Effect of facemask protraction on the development of impacted maxillary canines – a retrospective study.

  • Graziano Montaruli Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
  • Michele Tepedino Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy.
  • Maciej Iancu Potrubacz Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy.
  • Letizia Perillo Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Naples, Italy.
  • Claudio Chimenti Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy.
  • Domenico Ciavarella Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.


Objective: The aim of the present study was to evaluate if maxillary protraction with facemask increases the risk of maxillary canine impaction. Materials and method: The records of 76 skeletal Class III subjects with a cervical vertebral maturation stage between CS1 and CS3 and a displaced maxillary canine were retrospectively collected. Intraoral photographs, orthopantomography and lateral cephalograms were collected, and patients were divided into three groups depending on the type of treatment received – a Rapid Palatal Expander (RPE), a RPE in conjunction with a facemask (RPE-FM), or a Class III functional appliance (FA). The patient’s records were used to determine if the maxillary canines were correctly erupted after that phase of treatment. A binary logistic regression was used to evaluate the effect of treatment modality and skeletal maturation stage on the chance of maxillary canine impaction. Results: No effect of the three different treatment modalities and of the skeletal maturation stage on the risk of canine impaction was observed. Conclusions: The protraction facemask can be used in growing skeletal Class III subjects without increasing the risks of maxillary canine displacement.


1. Ericson S, Kurol J. Early treatment of palatally erupting maxillary canines by extraction of the primary canines. Eur J Orthod. 1988;10(4):283-295.
2. Luzzi V, Ierardo G, Corridore D, Di Carlo G1, Di Giorgio G, Leonardi E, Campus GG, Vozza I, Polimeni A, Bossù M. Evaluation of the orthodontic treatment need in a paediatric sample from Southern Italy and its importance among paediatricians for improving oral health in pediatric dentistry. J Clin Exp Dent. 2017;9(8):e995-e1001.
3. Baccetti T, Mucedero M, Leonardi M, Cozza P. Interceptive treatment of palatal impaction of maxillary canines with rapid maxillary expansion: a randomized clinical trial. Am J Orthod Dentofac Orthop. 2009;136(5):657-661.
4. Sigler LM, Baccetti T, McNamara JA. Effect of rapid maxillary expansion and transpalatal arch treatment associated with deciduous canine extraction on the eruption of palatally displaced canines: A 2-center prospective study. Am J Orthod Dentofac Orthop. 2011;139(3):e235-e244.
5. Naoumova J, Kurol J, Kjellberg H. Extraction of the deciduous canine as an interceptive treatment in children with palatal displaced canines - part I: Shall we extract the deciduous canine or not? Eur J Orthod. 2015;37(2):209-218.
6. Staderini E, Patini R, De Luca M, Gallenzi P. Three-dimensional stereophotogrammetric analysis of nasolabial soft tissue effects of rapid maxillary expansion: a systematic review of clinical trials. Acta Otorhinolaryngol Ital. 2018;38(5):399-408.
7. Mutinelli S, Cozzani M. Rapid maxillary expansion in early-mixed dentition: effectiveness of increasing arch dimension with anchorage on deciduous teeth. Eur J Paediatr Dent. 2015;16(2):115-122.
8. Tepedino M, Iancu-Potrubacz M, Ciavarella D, Masedu F, Marchione L, Chimenti C. Expansion of permanent first molars with rapid maxillary expansion appliance anchored on primary second molars. J Clin Exp Dent. 2018;10(3):e241-e247.
9. Monaco A, Tepedino M, Sabetti L, Petrucci A, Sgolastra F. An adolescent treated with rapid maxillary expansion presenting with strabismus: A case report. J Med Case Rep. 2013;7:222.
10. Becker A, Chaushu S. Success rate and duration of orthodontic treatment for adult patients with palatally impacted maxillary canines. Am J Orthod Dentofac Orthop. 2003;124(5):509-14.
11. Bishara SE. Impacted maxillary canines : A review. Am J Orthod Dentofac Orthop. 1992;101(2):159-71.
12. Tepedino M, Chimenti C, Masedu F, Iancu Potrubacz M. Predictable method to deliver physiologic force for extrusion of palatally impacted maxillary canines. Am J Orthod Dentofac Orthop. 2018;153(2):195-203.
13. Iancu Potrubacz M, Chimenti C, Marchione L, Tepedino M. Retrospective evaluation of treatment time and efficiency of a predictable cantilever system for orthodontic extrusion of impacted maxillary canines. Am J Orthod Dentofac Orthop. 2018;154(1):55-64.
14. Staderini E, Guglielmi F, Cornelis MA, Cattaneo PM. Three-dimensional prediction of roots position through cone-beam computed tomography scans-digital model su-perimposition: A novel method. Orthod Craniofac Res. 2019;22(1):16-23.
15. Tepedino M, Masedu F, Chimenti C. Comparative evaluation of insertion torque and mechanical stability for self-tapping and self-drilling orthodontic miniscrews - An in vitro study. Head Face Med. 2017;13(10):1-7.
16. Stewart JA, Heo G, Glover KE, Williamson PC, Lam EW M, Major PW. Factors that relate to treatment duration for patients with palatally impacted maxillary canines. Am J Orthod Dentofac Orthop. 2001;119(3):216-25.
17. Ericson S, Kurol J. Radiographic Examination of Ecto-pically Erupting Maxillary Canines. Am J Orthod Dentofac Orthop. 1987;91(6):483-92.
18. Mercuri E, Cassetta M, Cavallini C, Vicari D, Leonardi R, Barbato E. Skeletal features in patient affected by maxillary canine impaction. Med Oral Patol Oral Cir Bucal. 2013;18(4):e597-602.
19. Larsen H, Sorensen H, Artmann L, Christensen I, Kjaer I. Sagittal, vertical and transversal dimensions of the maxillary complex in patients with ectopic maxillary canines. Orthod Craniofac Res. 2010;13(9):34-9.
20. Laurenziello M, Montaruli G, Gallo C, et al. Determinants of maxillary canine impaction: Retrospective clinical and radiographic study. J Clin Exp Dent. 2017;9(11):e1304-e1309.
21. Basdra EK, Kiokpasoglou MN, Komposch G. Congenital tooth anomalies and malocclusions: A genetic link? Eur J Orthod. 2001;23(2):145-51.
22. Danielsen JC, Karimian K, Ciarlantini R, Melsen B, Kjær I. Unilateral and bilateral dental transpositions in the maxilla—dental and skeletal findings in 63 individuals. Eur Arch Paediatr Dent. 2015;16(6):467-76.
23. Scerri ES, McDonald F, Camilleri S. Comparison of the dental anomalies found in maxillary canine-first premolar transposition cases with those in palatally displaced canine cases. Eur J Orthod. 2016;38(1):79-84.
24. Oz AZ, Taner T. Displacement of maxillary canines after facemask treatment: a case report. Int J Orthod Milwaukee. 2014;25(2):47-9.
25. Iancu Potrubacz M, Tepedino M, Chimenti C. Maxillary canine–first premolar bilateral transposition in a Class III patient: A case report. Angle Orthod. 2015.
26. Ngan P, Moon W. Evolution of Class III treatment in orthodontics. Am J Orthod Dentofac Orthop. 2015;148(1):22-36.
27. Baccetti T, Franchi L, McNamara J A. The Cervical Vertebral Maturation (CVM) Method for the Assessment of Optimal Treatment Timing in Dentofacial Orthopedics. Semin Orthod. 2005;11(3):119-29.
28. Ciavarella D, Mastrovincenzo M, Tepedino M, et al. Early treatment of pseudo-class III malocclusion with modified swallowing occlusal contact intercept appliance (S.O.C.I.A.). J Indian Soc Pedod Prev Dent. 2018;36(2):206-12.
29. Peck S, Peck L, Kataja M. The palatally displaced ca-nine as a dental anomaly of genetic origin. Angle Orthod. 1994;64(4):249-56.
30. Becker A, Chaushu S. Etiology of maxillary canine impaction: A review. Am J Orthod Dentofac Orthop. 2015;148(4):557-67.
31. Broadbent BH. Ontogenic Development of Occlusion. Angle Orthod. 1941;11(4):223-41.
32. Di Carlo G, Saccucci M, Luzzi V, et al. Prevalence of maxillary canine impaction in skeletal Class III malocclusions compared to Class I malocclusions. J Clin Exp Dent. 2019;11(3):e264-8.
33. Clemente R, Contardo L, Greco C, Di Lenarda R, Perinetti G. Class III Treatment with Skeletal and Dental Anchorage: A Review of Comparative Effects. Biomed Res Int. 2018;2018:1-10.
How to Cite
MONTARULI, Graziano et al. Effect of facemask protraction on the development of impacted maxillary canines – a retrospective study.. Journal of Oral Research, [S.l.], v. 8, n. 5, p. 350-355, nov. 2019. ISSN 0719-2479. Available at: <http://joralres.com/index.php/JOR/article/view/joralres.2019.054>. Date accessed: 04 june 2020. doi: https://doi.org/10.17126/joralres.2019.054.