Inter-premolar width changes related to the orthodontic traction of maxillary impacted canines in adolescents and young adults: A retrospective CBCT study

Objective: Maxillary canine impaction is directly associated with a narrow maxillary arch, mainly in the inter-premolar widths. This study compared the transverse changes at the level of maxillary premolars after traction of maxillary impacted canines (MICs) in adolescents and young adults through three main goals: to compare unilateral versus bilateral cases, to compare buccally versus palatally MIC cases, and to compare the affected versus non-affected side exclusively in the unilateral group. Methods: This before and after CBCT study involved 45 MIC orthodontically tractioned until the occlusal plane with a standardized protocol. The sample was classified regarding the impaction type (unilateral versus bilateral), impaction location (palatal versus buccal) and the affected versus unaffected sides in the unilateral cases. MIC characteristics as impaction sector, height, and complexity of the traction, as well as α and β angles, canine root length and area were measured. Moreover, cephalometric characteristics were also evaluated. Mann-Whitney U or Wilcoxon signed-rank tests and multiple regressions were applied (α = 0.05). Results: Maxillary inter-premolar widths (first or second) expanded approximately 3 mm after traction of unilateral or bilateral MIC (P > 0.05). Changes in hemi-arch widths between palatal (1.67 mm) versus buccal (1.90 mm) MIC were similar (P > 0.05). In unilateral impaction, the transversal changes on the affected side were 2 mm versus almost 1 mm observed in the unaffected side (P < 0.05). Finally, the multiple linear regressions were identified to the ANB angle, the impaction sectors and the distance from middle raphe to the cusp tip of MIC as influential variables. Conclusion: The maxillary inter-premolar widths increase after traction of MIC without differences between type or location of impaction. In addition, the transverse change in the affected side in unilateral MIC is greater than the unaffected side resolving the earlier transverse asymmetry.