Management of Palatally Ectopic Canines Flashcards
Who created the guidelines?
RCS
When should you suspect that a canine is ectopic?
If it is not palpable in the buccal sulcus by 10-11 years
If palpation suggests assymetrical eruption pattern
Abnormal mobility of permanent teeth
By what age should the canines have erupted in a) girls b) boys
a) 12.3 years
b) 13.1 years
What is the sequalae of ectopic canines?
Root resorption of adjacent teeth
Resorption of canine crown
Cystic changes
What radiographic examination should you do for ectopic canines?
Parallax = apparent displacement of an object because of different positions of the observer
Horizontal parallax more reliable than vertical
Give examples of how you would carry out a) horizontal parallax b) vertical parallax
a) Two periapicals (one centred over upper central and one over canine) or upper standard occlusal midline and periapical
b) Periapical bisected angle and DPT or upper standard occlusal and DPT
What is the recommendation for CBCT for ectopic canines?
Not routinely used
Consider small field of view (FOV) CBCT if conventional radiographs fail to provide adequate information to construct treatment plan
What are the 5 treatment options for an ectopic canine and what should be done before starting any of these?
1) Interceptive treatment by extracting the primary canine
2) Surgical exposure and ortho alignment
3) Surgical removal of palatally ectopic permanent canine
4) Transplantation
5) No treatment/observe
Always seek advice from specialist
In what cases would you opt for interceptive extraction of the primary canine?
What is is needed after extraction?
Aged 10-13 years
No crowding
Ectopic canine not severely displaced
Need space maintainer and radiograph if no improvement in position at 12 months
When should surgical exposure and ortho alignment be considered for ectopic canines?
Pt willing to wear fixed appliance and motivated with good OH
Position should not be so severe that ortho wouldn’t work ie in midline
Younger pt - likelihood of success decreases with age
When should surgical removal of the palatally ectopic canine be considered?
When pt declines active treatment
Early root absorption of the adjacent incisor
If there is good contact between lateral incisor and fisrt premolar
Remember to discuss risk of damaging roots and nerve supply of adjacent teeth during surgery
In what cases would transplantation be done for the ectopic canine?
When would you have to do root canal therapy?
If the degree of malposition is too great for ortho alignment
Adequate space for canine and sufficient alveolar bone
No evidence of ankylosis
Ectopic tooth can be removed with minimal trauma and before closure of apex
When more than 3/4 root has formed and within 10 days of transplantation
When should you start to palpate the buccal sulcus?
From 8 years anually
Why does prognosis of ortho for the impacted canine decrease with age?
Higher risk of ankylosis and replacement resorption so optimal time during adolescence
Who makes the guidelines for the management of unerupted maxillary incisors?
RCS
