Management of the Ectopic Maxillary Canine

Question 1

Features of a normal maxillary canine?

Answer 1

Palpable in the buccal sulcus at 9-10yrs
Erupts 11-12 yrs
Width 7-9mm

Question 2

Prevalence of ectopic maxillary canines?

Answer 2

1-3%
More palatal than buccal 3:1..1:4
8% bilateral
Associated with missing or diminutive lateral incisors

Question 3

Aetiology of ectopic maxillary canines?

Answer 3

Familial
Long eruption path
Guidance theory
Crowding - chronology of eruption
Narrow upper arch
Lack of resorption of primary tooth
Follicular disturbance

Question 4

How to assess ectopic canines?

Answer 4

Clinical:

• Palpation buccally
• Mobility of primary tooth
• Space
• Canine bulge
• Angulation of lateral

Radiographic: (OPT) (upper occlusal)

• Location of canine - Parallax
• Resorption of primary tooth

Question 5

What is the principle of parallax?

Answer 5

SLOB
Same 
Lingual
Opposite
Buccal

Question 6

Complications of ectopic canines?

Answer 6

Root resorption
Ankylosis
Cysts (rare)
Eruption under bridge or denture

Question 7

How to treat the ectopic maxillary canine?

Answer 7

Extraction of primary canine
Before 11 yrs old
91% improvement if canine crown distal to midline of lateral
64% if mesial to midline of lateral

Question 8

How to manage ectopic maxillary canines?

Answer 8

Depends upon full history and examination
Leave
Extract
Orthodontic alignment (most common for palatal impaction) - open or closed exposure (bond gold chain) OR create space and maintain it to encourage natural eruption
Transplant

Question 9

When to do transplantation?

Answer 9

Too misaligned for ortho
Canine ankylosed (not suitable for ortho)
Pt not suitable for ortho
Poor prognosis primary canines
Adequate space
No over eruption of opposing teeth

Question 10

Transplantation prognosis?

Answer 10

After 5 years 72% had a good prognosis

After 10 years 54% had a good prognosis

Question 11

Best way to manage ectopic canines?

Answer 11

Diagnose early

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