Exposing Unerupted Teeth

Question 1

At the time of eruption, normally erupting teeth have what?

Answer 1

Developing root with about 3/4 of the final root length completed

Question 2

When is a tooth considered impacted?

Answer 2

Impacted teeth have a more completely developed root when compared to their erupting counterparts

Question 3

What is the order of the most common impacted teeth? (Excluding 3rd molars)

Answer 3

• Max canine
• Man 1st PM
• Man 2nd PM
• Man canine
• Max PM

Question 4

What is the estimated incidence of max canine impaction?

Answer 4

~2%
66-85% of impacted max canines are palatally impacted
8% of cases are bilateral

Question 5

Buccal and labially impacted canines are often associated with what?

Answer 5

Arch length deficiencies

Question 6

What local factors can cause tooth impaction?

Answer 6

Failure of deciduous roots to resorb
Abnormal position (eruption path)
Supernumerary tooth
Crowding
Dentigerous cysts
Thickened oral soft tissues
Oral soft tissue pathology
Soft Tissue pathology
Premature extraction of deciduous tooth

Question 7

What systemic factors can cause tooth impaction?

Answer 7

Childhood diseases
Hereditary factors
Genetic syndromes

Question 8

What are potential sequelae of canine impaciton

Answer 8

Palatal or labial malposition of impacted teeth
Migration of neighboring teeth
Internal resorption
External resorption
Dentigerous cyst formation
Referred pain
Combo of the above

Question 9

T/F - Treatment planning of unerupted teeth does not require a multidisciplinary approach

Answer 9

False - it does

Question 10

What are the different treatment approaches to address impacted teeth?

Answer 10

Orthodontics alone
Orthodontics and surgical exposure
Surgical exposure alone
Surgical exposure and orthodontics

Question 11

What are the surgical aims for impacted teeth

Answer 11

Provide optimal conditions for normal, unimpeded eruption (removal of hard/soft tissue pathology)
Provide access for application of ortho appliances

Question 12

What are the different surgical techniques to expose unerupted teeth?

Answer 12

Open eruption

Closed eruption

Question 13

What are the different open eruption techniques

Answer 13

Window technique

Apically positioned flap technique

Question 14

What are the different closed eruption techniques

Answer 14

Flap elevated, orthodontic appliance applied, flap closed

Question 15

What are the advantages of open eruption techniques?

Answer 15

If bonding of a bracket/chain fails, no additional surgery is needed

Question 16

What are the disadvantages of open eruption techniques?

Answer 16

Greater discomfort
Interference with function (eating)
Delayed healing
Bone exposure

Question 17

What are the advantages of closed eruption techniques?

Answer 17

Rapid healing
Less discomfort
Less interference with function

Question 18

What are the disadvantages of closed eruption techniques?

Answer 18

If bonding of bracket/chain fails, additional surgery is needed

Question 19

T/F - Open techniques are shown to be more effective at exposing teeth

Answer 19

False - “there is no evidence to support one surgical technique over the other in terms of dental health, aesthetics, economics, and patient factors”