Nadia Nizam

Date of Award


Degree Type


Degree Name

Master of Clinical Dentistry




The purpose of this study was to determine if there was a difference in esthetic outcome of palatally impacted maxillary canines treated with two different surgical exposure techniques: open vs closed. Each treatment group was composed of 16 subjects with unilateral palatally impacted maxillary canines of equal severity. The contralateral untreated canine was used as a control for the treatment groups. Subjective evaluation using a 100mm Visual Analog scale was used by orthodontists, dentists and lay persons to assess the final esthetic outcome. The esthetic features under investigation included crown height, amount of attached gingiva, mesiodistal angulation (tip), buccolingual angulation (torque), rotation and overall esthetics of the treated canine compared to the contralateral control canine.

The results show no statistical or clinical difference in overall esthetics between closed and open surgical technique as determined by all three examiner groups (orthodontists, dentists and lay persons). Torque was established to be unsatisfactory for both surgical techniques by orthodontist and dentist. The orthodontists found the amount of attached gingiva, to be unfavorable for both surgical techniques when compared to the untreated control side, although open exposure was better than closed when treatment groups were compared. Orthodontists also found that the closed technique lead to unsatisfactory outcomes with respect to crown height, rotation and tip. Dentists found that the closed surgical technique lead to unsatisfactory outcomes with respect to tip, rotation, amount of attached gingiva and crown height when comparing the treated canine with the control canine. Lay persons found poor satisfaction for tooth position (a combination of tip, torque and rotation) in both treatment groups when compared to the control canines, however, they found the appearance of the attached gingiva and crown height to be less satisfactory for the closed surgically exposed canine compared to the control canine. In conclusion, closed surgical exposure of palatal impacted maxillary canines lead to less satisfactory esthetic outcomes when compared to open surgical exposure. Although the difference was statistically significant, no clinical significance was established in this study between open and closed treatment groups or between treatment and control canines.



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