Pacific Coast Society of Orthodontists Bulletin Summer 2017 - 29

Let's Talk About That

KF: Do we see a higher instance of ankylosis
with IMC?
JP: The diagnosis of apical root ankylosis is generally related to the position of the canine apex
with the anatomic structure known as the Y line
of Ennis (inverted Y).12,13 The Y line of Ennis is
observed only on radiographs due to superimposition of the floor of the nasal cavity and
the border of the maxillary sinus (Figure 3). With
dilacerations or apical root ankylosis, apicotomy
(a root fracture for surgical treatment of
impacted maxillary canines) could be considered.
This technique is recommended when the
conventional forced eruption technique is not
working. However, this technique is not recommended for young patients with incomplete
root development or total ankylosis.13 

Figure 3. The Y line of Ennis (inverted Y), as
demarcated by the red arrows in the panoramic
radiograph. The impacted maxillary left canine
showed ankylosis during forced eruption.

References
1. Baccetti T. A controlled study of associated dental
anomalies. Angle Orthod 1998;68:267-274.
2. Peck S, Peck L, Kataja M. The palatally displaced canine
as a dental anomaly of genetic origin. Angle Orthod
1994;64:249-256.
3. Becker A. The Orthodontic Treatment of Impacted
Teeth. 2nd ed. Abingdon, Oxon, England: Informa
Healthcare; 2007:1-228.

Author's Note
This is the last interview I will
be conducting for the Bulletin.
It has been my pleasure to
introduce the individuals in
these interviews to you over
the past two years. I hope you
have enjoyed the diversity,
information, intellect, and
personalities our guests have
shared with all of us in this
feature.
-Ken Fischer, DDS

Summer 2017  PCSO Bulletin

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Upadhyay M, Yadav S. Evaluation of alveolar bone
dimensions in unilateral palatally impacted canine:
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Orthod 2015;37:596-602.
7. Ericson S, Kurol J. Resorption of maxillary lateral
incisors caused by ectopic eruption of the canines: a
clinical and radiographic analysis of predisposing factors.
Am J Orthod Dentofacial Orthop 1988;94:503-513.

8. Ericson S, Kurol J. Early treatment of palatally erupting
maxillary canines by extraction of the primary canines.
Eur J Orthod 1988;10:283-295.
9. Power SM, Short MB. An investigation into the
response of palatally displaced canines to the removal
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10. Schmidt AD, Kokich VG. Periodontal response to early
uncovering, autonomous eruption, and orthodontic
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Am J Orthod Dentofacial Orthop 2007; 131:449-455.
11. Zasciurinskiene E, Bjerklin K, Smailiene D, Sidlauskas
A, Puisys A. Initial vertical and horizontal position of
palatally impacted maxillary canine and effect on
periodontal status following surgical-orthodontic
treatment. Angle Orthod 2008;78:275-280.
12. Araujo EA, Araujo CV, Tanaka OM. Apicotomy:
Surgical management of maxillary dilacerated or
ankylosed canines. Am J Orthod Dentofacial Orthop
2013;144:909-915.
13. Puricelli E. Apicotomy: a root apical fracture for surgical treatment of impacted upper canines. Head Face
Med 2007;3:33.

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Summer 2017