Management of Unerupted Teeth Flashcards
What causes the failure of eruption?
Mechanical obstruction
- Supernumery tooth
- Cyst
- Odontogenic tumour
Insufficient space
- Micrognathia = undersized jaw
- Premature loss of primary teeth
Head and neck syndromes
- Cleidocranial dysostosis, pierre-robin
Genetic and endocrine abnormalities
- Hypothyroidism, hypopituitarism
Majority of cases = unknown
Dental features of cleidocranial dysplasia?
Hypoplastic maxilla and zygomas (cheekbones)
Multiple supernumerary teeth
Abnormal tooth morphology
Normal eruption of primary teeth
Severe eruption problems with permanent teeth
Pierre robin sequence dental features?
Retrognathic mandible
Crowding/eruption dentition
Airway issues
Early modern treatment (distraction) reduces impact
List the most to least common teeth to fail to erupt?
8s, maxillary canines, mandibular 5s, upper incisors
Supernumery teeth incidence?
15% of pts with clefts
Midline supernumerary teeth is 1-3%
Most common sites to have supernumery teeth?
Maxillary midline = most common
Then 9s, then supernumery mandibular premolars
What can supernumery teeth prevent and what can they cause?
May prevent eruption of permanent dentition or orthodontics
Can cause resorption of adjacent teeth
Maxillary canine teeth incidence?
Prevalence of no eruption and ectopic eruption of maxillary canines is 1.7%
Canine is 2nd to lower 3rd molar in its frequency of impaction
In 85% of cases the canine is found palatal to the lateral incisor tooth
Maxillary canine teeth radiological localisation?
Periapical - standard or parallax SLOB
Anterior occlusal
OPT
CBCT
Tx of unerupted maxillary canines?
No tx Extraction of primary canine Surgical removal Surgical exposure Surgical transplantation
When do surgically exposure maxillary impacted canines?
Pt willing to wear fixed ortho appliances - well motivated
Pt is considered unsuitable for interceptive extraction of the primary canine
The degree of malposition of the ectopic canine should not be too great to preclude orthodontic alignment
Surgical exposure types for palatal and buccal impacted canines?
Palatal
- Open exposure
- Closed exposure - bracket and gold chain
Buccal - apically respositioned flap or closed exposure
Surgical transplantation of maxillary canines indications?
It’s the last resort option
When it’s not possible to expose and orthodontically align the canine
Pt does not want prolonged ortho
Failed alignment after surgical exposure
Pre-op assessment for canine transplantation?
Must be enough room in arch
Sufficient room vertically
Sufficient alveolar bone available
What can delay the eruption of teeth?
Systemic causes:
- Eruption obstacles
- Gingival fibromatosis
- Cherubism
- Gorlin’s syndrome
- Cleidocranial dysplasia - Due to genetic factors
- Down’s syndrome
- Amelogenesis imperfecta - Endocrine diseases
- Hypopituitarism
- Hypothryroidism
- Hypoparathyroidism
- Pseudohypoparathyroidism
= Delayed eruption, abnormal teeth and small teeth
Local causes:
- Local obstruction of eruption
- Retention of primary tooth
- Loss of space
- Crowding
- Compact bone
- Scar tissue
- Supernumerary/supplemental teeth - Early extraction of primary premolars
- Loss of space
- Extraction between 6 and 7 yrs old delays the eruption of the permanent successor - Supernumerary teeth
- 1-3%
- Usually Mx midline - Pathoology
- Eruption/dentigerous cyst
- Odontomas
- Odontogenic tumours
- Fibromatosis
- Ankylosis (20% of 6s and 7s eruption disturbances are due to ankylosis)
