Ectopic Canines Flashcards
What do we do if canines are missing (at least 1)?
Palpate buccally and palatally
Check mobility of primary canine
Assess position of lateral and assess their mobility
What special investigations can we do for missing canines?
OPT
2 PAs
and then parallax
How does parallax work?
This is where we use SLOB rule - same lingual, opposite buccal
WHat is the cause of unerupted ectopic canines?
Long path of eruption -can result in delayed eruption
Crowding in upper arch preventing eruptuon
supernumerary tooth present
genetic component, more common in females, class II div II pts, if family history of missing tooth or ectopic tooth then more common
Ectopic tooth germ position
diastema
trauma which damages tooth germ developing
cyst or midline pathology
retained primary tooth/lack of exfoliation
early exfoliation, teeth shift and crowding prevents eruption
What is IOTN used for?
To assess for need and eligibility of NHS ortho tx
What does 5i mean?
Impended eruption of teeth due to crowding, displacement, supernumerary teeth, retained primary tooth or pathological cause
What are tx aims when we have impacted canines?
We want to facilitate eruption of these teeth and we also want to deal with our malocclusion problems (Ie correct incisor relationship, molar relationship, any OJ or OB)
What are some tx options for class II Div II pt with ectopic canine?
Accept/do nothing - risks with this!!
Surgical removal of ectopic canine
Surgical exposure of ectopic canine and realignment with ortho
Removable appliance
Growth modification
Autotransplantaiton
What are risks of leaving an ectopic canine?
Can cause resorption of roots of lateral incisor/central incisor
need to be prepeared for eventual loss of C which will result in space which if wanting tx this will be complex
risk of resorption of canine crown
cystic change - rare
When might we opt for surgical removal of ectopic canine?
If canine is too close to midline
if canine is too high up
if there is no risk to adj teeth During procudure
c has good prognosis and pt happy with appearance
if causing early resorption of adjacent teeth
if pt refuses ortho tx
When might we we opt for surgical exposure and alignment?
If canine is in good position that we can expose it then bring down
first off we may have to xla primary tooth
then we make cut in gum and can use traction via gold chain to encourage canine t erupt
then ortho appliances to align
When might we carry out autotransplantation?
If tooth is too complex for alignment
if there is ankylosis of the canine
if canine root 2/3 to 3/4 dev
if pt wants quick fix
What are risks of autotransplantation?
RCT
ankylosis or external root resorption of transplant
Why do we refer pts who have ectopic canines?
we do this because pt has:
- high tx need according to IOTN - 5i
- significant dental health risk of doing nothing - risk of resorption of adjacent tooth, difficult restorative tx req
- fixed applianced will be lieu
What are some risks of tx for ectopic canines?
normal ortho risks - root resorption, relapse, decalcification
pt must be committed and compliant for length tx journey
if shorter roots pre tx then in risk of RR
failure to achieve tx aims - tooth not responding to wroth forces
