BDS4 Seminar 2 -Unerupted maxillary incisors and Unerupted Ectopic canines Flashcards
what are options for unerupted ectopic canines
- Accept the malocclusion - leave
- If c still present consider interceptive XLA of c
- surgical removal of canine
- surgical exposure and ortho alignment
- autotransplantation
what is tx aims?
- Facilitate eruption of 23
- Align upper and lower arches
- Correct Class skeletal II relationship
- Produce Class I incisor relationship, ( i.e. reduce the overbite and correct the interincisal angle )
- Produce class I molar relationship
- Consider restorative treatment for 12, 22
what is intra oral assessment for ectopic canines
- palpate buccally palatally
- ‘c’ - moblie and colour
- ‘2’ - position and mobility
special investigatons for ectopic canines and incisors?
- OPT and AOM - vertical
or - 2 - PAs - horizontal
- cbct
aetiology and incidence of ectopic canines?
Long path of eruption
Genetic link - Association with other dental anomalies, (class II/II malocclusion, missing
or diminutive upper lateral incisors), females
more commonly affected
Crowding – canine often last tooth to erupt
Ectopic position of the tooth germ
what are things to consider when accepting malocclusion for unerupted ectopic canines?
- Extn ‘c” unlikely to make much difference?
- is it distal to the midline of the lateral?
- is patient 13 years
- is there sufficient space for canine
what are risks of leaving canine unerupted?
- Resorption of the roots of adjacent teeth
- Resorption of the canine crown
- Ankylosis of the unerupted canine
- Eventual loss of primary canine and complex restorative solutions may be required in the future
- Cystic change of canine (rare)
when might canine to be surgically removed?
- not deemed alignable
- can extract without damaging other teeth
- patient happy appearance - good long term prognosis of ‘c”
- radiograph evidence early root resorption adjacent teeth
- Patient does not want to wear orthodontic appliances
when might canine not be alignable?
- too high – above apical third of incisor roots
- too close to dental midline
- angle greater than 55 degrees to midsagittal plane
how would a removabe appliance affect unerupted canines?
- Removable appliance alone for this patient is not going to be able to comprehensively treat the malocclusion
- Removable appliance could be used at the start of treatment to aid overbite reduction
why might use growth modification for this patient?
- Functional Appliance - Twin block
- Converts class II division II incisor relationship to class I
- Facilitates mandibular growth
- Aids overbite reduction
- Headgear to restrain maxillary growth –
what is fixed applainces and surgical exposure option? canine
- Make sufficient space for the tooth. A deciduous canine if retained, may require removal.
- Surgically expose the canine . Open or closed exposure depending on site of canine.
- Orthodontic traction - gold chain (closed exposure) or a traction hook for an open exposure
*Upper and Lower fixed appliances.
*Highly anchorage demanding may -need palatal arch - Fixed and removable retainers
when would autotransplantation be indicated
- Malposition of the tooth is too great for orthodontic alignment to be possible.
- There is no evidence of ankylosis of the canine
- The canine root development is ideally 2/3 to 3/4 length root
- Patient is looking for a quicker treatment option
what are additional risks to autotransplantation
- Patient may need to undergo root canal treatment of the transplanted tooth
- Patient needs to accept risk of ankylosis or external root resorption of the
transplanted tooth
what should you warn this particular patient in regards to routine ortho tx risks - canine
when to start palpating for canines?
10-11 years
what are aetiology of maxillary incisors?
▪ Unerupted supernumerary – most common reason for a delayed upper central incisor
▪ Retained primary tooth
▪ Early loss of primary tooth
▪ Trauma to the deciduous tooth leading to dilaceration of the unerupted tooth
▪ Crowding
▪ Ectopic position of the tooth germ
what are options of unerupted maxillary incisors?
- Accept
- bring central into line of arch
- surgical remove unerupted central
problems with accepting unerupted maxillary incisor?
- large anterior space affect aesthetics and social development
- drifting make future tx harder
- risk of root resoprtion adjacent teeth
- risk of cyst formation
how to bring incisor into line of arch?
- make space for tooth - URA or fixed
- (if 9 years and position of unerupted tooth favoured may wait once space for potential sponetanous eruption)
- surgically expose tooth
*closed exposure gold chain - palatal surface upper central - apply traction by gold chain + ortho appliance
*traction start 2 weeks after exposure
risks of bring incisor into line of arch?
- Tooth fails to erupt and / or move
- Ankylosis of the central incisor
- External root resorption of the central
incisor - Poor resulting gingival aesthetics
what are indications of surgically removing unerupted incisor?
- Patient not keen on extensiveness of tx
- If the unerupted tooth fails to respond to the orthodontic traction (i.e. ankylosed)
- Severe dilaceration so not possible to align tooth within the bone
what are risks with surgically removing unerupted incisor?
- Damage to adjacent tooth roots
- Loss of space within the arch for a future
prosthetic tooth if not correctly managed - Loss of alveolar bone in the area may
complicate future prosthesis ( especially
with implants)
if surgically remove unerupted central incisor what are tx options?
- ortho fixed move ‘2’ to beside ‘1’ and restore as a central
- ortho fixed open space for
*implant
*RBB
*RPD - do nothing allow mesial drift of ‘2’ and ‘1’
*if patient <9 years get more space closure
*space could be reopened later - autotransplantation if poor prognosis
what are general causes/syndromes associated with delayed eruption?
▪ Down Syndrome
▪ Cleidocranial dysostosis
▪ Cleft lip and palate
▪ Hereditary gingival fibromatosis
▪ Turner syndrome
▪ Rickets
what is primary failure of eruption?
Failure of eruption with no identifiable local or systemic cause.
- what might ortho force do to teeth of primary failure eruption?
- what are features of it?
- what mutation is it associated with?
- ankylosis
- Unilateral or bilateral
* Lateral open bites
* Posterior teeth most frequently
affected
- Unilateral or bilateral
- parathyroid hormone 1 receptor (PTH1R)
how to recognise unerupted exctopic incisors early?
- Asymmetrical eruption pattern ( > 6 months since contra-lateral tooth erupted )
- Disturbance of the normal sequence of eruption ( e.g both upper laterals erupted before an upper central )
what are management principles of unerupted maxillary central incisors?
what is patient communication for ortho risks of unerupted maxillary incisors?
