Management of unerupted teeth Flashcards
Eruption of permanent teeth can be divided into the following phases (5)
Pre-eruptive movement (follicle) Intra-osseus movement (follicle) Mucosal penetration Pre-occlusal movement Occlusal function
Disturbed tooth eruption can be due to (2)
Local factors
Systemic factors
Systemic factors causing delayed tooth eruption (11)
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
Cleidocranial dysplasia features (6)
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
Delayed eruption in Down’s syndrome (2)
Irregular eruption sequence
Delayed in 75% of patients
Delayed eruption in amelogenesis imperfecta (1)
Disturbed enamel formation and eruption
Delayed eruption in mucopolysaccharidoses (2)
Family of inherited metabolic diseases
Some have disturbed tooth eruption
Delayed eruption in endocrine diseases (3)
Delayed eruption
Small teeth
Abnormal teeth
Local factors causing delayed tooth eruption
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
Why does early extraction of primary molar teeth cause delayed tooth eruption (2)
- extraction between 6 and 7 years delays eruption of permanent successor
- loss of space
Supernumerary teeth in delayed tooth eruption (3)
Occur in 15% of patients with clefts
Incidence of midline supernumerary teeth is 1-3%
Most common site is maxillary midline
Ankylosis causing delayed tooth eruption (1)
20% of eruption disturbances affecting the first and second permanent molars is due to ankylosis
Unerupted teeth - symptomology (6)
Failure to erupt as expected Over-long retention of deciduous predecessor Proclination of adjacent teeth Loosening of teeth Pain Swelling
Localisation of unerupted teeth (3)
Observation Palpation Radiographs -periapical standard or parallax -occlusal -OPT
Treatment of unerupted teeth (5)
No treatment Surgically remove Surgically expose Transplantation Extract teeth to allow eruption
Complications affecting unerupted teeth (6)
Often there are no clinical effects Cyst formation Pericoronitis Resorption of adjacent teeth Eruption later under a bridge or a denture Hypercementosis Internal resorption
Non-erupted and ectopic eruption of maxillary canine teeth prevalence (2)
1.7%
Second only to lower 8 in frequency of impaction
Where is the maxillary canine tooth usually found when it ectopic (2)
in 85% of cases it is found palatal to the lateral incisor
Localisation of ectopic canine - palpation (2)
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
Radiological localisation of unerupted canines (3)
PA - standard or parallax
Anterior occlusal
Extraoral OPT
Leaving unerupted canine tooth undisturbed (5)
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 ??
Treatment of choice of ectopic canines 10-13 years (2)
“ 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
Surgical exposure and orthodontic alignment of maxillary canine teeth (4)
Palatal
-open
-closed exposure – bracket and gold chain
Buccal
-apically repositioned flap
-closed exposure – bracket and gold chain
Surgical transplantation for maxillary canine teeth - indications (4)
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
Pre-op assessment for surgical transplantation of maxillary canine teeth (3)
There must be sufficient room within the arch
There must be sufficient room vertically
There must be sufficient alveolar bone available
