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INTRODUCTION
Apart from the third molars, the maxillary canines are
most often prevented from assuming their correct
alignment in the row of teeth. The prime cause of this
is lack of space, because maxillary canines erupt after
the adjacent teeth. Depending on age and the particular orthodontic state, the methods of treatment can
entail exposure and orthodontic alignment, autologous tooth transposition1 or removal by osteotomy.
As most of the maxillary canines are displaced
palatally,2,4 they must be approached from that direction. When only the displaced tooth is exposed and a
ligature is used, and provided that the displaced tooth
is both palpable and visible, excision of the oral
mucosa around the crown of the canine tooth5 or an
incision to obtain a roll flap6,7 are indicated. However,
if it cannot be palpated, and in all tooth extractions
requiring osteotomy, a more generous incision must
be made to ensure good general viewing during the
operation.
Different types of incision are recommended for
removal of teeth from the palate (Fig. 1). One possible
way to classify these is to differentiate between paramarginal types of incision3,810 and incisions of the gingival margin.1113 Another way is to divide the types of
incisions into those that are as gentle as possible to the
vascular nerve bundle at the foramen incisivum either
by cutting round it or by avoiding it4,1416 and those that
sever these structures.10,11,17 The present investigation
will shed some light on the incidence of postoperative
sensory alterations in the mucous membrane of the
mouth in the region of the anterior teeth after the
nasopalatine nerve has been severed peroperatively.
RESULTS
In the patients examined after the operation, tooth 13
was treated by severing the nasopalatine nerve in 26
cases and tooth 23 in 33 cases. Twenty-five of the
patients were male and 34 female. At the time of the
operation the patients mean (SD) age was 23 (15)
years (range 948, median 16).
At the follow-up examination 1 week postoperatively all patients had objective sensory disorders. The
area of the anaesthetized zones extended from the
ventral plica palatina transversa into the interdental
papillae of the anterior teeth. There was no sensation
of numbness in the tips of the papillae or in the
mucous membrane of the palate dorsally from the
first plica palatina transversa. The subjective sensory
disorders recorded at the same time indicated alterations in keeping with a slight swelling in 52 of the
cases. Seven patients did not notice any sensory
changes. After 2 weeks, 31 patients still had objective
sensory disorders. By 4 weeks no subjective or objective sensory disorders were diagnosed in any of the
patients.
DISCUSSION
Some types of incisions were favoured to avoid potential sensory disorders of the nasopalatine nerve by
cutting around the papilla incisiva or avoiding it. The
greatest disadvantage of these types of incisions is the
general lack of visibility within the operating area.
Usually there is contact between the crown of the
canine and the root of a functioning adjacent tooth,
primarily the lateral incisor. With a paramarginal type
of incision or cutting around the papilla incisiva, or
both, the crown of the tooth that has to be removed is
in these cases completely or partly covered by retained
mucous membrane, and removal of the tooth under
good viewing conditions is not guaranteed. It has
therefore been recommended that, in the case of
crowding between a displaced tooth and the roots of
teeth that are properly positioned, an incision of the
gingival margin or a modified variation which is gentle to the papilla,3 offers better viewing and so should
be used.11,12,17 Potential contacts between the canine
and the roots of properly positioned teeth can be recognized by direct viewing. Damage of adjacent periodontia during removal of the bone is then less likely.
There is no bleeding worth mentioning from the
severed periodontal vessels at the foramen incisivum.
In this prospective study no subjective or objective
sensory disorders were found more than 4 weeks after
operation in any of the patients. Any concerns about
postoperative neurological deficiencies have already
been investigated by us, retrospectively, over the last few
years.18 Neurological deficiencies of the nasopalatine
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The Authors
A. Filippi DDS
Y. Pohl DDS
U. Tekin DDS
Department of Oral Surgery
University of Gieen
Germany