Management of unerupted teeth

Question 1

Eruption of permanent teeth can be divided into the following phases (5)

Answer 1

Pre-eruptive movement (follicle)
Intra-osseus movement (follicle)
Mucosal penetration
Pre-occlusal movement
Occlusal function

Question 2

Disturbed tooth eruption can be due to (2)

Answer 2

Local factors

Systemic factors

Question 3

Systemic factors causing delayed tooth eruption (11)

Answer 3

Delayed eruption due to eruption obstables
-gingival fibromatosis
-cherubism
-Gorlin syndrome
-cleidocranial dysplasia
Delayed eruption due to genetic factors
-Trisomy 21 Syndome (Down's)
-amelogenesis imperfecta
-mucopolysaccharidoses
Endocrine diseases 
-hypopituitarism
-hypothyroidism (Cretinism)
-hypoparathyroidism
-pseudohypoparathyroidism

Question 4

Cleidocranial dysplasia features (6)

Answer 4

Hypoplastic maxilla and zygomas
Hypoplastic or absent clavicles
Multiple supernumerary teeth
Abnormal tooth morphology
Normal eruption of primary teeth
Severe eruption problems with permament teeth

Question 5

Delayed eruption in Down’s syndrome (2)

Answer 5

Irregular eruption sequence

Delayed in 75% of patients

Question 6

Delayed eruption in amelogenesis imperfecta (1)

Answer 6

Disturbed enamel formation and eruption

Question 7

Delayed eruption in mucopolysaccharidoses (2)

Answer 7

Family of inherited metabolic diseases

Some have disturbed tooth eruption

Question 8

Delayed eruption in endocrine diseases (3)

Answer 8

Delayed eruption
Small teeth
Abnormal teeth

Question 9

Local factors causing delayed tooth eruption

Answer 9

Local obstruction of eruption
-retention of the deciduous predecessor
-loss of space
-crowding
-supernumerary of supplemental teeth
-scar tissue
-compact bone
Early extraction of primary molar teeth
Supernumerary teeth
Local obstruction of eruption
-eruption cyst
-dentigerous cyst
-odontomas
-odontogenic tumours
-fibromatosis
-ankylosis

Question 10

Why does early extraction of primary molar teeth cause delayed tooth eruption (2)

Answer 10

• extraction between 6 and 7 years delays eruption of permanent successor
• loss of space

Question 11

Supernumerary teeth in delayed tooth eruption (3)

Answer 11

Occur in 15% of patients with clefts
Incidence of midline supernumerary teeth is 1-3%
Most common site is maxillary midline

Question 12

Ankylosis causing delayed tooth eruption (1)

Answer 12

20% of eruption disturbances affecting the first and second permanent molars is due to ankylosis

Question 13

Unerupted teeth - symptomology (6)

Answer 13

Failure to erupt as expected
Over-long retention of deciduous predecessor
Proclination of adjacent teeth
Loosening of teeth
Pain 
Swelling

Question 14

Localisation of unerupted teeth (3)

Answer 14

Observation
Palpation
Radiographs
-periapical standard or parallax
-occlusal
-OPT

Question 15

Treatment of unerupted teeth (5)

Answer 15

No treatment
Surgically remove
Surgically expose
Transplantation
Extract teeth to allow eruption

Question 16

Complications affecting unerupted teeth (6)

Answer 16

Often there are no clinical effects
Cyst formation
Pericoronitis
Resorption of adjacent teeth
Eruption later under a bridge or a denture
Hypercementosis
Internal resorption

Question 17

Non-erupted and ectopic eruption of maxillary canine teeth prevalence (2)

Answer 17

1.7%

Second only to lower 8 in frequency of impaction

Question 18

Where is the maxillary canine tooth usually found when it ectopic (2)

Answer 18

in 85% of cases it is found palatal to the lateral incisor

Question 19

Localisation of ectopic canine - palpation (2)

Answer 19

For MOST children digital palpation of the canine area in the mixed dentition period could suffice without radiological examination
-children >10 should have rads if canines cannot be palpated

Question 20

Radiological localisation of unerupted canines (3)

Answer 20

PA - standard or parallax
Anterior occlusal
Extraoral OPT

Question 21

Leaving unerupted canine tooth undisturbed (5)

Answer 21

May well have no clinical effects
Resorption of adjacent teeth
-12.5% of adjacent incisors show resorption
-most frequently seen between 11 & 12 years of age
Cyst formation
The canine may erupt later under a bridge or denture
Problem once the deciduous canine is lost ??

Question 22

Treatment of choice of ectopic canines 10-13 years (2)

Answer 22

“ Primary canine extraction is the treatment of choice in the age group 10-13 years, when the permanent maxillary canine has a palatal ectopic path of eruption ”

				Ericson & Kurol, 1988

Question 23

Surgical exposure and orthodontic alignment of maxillary canine teeth (4)

Answer 23

Palatal
-open
-closed exposure – bracket and gold chain
Buccal
-apically repositioned flap
-closed exposure – bracket and gold chain

Question 24

Surgical transplantation for maxillary canine teeth - indications (4)

Answer 24

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 25

Pre-op assessment for surgical transplantation of maxillary canine teeth (3)

Answer 25

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