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BDS 4: Orthodontics > Impacted Teeth > Flashcards

Impacted Teeth Flashcards

1
Q

What are some hereditary factors that could result in delayed eruption of maxillary incisors?

A

Supernumerary teeth
Cleft lip and palate
Cleidocranial dysostosis
Odontomes
Abnormal tooth/tissue ratio
Generalised retarded eruption

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2
Q

What are some reasons for impacted 6s?

A

Bulbous Es
Crowding
Mesial path of eruption
PFE (primary failure of eruption)

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3
Q

What are some reasons for impacted teeth?

A

Delayed exfoliation of the deciduous tooth
Abnormal position of tooth germ
Supernumerary teeth
Odontomes
Cysts
Trauma (e.g. trauma to A’s)
Ankylosis (fusion of alveolar bone & root cementum)
Tumours
Systemic causes
Genetic causes

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4
Q

What are the disadvantages of a lateral cephalogram?

A

Increased radiation – low dose but exposes all head & neck region (susceptible tissue)

2D image of a 3D shape

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5
Q

What are some disadvantages of OPGs?

A

Poor quality (especially in midline)
Narrow focal trough (we don’t always see the true picture)
Often require supplementary views to confirm location (parallax)

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6
Q

How does the abbrevitaion SLOB help us with the parallax technique?

A

SLOB
Same Lingual (palatal)
Opposite Buccal (labial)

The tube shift is up in occlusal, If tooth moves upwards (towards root apex) it is SAME, therefore Lingual/Palatal

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7
Q

What are the treatment options for impacted 5s?

A
  1. No treatment - Pt accepts
  2. Removal/incorporate into ortho ext pattern
  3. Expose & bond
Expose and bond procedure
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8
Q

Why are impacted teeth an indicator of a ‘great need’ for tx according to the IOTN?

5i on IOTN

A

Tx will provide the following:
- Minimise damage to adjacent teeth
- Speech benefits
- Occlusal function benefits
- Psychosocial benefits

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9
Q

What are the advantages and disadvantages of upper/lower standard occlusals?

A

Avantages
- Good detail
- Low dosage

Disadvantages
- Findings need to be compared against complementary radiograph (parallax)

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10
Q

What is usually the cause of imapcted 5s?

A

Likely premature loss of 2nd primary molars (E)

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11
Q

Which position do impacted 5s normally erupt and why?

A

Impacted lower 5’s will often erupt lingually (through lingual cortex) to avoid thicker buccal cortical bone

As teeth erupt into path of least resistance

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12
Q

What are some environmental factors that could result in delayed eruption of maxillary incisors?

A

Trauma to As
Early extraction or loss of deciduous teeth
Retained deciduous teeth
Cystic formation
Endocrine abnormalities
Bone disease

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13
Q

What are the risks of aligning impacted canines?

A
  • Root resorption to adjacent teeth
  • Canine root resorption
  • Loss of vitality
  • Ankylosis
  • Poor tissue contour at completion of treatment
    Increased pocket depths
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14
Q

What are some visual indicators of impaction?

A
  • Obvious bulges buccally or palatal/lingually
  • Angulation of lateral incisor
  • Colour changes in deciduous teeth (indicates previous trauma or possible resorption from an impacted tooth)
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15
Q

What would you do during a clinical examination of an impacted tooth?

A
  • Inspect
  • Palpate (buccally)
  • Compare charting to expected eruption dates & other arches/side of px mouth
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16
Q

What are the treatment options for impacted canines?

A
  1. No treatment
  2. Interceptive treatment - Removal of C’s (bilaterally to avoid centreline shift)
  3. Exposure & orthodontic alignment
  4. Surgical removal
  5. Transalveolar Implant
  6. Surgical repositioning
17
Q

How do you manage delayed eruption of maxillary incisors?

A
  • Remove obstruction (primary tooth or supernumerary tooth and wait for impacted tooth to come through)
  • Ensure sufficient space (Sectional Fixed Appliance or Retainer)
  • Review for 3-6 months
18
Q

What is a Lateral Cephalogram used for?

A

Show A-P plane skeletal relationship
Trace various landmarks & compare to average values
Show position of unerupted canines (in A-P & vertical planes)

A-P = Anteroposterior

19
Q

What may happen to lateral incisors if there is an impacted canine?

A

Resorption of the lateral roots

20
Q

What are flared lateral incisors an indicator of?

A

Flared laterals are a good indication of unerupted canine presence

21
Q

What is the most and second most common impacted tooth

A
  1. 3rd molars (25% incidence)
  2. 5s (20% incidence)
22
Q

What are the risks of impacted teeth?

A

Root resorption (of adjacent teeth in pathway of impacted teeth)
Cyst formation
Poor aesthetics

23
Q

What are some reasons for impacted canines?

A
  • Long path of eruption (Maxillary canine close to zygomatic process, high in maxilla)
  • Earlier development than adjacent 2’s
  • Small or absent 2’s – Lack of guided eruption by 2’s
  • C’s resistant to resorption
  • Polygenic inheritance
24
Q

What information do OPGs reveal?

A

Unerupted teeth
Root position, shape & apex closure
Stages of tooth development
Bone support
Condyles
Pathology (e.g. cysts, supernumaries, tumours & periapical radiolucency’s)

25
Q

When does delayed eruption of maxillary incisors require monitoring or intervention?

A
  • There is eruption of contralateral teeth that occurred greater than six months previously
  • Both central incisors remain unerupted and the lower incisors have erupted greater than one year previously
  • There is deviation from the normal sequence of eruption (eg lateral incisors erupting prior to the central incisor)
26
Q

What two radiographs are used in parallax to locate unerupted canines?

A

OPG and upper standard occlusal to locate un-erupted canines

27
Q

What are the advantages of a lateral cephalogram?

A

Profile view – Helps localise tooth positioning in horizontal plane
Provides good idea of the degree of vertical impaction

28
Q

What are some indications of surgical removal of impacted canines?

A

Poorly positioned, curved root or XLA need in tx plan

Uncrowded mouths will require prosthetic replacement (e.g. bridge)

29
Q

What are the advantages and disadvantages of CBCT/MRI scans?

A

Advantages
- Good detail in 3 dimensions (3D)
- CBCT can give high degree of accuracy for relatively little radiation exposure

Disadvantages
- Expensive
- High resolution CBCT scans use higher dosage radiation
- MRI –uncomfortable for px

30
Q

What are some advantages of OPGs?

A

Shows all teeth
Complete view of both jaws
Can be used to localise position as objects closer/further away from beam will be magnified/diminished

31
Q

Define impacted teeth

A

A tooth that has failed to erupt due to identifiable obstruction/ barrier to eruption of normally positioned tooth

32
Q

How do you treat an impacted 6?

A

Observe & if persists after 8 y/o then Interceptive tx (Extract E & Disimpact 6)

BDS 4: Orthodontics (12 decks)

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