Management of Ectopic Maxillary Canine

Question 1

Normal characteristics

Answer 1

Palpable in buccal sulcus at 9-10 years where they form
Erupts 11-12 years (earlier in lower arch)
Width 7-9mm
Larger than Primary

Question 2

Ectopic characteristics

Answer 2

Prevalence 1-3%
More in palatal than buccal but now 1:1
8% bilateral
Associated with missing or diminutive lateral incisors

Question 3

Aetiology

2 main theories

Answer 3

Familial/genetic - more common in girls and associated with other genetic anomalies e.g hypodontia

Guidance theory - long path of eruption + diminutive lateral incisors = lack of guidance into normal position

Long eruption path - due to formation more superiorly

Crowding - chronology of eruption - esp in buccally placed canines - canines erupt after other anteriors therefore no space
Narrow upper arch
Lack of resorption of primary tooth i.e C therefore no space
Follicular disturbance - often with 8s –> enlarged follicle

Question 4

Assessment - two necessary methods

Answer 4

Clinical - first

Radiographic

Question 5

Difference between ectopic and impacted

Answer 5

Ectopic is in wrong place

Impacted may be in right place just prevented from erupting

Question 6

Assessment - clinical

Answer 6

Palpation - buccally - canine bulge
Mobility of primary tooth - C - suggests root resorption
Space present
Angle of lateral incisor

Question 7

Inclination of lateral incisors

Answer 7

Proclined - crown of 3 is resting on root of 2 - proclining 2

Question 8

Assessment - radiographic

Answer 8

Parallax - locate canine

Resorption of primary C - status

Question 9

Parallax

Methods

Answer 9

Taking two films of same object at two different angles - apparent displacement of an object relative to the image of a reference object caused by the change in the angle of the tube

Central/lateral incisors used as reference object

OPT
THEN
Upper standard occlusal - 65-70 degrees at occlusal plane

Question 10

Principle of parallax

If canine moves in same direction as tube (up) - lingual

If canine moves in different direction to tube (up) - buccal

Answer 10

Same
Lingual
Opposite
Buccal

Question 11

Complications of ectopic canines

Answer 11

Root resorption of interfering teeth
Ankylosis
Cysts which are rare
Eruption under bridge or denture

Question 12

Intervention/interceptive treatment

Answer 12

Extraction of C before 11 y/o - sometimes creates sufficient space for 3 but cautious in case 3 doesn’t come down
91% improvement of canine crown distal to lateral midline
64% if mesial to midline of lateral

Question 13

Management of ectopic canine

Answer 13

Leave
Extract
Orthodontic alignment
Transplant

Question 14

Management of ectopic canine - leave

Answer 14

No space
Good aesthetic anyway
Wildly displaced - no chance of erupting/resorbing other teeth

Question 15

Management of ectopic canine - extract

Answer 15

Position of canine - affecting potential orthodontic movement of other teeth e.g crown overlying apex of other teeth

Question 16

Management of ectopic canine - orthodontic alignment

2 main options
3rd newer option

Answer 16

Open exposure
Closed exposure - bond gold chain
Create space - encourage natural eruption

Question 17

Displaced maxillary canine

Answer 17

85% palatal
15% buccal
via CBCT stats

Question 18

Displaced canines - palatal impactions

Options for treatment

Answer 18

Leave
Extract
Expose + align
Transplant

Question 19

Management of ectopic canine - orthodontic alignment OPEN EXPOSURE

Answer 19

Surgery to cut window in palatal soft tissues
Bone is cut away to exposure canine
Pack of gauze sutured in to cover canine - 7-10days to prevent soft tissues growing over canine tooth
Allows normal eruption
Can take 3 years of orthodontics

Question 20

Management of ectopic canine - orthodontic alignment - CLOSED EXPOSURE - bond gold chain

Disadvantage

Answer 20

Adults more likely to develop ankylosis of canines - more likely to be fused to bone and won’t move with orthodontics
GA
Surgeons expose canine and bond gold chain to canines
Fixed appliance attached to chains and used to bring teeth into alignment
Disadvantages - don’t know which angle the canine will come out

Study found no difference in periodontal or surgical outcomes

Question 21

Management of ectopic canine - orthodontic alignment - CREATE SPACE

Answer 21

Encourage natural eruption non-surgically
Quad helix - increases perimeter of arch
Push coil - pushes teeth apart around C to make space for 3 to erupt
6 month treatment

Question 22

Buccal canines

Answer 22

Buccally impacted - soft tissue

Question 23

Buccal impaction

Answer 23

Open exposure

Closed exposure

Question 24

Buccal impaction - open exposure -

Answer 24

apically repositioned flaps 
reflect soft tissues buccally and reposition apically 
suture higher up tooth 
attached gingiva higher 
bracket applied to tooth

Question 25

Transplantation

When

Answer 25

Canine ankylosed - fused to bone - ortho ineffective
Pt not suitable for ortho
Poor prognosis primary canines
Adequate space
No over eruption of opposing teeth e.g lower 3
Too misaligned for ortho

Question 26

Transplantation
When
follow up

Answer 26

Canine ankylosed - fused to bone - ortho ineffective - trauma excessive - more damage to PDL –> external resorption
Pt not suitable for ortho
Poor prognosis primary canines
Adequate space
No over eruption of opposing teeth e.g lower 3
Too misaligned for ortho

RCT within 10 days

Question 27

Transplantation - prognosis

Answer 27

5 years - 72%

10 years - 54% good prognosis

Question 28

Summary

Answer 28

Diagnose early

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