9) 4 (3.6) 3 (2.8) 110 (100) Table 2 The frequency of root resorption in each sector. Sectors/Degree of resorption 1 2 3 4 5 Total Mild 3 7 0 1 1 12 (63.2%) Moderate 0 4 0 0 0 4 (21.0%) Severe 0 1 0 2 0 3 (15.8%) Total 3 (15.8%) 12 (63.2%) 0 (0%) 3 (15.8%) 1 (5.2%) 19 (100%) Discussion The maxillary canine is often impacted during the development of permanent dentition. Knowing the risks of impacted maxillary canines, especially their tendency to dissolve the roots of neighboring teeth, highlights the importance of early detection and intervention to prevent lasting damage [ 13 ]. During the incidence of canine impaction, the most important part is determining whether or not root resorption occurred in the adjacent teeth. A number of 4500 panoramic radiographs were obtained from the Radiographic Department at the dental clinics of the College of Dentistry, Qassim University. Our study employed clear participant selection criteria to ensure the validity and generalizability of our findings. One of the inclusion criteria was to involve patients ≥ 12 years old. This age guarantees accurate assessment of impaction and root resorption due to the complete development of permanent teeth at this age. Additionally, excluding patients with specific conditions such as cleft lip and palate, jaw fractures, and prior orthodontic treatment minimized extraneous factors that could potentially influence the degree and incidence of root resorption on adjacent teeth. This meticulous selection process strengthened the internal validity of the study and enhanced the trustworthiness of our conclusions. By carefully selecting participants, we built a reliable foundation for our study, leading to valuable insights and ultimately better diagnosis for impacted canine cases. Several patients were found with impacted canines (n = 82). The total number of impacted canines was 110 with a prevalence of 2.4%. Different studies reported similar results regarding the incidence of maxillary canine impaction [ 3 , 11 ]. In the current study, the impacted canines were found to be higher in males (56.1%) than females (43.9%). Although this suggests a potential gender difference, statistical analysis did not reveal a significant association. It has been reported that females showed a higher incidence of impacted canines than males [ 9 , 11 ]. The disagreement with the results could be an outcome of including more male patients in our study. Interestingly, a significant gender difference emerged when we looked at root resorption. Males with impacted maxillary canines exhibited a higher rate of root resorption compared to females ( p = 0.01). Most of the current studies showed a higher incidence of toot resorption in females [ 8 , 9 ]. Another study showed no relationship between gender and the prevalence of root resorption in cases with impacted maxillary canines [ 12 ]. Our higher proportion of male participants might explain this discrepancy. The root resorption can occur in both genders; however, in our sample, males exhibited a higher rate of root resorption than females. Lateral incisors are in close proximity to canines. In our samples, the most affected teeth were lateral incisors (89.5%). Nagani et al. (2021) evaluated the effect of impacted maxillary canines on the roots of the adjacent teeth. They also found that the lateral incisors were the most affected teeth with root resorption (62.5%) [ 4 ]. Another study reported that the maxillary lateral incisors are most commonly affected with root resorption (55.7%) in cases with impacted maxillary canines [ 8 ]. This highlights the crucial need to carefully assess lateral incisors for resorption in every case with impacted maxillary canines. Our study aimed to investigate the relationship between the location of impacted maxillary canines and the degree of root resorption in adjacent teeth. While our findings indicated a higher prevalence of root resorption in sectors 1 and 2 (79%), previous research has presented mixed results. Rafflenbeul et al. (2019) similarly identified sectors 1–3 as hotspots for root resorption with the tendency of lower incidences in sectors 4 and 5 [ 8 ]. However, other studies showed that the more severe the displacement, the higher the incidence of root resorption [ 9 , 11 ]. Despite the inconsistencies, our study underlines the importance of meticulously evaluating all impacted maxillary canines for potential root resorption, regardless of their location, to ensure optimal patient care. While panoramic radiographs offered a convenient screening tool in our study, they may not always give the full picture. Their two-dimensional limitations highlight the potential for underestimating the true extent of resorption. For more accurate assessment, especially in complex cases, advanced imaging techniques like Cone Beam Computed Tomography (CBCT) can provide detailed three-dimensional views, leading to more reliable results. Conclusion This study aimed to quantify the occurrence of root resorption in patients with impacted maxillary canines, revealing a significant gender difference. Male participants showed a statistically higher incidence of root resorption compared to females. Additionally, the location of the impacted canine emerged as a crucial factor, with canines located in sectors 1 and 2 demonstrating the highest correlation with adjacent tooth resorption. Declarations Acknowledgment Researchers would like to thank the Deanship of Scientific Research, Qassim University for funding publication of this project. Ethics approval and consent to participate Ethical approval was received from the Committee of Research Ethics, Deanship of Scientific Research, Qassim University (Date: 24 Nov 2021 – Number: 21-04-11). An informed consent was obtained from all subjects and/or their legal guardians. Consent for publication Not Applicable. Availability of data and materials The data that support the findings of this study are available on request from the corresponding author. Competing interests The authors declare no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not for- profit sectors Authors' contributions Ebrahim Saleh Alshawy collected and analysed the data, supervised and designed the project, and wrote, edited and reviewed the initial and final draft of the research. Waleed Khalid Alharbi collected and analysed the data, wrote the initial manuscript, and reviewed the final draft of the research. All authors have critically reviewed and approved the final draft and are responsible for the content and similarity index of the manuscript. References Lai CS, Bornstein MM, Mock L, Heuberger BM, Dietrich T, Katsaros C. Impacted maxillary canines and root resorptions of neighbouring teeth: a radiographic analysis using cone-beam computed tomography. Eur J Orthod. 2013;35:529–38. Ericson S, Kurol J. Incisor resorption caused by maxillary cuspids. A radiographic study. Angle Orthod. 1987;57:332–46. Alshawy E. The Prevalence and Categories of Impacted Maxillary Canines: A Radiographic Study. Cureus. 2023;15. Nagani NI, Ahmed I, Rizwan S, Pervez H, Khan T, Arif T. Frequency & association of maxillary ectopic canine with incisor root resorption & dental agenesis. J Pak Med Assoc. 2021;71:277–81. Ericson S, Kurol J. Incisor root resorptions due to ectopic maxillary canines imaged by computerized tomography: a comparative study in extracted teeth. Angle Orthod. 2000;70:276–83. Nagpal A, Pai KM, Setty S, Sharma G. Localization of impacted maxillary canines using panoramic radiography. J Oral Sci. 2009;51:37–45. Jung YH, Liang H, Benson BW, Flint DJ, Cho BH. The assessment of impacted maxillary canine position with panoramic radiography and cone beam CT. Dentomaxillofac Radiol. 2012;41:355–60. Rafflenbeul F, Gros CI, Lefebvre F, Bahi-Gross S, Maizeray R, Bolender Y. Prevalence and risk factors of root resorption of adjacent teeth in maxillary canine impaction, among untreated children and adolescents. Eur J Orthod. 2019;41:447–53. Guarnieri R, Cavallini C, Vernucci R, Vichi M, Leonardi R, Barbato E. Impacted maxillary canines and root resorption of adjacent teeth: A retrospective observational study. Med Oral Patol Oral Cir Bucal. 2016;21:e743. Tronstad L. Root resorption–etiology, terminology and clinical manifestations. Endod Dent Traumatol. 1988;4:241–52. Alfaleh W, Al Thobiani S. Evaluation of impacted maxillary canine position using panoramic radiography and cone beam computed tomography. Saudi Dent J. 2021;33:738. Yan B, Sun Z, Fields H, Wang L. Maxillary canine impaction increases root resorption risk of adjacent teeth: a problem of physical proximity. Am J Orthod Dentofac Orthop. 2012;142:750–7. Alqerban A, Jacobs R, Fieuws S, Willems G. Predictors of root resorption associated with maxillary canine impaction in panoramic images. Eur J Orthod. 2016;38:292. Bjerklin K, Ericson S. How a computerized tomography examination changed the treatment plans of 80 children with retained and ectopically positioned maxillary canines. Angle Orthod. 2006;76:43–51. Becker A, Chaushu S, Casap-Caspi N. Cone-beam computed tomography and the orthosurgical management of impacted teeth. J Am Dent Assoc. 2010;141(Suppl 3):14S–8. Ericson S, Kurol J. Early treatment of palatally erupting maxillary canines by extraction of the primary canines. Eur J Orthod. 1988;10:283–95. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3908492","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":270472183,"identity":"14f23525-74cb-4e0c-bac2-14dc61e22b68","order_by":0,"name":"Ebrahim Alshawy","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIie3RMQrCMBSA4VcKdWnNGgfRIwQEEQS9SovQLi0IgggKZoqjs7eIizhGAnbpAZQuihfo2kWMCOIUdRPMPyQZ8hF4ATCZfjNLWFRtlfsC9mfmQVzxNcH+hwSBfdqV217Aj5cNhkk3oEietKRGHSK9bBDwPBxjyKKA4pBoCRFApMXshOdxG1tMKgJ60heVYleyecKPmSJXRVBa6F8BlwiPyYQfXEWoIhDrX8HSHUqPpfNVFo46/j5qMRwPtQQtFutzyaatairXh2LWrS9RyrXk+RFNNQfw1cHR33+pQd8MymQymf63G9zYS5/FtOeuAAAAAElFTkSuQmCC","orcid":"","institution":"Department of Orthodontics and Pediatric Dentistry, College of Dentistry, Qassim University, Buraydah, Qassim","correspondingAuthor":true,"prefix":"","firstName":"Ebrahim","middleName":"","lastName":"Alshawy","suffix":""},{"id":270472184,"identity":"7ddbef09-71ba-4d37-8d5f-c174738e6e4e","order_by":1,"name":"Waleed Alharbi","email":"","orcid":"","institution":"Department of Orthodontics and Pediatric Dentistry, College of Dentistry, Qassim University, Buraydah, Qassim","correspondingAuthor":false,"prefix":"","firstName":"Waleed","middleName":"","lastName":"Alharbi","suffix":""}],"badges":[],"createdAt":"2024-01-29 08:46:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3908492/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3908492/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50569633,"identity":"fdf030c6-56ea-4803-8a2e-2994256f8c4b","added_by":"auto","created_at":"2024-02-02 15:33:25","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":997171,"visible":true,"origin":"","legend":"\u003cp\u003eShows the 5 sectors introduced by Ericson and Kurol in 1988. The impacted canine, in this case, is located in sector 5, as the tip of the impacted maxillary canine has passed the midline of the maxillary central incisor.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3908492/v1/3d6c6c72d09c9adc2a09be67.jpg"},{"id":50569635,"identity":"65bba15c-64fb-4eb5-8b44-0d9251b25632","added_by":"auto","created_at":"2024-02-02 15:33:25","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":983326,"visible":true,"origin":"","legend":"\u003cp\u003eShows an impacted maxillary right canine. The impacted tooth has forced the root of the upper right lateral incisor to tip mesially with evident root resorption on the distal side.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3908492/v1/512e29b82f54d15225c251db.jpg"},{"id":67600033,"identity":"4417b792-94b7-4d73-a2f0-727511bb9261","added_by":"auto","created_at":"2024-10-28 03:01:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2306560,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3908492/v1/f35dc68b-dcd3-4ed0-828e-ff20d591fe46.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association of impacted maxillary canines with root resorption of adjacent teeth. A Radiographic Retrospective Study","fulltext":[{"header":"Background","content":"\u003cp\u003eTeeth are considered impacted when they stay embedded in the jaw and past their expected time of eruption [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Impacted maxillary canines are a common issue in dental practice with a prevalence of 1\u0026ndash;3% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The presence of impacted teeth in an orthodontic patient carries a great concern for orthodontists [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The clinical and radiographical diagnosis and localization of impacted canines are sometimes challenging. The effect of embedded teeth on the roots of the adjacent teeth should be examined carefully before attempting an orthodontic or surgical management [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The absence of good monitoring and a postponement in the impacted canine treatment can result in several complications, including teeth displacement, follicular cysts, loss of vitality in nearby teeth, recurrent infections and pain, canine ankyloses, shortening of the dental arch, internal and external resorption of the canine and the neighboring teeth, and a combination of these factors [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Such unwanted outcomes are probably avoidable with the help of an adequate diagnosis, precise analysis, and early action [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLoss of dental cementum and dentin linked to physiological and pathological activities of the tooth-resorbing cells is referred to as root resorption [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Impaction of the maxillary canine occurs frequently during the permanent dentition development. Root resorption of neighboring teeth is the most frequent and unfortunate consequence [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This resorption, often asymptomatic and gradually resorbing the roots of the incisors, usually goes unnoticed until detected on X-rays. Accurately assessing the root resorption is crucial, as numerous factors influence treatment options and prognosis. The best course of treatment depends on the extent of resorption, severity of impaction, and overall dental health. Knowing whether incisor resorption has occurred is particularly critical, as it significantly impacts tooth extraction strategies. When root resorption is discovered prior to the start of orthodontic therapy, a choice must be made regarding whether to extract the resorbed tooth or to move the impacted canine away from the resorbed tooth. Extraction of the resorbed tooth would be followed by orthodontic alignment of the impacted canine, closure of the gap, and reshaping [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Improper force application and direction during this process can cause further resorption [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother crucial component to evaluate in a clinical case with root resorption is the severity of root resorption. The extent of root resorption was classified into four categories by Ericon and Kurol [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. If the resorption is severe, extraction of the affected teeth and realignment might be the best choice of treatment; since the resorption is permanent. The proximity and cusp position of the impacted canine is also an important factor to evaluate [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Impacted canines in sectors 1 and 2 have a chance of self-correction, emerging on their own; while impacted canines in sectors 4 and 5 are difficult to align with orthodontic appliances.\u003c/p\u003e \u003cp\u003eThe current study aims to investigate the severity of root resorption on maxillary teeth in patients with impacted maxillary canines. The frequency and severity of root resorption in each sector will be documented.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eEthical approval was received from the Committee of Research Ethics, Deanship of Scientific Research, Qassim University (Date: 24 Nov 2021 \u0026ndash; Number: 21-04-11). A number of 4500 (2500 males and 2000 females) panoramic radiographs were obtained from the Radiographic Department at the dental clinics of the College of Dentistry, Qassim University. Panoramic radiographs were taken with a Soredex CRANEX Novus machine (Soredex, Helsinki, Finland).\u003c/p\u003e \u003c/p\u003e \u003cp\u003eInclusion criteria involved patients\u0026thinsp;\u0026ge;\u0026thinsp;12 years old with good-quality panoramic radiographs. Patients with syndromes, such as cleft lip and palate, pathological conditions in the interested area, and previous history of fracture of the maxilla or orthodontic treatment, were excluded.\u003c/p\u003e \u003cp\u003e To understand the relationship between impacted maxillary canines and root resorption, we gathered some key details from each participant, such as: date of X-ray, file number, age, gender, presence of hereditary diseases, local pathological conditions, presence of impacted maxillary canines, and the degree of root resorption. The severity of root resorption and position of impacted canines were classified according to Ericson and Kurol\u0026rsquo;s classification [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The root resorption was classified into four categories: the first category was no signs of root resorption (=\u0026thinsp;0), followed by mild resorption (=\u0026thinsp;1, where half of the dentin was resorbed), moderate resorption (=\u0026thinsp;2, where most of the dentin was resorbed, but the pulp is intact), and severe resorption (=\u0026thinsp;3, where the pulp was exposed). Ericson and Kurol, 1988, divided the position of impacted maxillary canines into 5 sectors [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the 5 different sectors introduced by Ericson and Kurol.\u003c/p\u003e \u003cp\u003eAn orthodontist examined the panoramic radiographs to assess the severity of root resorption. To assess the Intra-rater reliability, all samples were re-evaluated after a month of the initial evaluation [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDescriptive statistics, including the number of root resorption occurrences and percentages, were used to report the results. The Kappa test was used to assess the Intra-rater reliability for the severity of root resorption and the position of the canine tip (sector). To identify any significant differences between genders we used the Chi-squared test. The level of significance was set at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. All statistical analyses were carried out using SPSS (IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eWe identified 82 cases of patients with impacted canines. The total number of impacted teeth was 110 with a prevalence of 2.4%. The included panoramic radiographs were taken between 2018 and 2022. The mean age of the study population was 25.9 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;12.3). Interestingly, we found a slightly higher number of impacted canines in males (56.1%) compared to females (43.9%) with a M:F ratio of 1.28:1. Although more males were affected, this difference was not statistically significant (df\u0026thinsp;=\u0026thinsp;1, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.238).\u003c/p\u003e \u003cp\u003eA number of 19 impacted maxillary canines in 18 patients caused mild to severe resorption of the lateral incisors (n\u0026thinsp;=\u0026thinsp;17, 89.5%) and central incisors (n\u0026thinsp;=\u0026thinsp;2, 10.5%). The prevalence of root resorption of adjacent teeth was 17.3%. There were 12 males (66.7%) and 6 females (33.3%) affected with root resorption. There was a significant difference detected between males and females (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01). Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows an example of root resorption on the adjacent lateral incisor. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the frequency of impacted canines in the different sectors and the degree of resorption on adjacent teeth. The frequency and degree of root resorption in each sector are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eThe Intra-rater reliability for the degree of root resorption and location of the impacted canines were considered high, with percentages of 85% and 100%, respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe overall frequency of sectors and degree of resorption.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSectors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (23.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14 (12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e110 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDegree of resorption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNo resorption\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMild\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eSevere\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91 (82.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e110 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe frequency of root resorption in each sector.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSectors/Degree of resorption\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12 (63.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (21.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (15.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (15.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (63.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (15.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (5.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe maxillary canine is often impacted during the development of permanent dentition. Knowing the risks of impacted maxillary canines, especially their tendency to dissolve the roots of neighboring teeth, highlights the importance of early detection and intervention to prevent lasting damage [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDuring the incidence of canine impaction, the most important part is determining whether or not root resorption occurred in the adjacent teeth. A number of 4500 panoramic radiographs were obtained from the Radiographic Department at the dental clinics of the College of Dentistry, Qassim University. Our study employed clear participant selection criteria to ensure the validity and generalizability of our findings. One of the inclusion criteria was to involve patients\u0026thinsp;\u0026ge;\u0026thinsp;12 years old. This age guarantees accurate assessment of impaction and root resorption due to the complete development of permanent teeth at this age. Additionally, excluding patients with specific conditions such as cleft lip and palate, jaw fractures, and prior orthodontic treatment minimized extraneous factors that could potentially influence the degree and incidence of root resorption on adjacent teeth. This meticulous selection process strengthened the internal validity of the study and enhanced the trustworthiness of our conclusions. By carefully selecting participants, we built a reliable foundation for our study, leading to valuable insights and ultimately better diagnosis for impacted canine cases.\u003c/p\u003e \u003cp\u003eSeveral patients were found with impacted canines (n\u0026thinsp;=\u0026thinsp;82). The total number of impacted canines was 110 with a prevalence of 2.4%. Different studies reported similar results regarding the incidence of maxillary canine impaction [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In the current study, the impacted canines were found to be higher in males (56.1%) than females (43.9%). Although this suggests a potential gender difference, statistical analysis did not reveal a significant association. It has been reported that females showed a higher incidence of impacted canines than males [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The disagreement with the results could be an outcome of including more male patients in our study. Interestingly, a significant gender difference emerged when we looked at root resorption. Males with impacted maxillary canines exhibited a higher rate of root resorption compared to females (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01). Most of the current studies showed a higher incidence of toot resorption in females [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Another study showed no relationship between gender and the prevalence of root resorption in cases with impacted maxillary canines [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Our higher proportion of male participants might explain this discrepancy. The root resorption can occur in both genders; however, in our sample, males exhibited a higher rate of root resorption than females.\u003c/p\u003e \u003cp\u003eLateral incisors are in close proximity to canines. In our samples, the most affected teeth were lateral incisors (89.5%). Nagani et al. (2021) evaluated the effect of impacted maxillary canines on the roots of the adjacent teeth. They also found that the lateral incisors were the most affected teeth with root resorption (62.5%) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Another study reported that the maxillary lateral incisors are most commonly affected with root resorption (55.7%) in cases with impacted maxillary canines [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This highlights the crucial need to carefully assess lateral incisors for resorption in every case with impacted maxillary canines.\u003c/p\u003e \u003cp\u003eOur study aimed to investigate the relationship between the location of impacted maxillary canines and the degree of root resorption in adjacent teeth. While our findings indicated a higher prevalence of root resorption in sectors 1 and 2 (79%), previous research has presented mixed results. Rafflenbeul et al. (2019) similarly identified sectors 1\u0026ndash;3 as hotspots for root resorption with the tendency of lower incidences in sectors 4 and 5 [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, other studies showed that the more severe the displacement, the higher the incidence of root resorption [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Despite the inconsistencies, our study underlines the importance of meticulously evaluating all impacted maxillary canines for potential root resorption, regardless of their location, to ensure optimal patient care.\u003c/p\u003e \u003cp\u003eWhile panoramic radiographs offered a convenient screening tool in our study, they may not always give the full picture. Their two-dimensional limitations highlight the potential for underestimating the true extent of resorption. For more accurate assessment, especially in complex cases, advanced imaging techniques like Cone Beam Computed Tomography (CBCT) can provide detailed three-dimensional views, leading to more reliable results.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study aimed to quantify the occurrence of root resorption in patients with impacted maxillary canines, revealing a significant gender difference. Male participants showed a statistically higher incidence of root resorption compared to females. Additionally, the location of the impacted canine emerged as a crucial factor, with canines located in sectors 1 and 2 demonstrating the highest correlation with adjacent tooth resorption.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearchers would like to thank the Deanship of Scientific Research, Qassim University for funding publication of this project. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was received from the Committee of Research Ethics, Deanship of Scientific Research, Qassim University (Date: 24 Nov 2021 \u0026ndash; Number: 21-04-11). An informed consent was obtained from all subjects and/or their legal guardians.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not for- profit sectors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEbrahim Saleh Alshawy collected and analysed the data, supervised and designed the project, and wrote, edited and reviewed the initial and final draft of the research. Waleed Khalid Alharbi collected and analysed the data, wrote the initial manuscript, and reviewed the final draft of the research. All authors have critically reviewed and approved the final draft and are responsible for the content and similarity index of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLai CS, Bornstein MM, Mock L, Heuberger BM, Dietrich T, Katsaros C. Impacted maxillary canines and root resorptions of neighbouring teeth: a radiographic analysis using cone-beam computed tomography. Eur J Orthod. 2013;35:529\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEricson S, Kurol J. Incisor resorption caused by maxillary cuspids. A radiographic study. Angle Orthod. 1987;57:332\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlshawy E. The Prevalence and Categories of Impacted Maxillary Canines: A Radiographic Study. Cureus. 2023;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNagani NI, Ahmed I, Rizwan S, Pervez H, Khan T, Arif T. Frequency \u0026amp; association of maxillary ectopic canine with incisor root resorption \u0026amp; dental agenesis. J Pak Med Assoc. 2021;71:277\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEricson S, Kurol J. Incisor root resorptions due to ectopic maxillary canines imaged by computerized tomography: a comparative study in extracted teeth. Angle Orthod. 2000;70:276\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNagpal A, Pai KM, Setty S, Sharma G. Localization of impacted maxillary canines using panoramic radiography. J Oral Sci. 2009;51:37\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJung YH, Liang H, Benson BW, Flint DJ, Cho BH. The assessment of impacted maxillary canine position with panoramic radiography and cone beam CT. Dentomaxillofac Radiol. 2012;41:355\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRafflenbeul F, Gros CI, Lefebvre F, Bahi-Gross S, Maizeray R, Bolender Y. Prevalence and risk factors of root resorption of adjacent teeth in maxillary canine impaction, among untreated children and adolescents. Eur J Orthod. 2019;41:447\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuarnieri R, Cavallini C, Vernucci R, Vichi M, Leonardi R, Barbato E. Impacted maxillary canines and root resorption of adjacent teeth: A retrospective observational study. Med Oral Patol Oral Cir Bucal. 2016;21:e743.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTronstad L. Root resorption\u0026ndash;etiology, terminology and clinical manifestations. Endod Dent Traumatol. 1988;4:241\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlfaleh W, Al Thobiani S. Evaluation of impacted maxillary canine position using panoramic radiography and cone beam computed tomography. Saudi Dent J. 2021;33:738.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYan B, Sun Z, Fields H, Wang L. Maxillary canine impaction increases root resorption risk of adjacent teeth: a problem of physical proximity. Am J Orthod Dentofac Orthop. 2012;142:750\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlqerban A, Jacobs R, Fieuws S, Willems G. Predictors of root resorption associated with maxillary canine impaction in panoramic images. Eur J Orthod. 2016;38:292.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBjerklin K, Ericson S. How a computerized tomography examination changed the treatment plans of 80 children with retained and ectopically positioned maxillary canines. Angle Orthod. 2006;76:43\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBecker A, Chaushu S, Casap-Caspi N. Cone-beam computed tomography and the orthosurgical management of impacted teeth. J Am Dent Assoc. 2010;141(Suppl 3):14S\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEricson S, Kurol J. Early treatment of palatally erupting maxillary canines by extraction of the primary canines. Eur J Orthod. 1988;10:283\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"impacted, resorption, canines, roots","lastPublishedDoi":"10.21203/rs.3.rs-3908492/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3908492/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe study aims to record the grade of resorption in maxillary teeth in patients with impacted maxillary canines.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe collected a number of 4500 panoramic radiographs from the Radiographic Department at the dental clinics of the College of Dentistry, Qassim University. Patients\u0026thinsp;\u0026ge;\u0026thinsp;12 years old with good-quality panoramic radiographs were included. The root resorption severity was categorized into 4 groups (no, mild, moderate, and severe resorptions). The location of the impacted maxillary canine was divided into 5 sectors. Chi-squared test was used to identify any significant differences between genders. The Kappa test was used to assess the Intra-rater reliability for the severity of root resorption. The level of significance was set at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA number of 19 impacted maxillary canines caused mild to severe resorption of the lateral incisors (n\u0026thinsp;=\u0026thinsp;17, 89.5%) and central incisors (n\u0026thinsp;=\u0026thinsp;2, 10.5%). The prevalence of root resorption of adjacent teeth was 17.3%. There were 12 males (66.7%) and 6 females (33.3%) affected with root resorption, with a significant difference detected (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01) between the two genders. Most of the root resorption occurred with impacted canines in sectors 1 and 2 (79%).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eImpaction of maxillary canines occurred more in males than females. The root resorption occurred more frequently in male compared to female patients with highly significant differences. The most affected teeth were lateral incisors (89.5%).\u003c/p\u003e","manuscriptTitle":"Association of impacted maxillary canines with root resorption of adjacent teeth. A Radiographic Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-02 15:33:20","doi":"10.21203/rs.3.rs-3908492/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"10ec0362-c93a-466f-aab6-a413adae35e1","owner":[],"postedDate":"February 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-28T02:53:48+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-02 15:33:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3908492","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3908492","identity":"rs-3908492","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}