Surgical exposure of the unilateral palatally impacted canine – a mixed-methods investigation

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Date
2024
Authors
Murphy, Claire.
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University College Cork
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Abstract
Aims: • To assess the volumetric palatal tissue changes that occur with open exposure under local anaesthesia of a unilateral palatally impacted canine (PIC). • To assess the patient pain experience in the first post-operative week following open exposure of a unilateral PIC. • To investigate if a relationship exists between severity of impaction of a unilateral PIC, operator perceived difficulty, duration of surgical procedure, volume of tissue removal and post-operative pain. • To assess the patient’s knowledge, understanding including perceived benefits and risks, attitude, experience and level of involvement in shared decision-making regarding open exposure under local anaesthesia of a unilateral PIC. Materials and methods: Following ethical approval, thirty adolescents referred to the Oral Surgery Department at Cork University Dental School and Hospital (CUDSH) for open exposure of a unilateral PIC were invited to participate in the study . All participants had a unilateral PIC exposed under local anaesthesia by the same Specialist Oral Surgeon. For the first week following surgery, all participants completed the short form McGill Pain Questionnaire (SF-MPQ) and a pain diary at specified time points. To assess the volume of tissue removal, intraoral scans were recorded using a Dexis IS3800W scanner pre- and intra-operatively. Scans were imported into Geomagic Studio software and converted to mesh files. These files were then aligned and a digital model of the excised portion was generated. Volumetric measurement of the excised portion was created using Rhino 3D software. Perceived surgical difficulty was assessed by the surgeon using a 100mm VAS and a surgical questionnaire. Surgical duration was also recorded. Orthopantomograms were used to assess the severity of canine impaction using the method of Ericson and Kurol (1988). Data from all variables were then compared individually to pain data. Relationships with post-operative pain were assessed using ANOVA models with SF-MPQ (Total) as the outcome variable, and separate ANOVA models were used for each of canine grading, operator perceived difficulty, surgical duration and volume of tissue removal, with p <0.05. Approximately 10 days post-operatively, one-to-one semi-structured interviews were undertaken with fifteen of the adolescents by a trained interviewer. Interviews were recorded, transcribed verbatim and subjected to interpretive phenomenological analysis (IPA) by QDA Ltd. (Dublin, Ireland) using NVivo software. Results: The mean volume of tissue removal with open exposure of a PIC was 0.193cm3 (SD 0.064cm3). Regarding severity of impaction, the mean sector was 3.1 and the mean alpha-angle was 38.06. The mean operator perceived difficulty was 11.98mm (SD 9.94mm). The average surgical duration was 9 minutes and 12 seconds (SD 0.11 minutes). Pain peaked the night of surgery, followed by an overall decline over the first post-operative week. No statistically significant relationship was found between patient perceived pain and any of the quantitative variables (volume of tissue removal p = 0. 1921; severity of impaction p = 0.6973; operator perceived difficulty p = 0.4635 and surgical duration p = 0.3859). The qualitative analysis found that participants had a good overall knowledge of the treatment process. They expressed high levels of satisfaction with the explanations provided regarding all aspects of the surgery. Participants initially felt nervous, but anxiety dissipated when provided with reassurance from the surgeon and after administration of the local anaesthetic. In general, participants were not well versed in the causes for impaction or the possible risks of leaving a PIC untreated. Regarding shared decision-making, participants felt involved in this, along with their parents and the operator. Surgery had a minimal impact on eating, speaking and other activities. Overall, participants had more positive than negative experiences. Conclusions: • The mean volume of tissue removed during open exposure of a PIC was less than 0.2cm3. • In general, pain peaked the night of the procedure, and then had an overall reduction in the first post-operative week. • No relationship existed between severity of impaction of a unilateral PIC, operator perceived difficulty, duration of surgical procedure, volume of tissue removal and post-operative pain. • Patients had varying levels of knowledge and understanding regarding open exposure of a PIC and felt pleased with their level of involvement in the shared decision-making.
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Keywords
Orthodontic , Impacted canine , Surgical exposure , Mixed-methods
Citation
Murphy, C. 2024. Surgical exposure of the unilateral palatally impacted canine – a mixed-methods investigation. DClinDent Thesis, University College Cork.
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