Management of Unerupted Teeth

Question 1

what can cause a tooth to fail to erupt?

Answer 1

Mechanical obstruction: (something in the way)
eg Supernumery tooth, Cyst, Odontogenic tumour

Insufficent space:
eg Micrognathia, Premature loss of decidous teeth

Head and neck syndromes:
e.g Cleidocranial dysostosis, Pierre-Robin.

Genetic and endocrine abnormalities
e.g hypothyroidism, hypopituitarism

Question 2

what are the dental features of cleidocranial dysplasia?

Answer 2

• Hypoplastic maxilla and zygomas (cheek bones)
• Multiple supernumerary teeth
• Abnormal tooth morphology
• Normal eruption of primary teeth
• Severe eruption problems with permanent teeth

Question 3

what are the dental features of Pierre Robin sequence?

Answer 3

• Retrognathic mandible
• Crowding/Uneruption dentition
• Airway issues (air way is tight)
• Early modern treatment (distraction) reduces impact

Question 4

which teeth in order are most likely to fail to erupt

Answer 4

8’s>Maxillary canines>Mandibular 5’s>Upper incisors

Question 5

where are you most likely to get supernumery teeth?

Answer 5

Most common site is the maxillary midline, then 9’s, then supernumery mandibular premolars

May prevent eruption of permanent dentition or orthodontics

Question 6

what is the name given to a supermunery tooth between the upper central incisors?

Answer 6

Mesiodens

Question 7

how do we carry out radiological localization of unerupted canines?

Answer 7

using parallax and SLOB technique (can be vertical or horizontal)
or
CBCT

Question 8

are upper canines usually buccal or palatal to laterals?

Answer 8

PALATAL

In 85% of cases the canine is found palatal to the lateral incisor tooth – cannot just assume need to check with clinical investigation and imaging

Question 9

What is the treatment of unerupted maxillary canines?

Answer 9

• No treatment
• Extraction of the deciduous canine (need to check balancing)
• Surgical removal
• Surgical exposure (open or closed) and ortho
• Surgical transplantation

Question 10

what is used to Surgical exposure and orthodontic align impacted maxillary canines?

Answer 10

Palatal
- Open
- Closed exposure – bracket and gold chain

Buccal
- Apically repositioned flap - open
- Closed exposure – bracket and gold chain

Question 11

what are the indications of Surgical exposure and orthodontic alignment

Answer 11

• tooth cant be too severely impacted
• pt needs to be happy to wear prolonged orthodontics

Question 12

what are the indications for Indications surgical transplantation?

Answer 12

• It is the last resort option
• When it is not possible to expose and orthodontically align the canine
• Patient does not want prolonged orthodontics
• Failed alignment after surgical exposure

Question 13

what is assessed in the pre-op assessment of surgical transplantation?

Answer 13

There must be sufficient room within the arch
There must be sufficient room vertically
There must be sufficient alveolar bone available