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Module 6 - Oral Surgery > Maxillary Canines > Flashcards

Maxillary Canines Flashcards

1
Q

What is the second most commonly impacted tooth?

A

Maxillary canines

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2
Q

What is the prevalence of impacted maxillary canines?

A

1.7%

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3
Q

Where are maxillary canines often impacted? Why?

A
  • 80% PALATALLY ECTOPIC.
  • Tooth germ of permanent canine originates on the PALATAL aspect of the arch.
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4
Q

When should maxillary canines be palpable?

A
  • Palpable in the LABIAL SULCUS by 10-11 years.
  • Also palpate hard palate to see if you feel a bulge.
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5
Q

11 causes for canine impaction?

A
  • Lack of space.
  • Absence of lateral incisor to guide eruption.
  • Genetic theory
  • Non resorption of deciduous teeth.
  • Ankylosis of impacted canine.
  • Contraction or collapsed maxilla arch.
  • Presence of pathology/ supernumerary/ scar tissue in path of eruption.
  • Trauma causing a disturbance in tooth germ axis (ex. dilacerated).
  • Cleft lip and palate, syndromes, cleidocranial dysplasia.
  • Long path of eruption (22mm).
  • Displacement of the crypt.
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6
Q

What is the guidance theory?

A

The distal aspect of the lateral incisor is the guide for canine eruption. can also be because the lateral is. PEG LATERAL.

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7
Q

How long is the path of eruption for a canine?

A

22mm

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8
Q

6 clinical tests/ signs that there might be an impacted maxillary canine?

A
  • Palpate.
  • Evidence of rotation/ tilting of adjacent teeth.
  • Mobility/ sensibility of adjacent teeth.
  • 6 months since contralateral tooth erupted.
  • Presence of deciduous canine.
  • Family history of impacted canines.
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9
Q

Why is sensibility/ mobility testing indicated when investigating a potentially impacted maxillary canine?

A

Could be due to EXTERNAL ROOT RESORPTION typically of the 2 but could be of the 1.

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10
Q

3 ways to raidographically investigate an impacted canine?

A
  • Vertical parallax (maxillary occlusal + DPT).
  • Horizontal parallax (2 PAs).
  • CBCT
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11
Q

What is the slob rule?

A

Same lingual opposite buccal.

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12
Q

3 uses of DPT for investigating impacted maxillary canines?

A
  • Root morphology
  • Assess for pathology.
  • Assess for positioning using vertical parallax.
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13
Q

What does an enlarged follicular space suggest? What is a normal size of follicular space.

A
  • Follicle could be undergoing CYST FORMATION.
  • Normal/ expected space is around 3-4mm.
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14
Q

What is the treatment for dilacerated teeth?

A
  • CANNOT be ORTHODONTICALLY ALIGNED/ TRANSPLANTED.
  • Either XLA or leave alone if pathology-free.
  • If XLA then orthodontic closure of space OR orthodontic opening of space and an implant.
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15
Q

3 sequelae of canine impaction?

A
  • Resorption of incisor roots (up to 12.5%).
  • Cystic change (incidence low).
  • Infection of cyst when close to mucosa, possible sinus formation.
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16
Q

How can impacted canines cause incisor resorption? How prevalent is this?

A
  • Canine must be SUPERFICIAL (almost at line of the arch) and NOT IN A VERY HIGH POSITION aka must be INTIMATELY RELATED WITH THE ROOTS OF THE INCISORS.
  • up to 12.5%.
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17
Q

What indicates cystic change? What is the cyst called?

A
  • Expansion of the follicular space.
  • DENTIGEROUS CYST.
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18
Q

3 sequelae of cyst formation?

A
  • Resorption of adjacent teeth.
  • Resorption of bone.
  • Can penetrate through mucosa and become infected.
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19
Q

5 treatment options for impacted canines?

A
  • Conservative
  • Interceptive
  • Exposure
  • Surgical removal
  • Transplantation
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20
Q

4 clinical indications for a conservative approach?

A
  • Patient does not want ortho.
  • Patient happy with aesthetics + good contact between 2 and 4.
  • Adjacent teeth vital.
  • Healthy C.
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21
Q

2 downsides to retaining a C? Till around what age can it remain healthy?

A
  • Prone to attrition.
  • Short roots means composite buildup would cause poor crown-root ratio + not very aesthetic result.
  • around 40 years.
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22
Q

3 radiographic indications for a conservative approach?

A
  • Tooth very high.
  • No associated pathology.
  • No resorption.

usual after 14 years of age.

23
Q

3 clinical indications for an interceptive approach?

A
  • Patient 10-13 years.
  • Minimal crowding.
  • Space maintenance.
24
Q

When would you expect the permanent canine to erupt with the interceptive approach? How often does this occur?

A
  • Expect permanent canine to erupt WITHIN 6 MONTHS.
  • If no change in position after 12 MONTHS alternative treatment.
  • Erupts normally in 78% of cases.
25
Q

2 clinical indications for exposure and alignment?

A
  • Well motivated patient (orthodontics + OH).
  • Best done early.
26
Q

2 radiographic indications for exposure and alignment?

A
  • Not grossly displaced.
  • Favorable root morphology (STRAIGHT, CONICAL ROOT).
27
Q

What are the 2 techniques for exposure and alignment of a maxillary canine?

A
  • open technique: apically repositioned flap or palatal window.
  • closed technique: orthodontic bracket and gold chain allowing orthodontic traction.
28
Q

Indications for an apically repositioned flap (3)?

A
  • Tooth BUCCALLY placed or in LINE OF THE ARCH + VERY SUPERFICIAL.
29
Q

Risks of an apically repositioned flap?

A
  • Suture gingivae much higher to leave eruption path unimpeded.
  • Risk of EXPOSED CANINE ROOTS (abrasion, sensitivity, poor aesthetics).
30
Q

Process of carrying out a palatal window (5)?

A
  • Lift mucoperiosteum + remove bone and follicle to reveal crown.
  • Cut a WINDOW into the soft tissue.
  • Suture flap back.
  • Make an ACRYLIC/DRESSING PLATE held on my ADAMS CLIPS, packed with COPACK SOFT TISSUE DRESSING.
  • Leave undisturbed for a WEEK. Clean with MOUTHWASH + brush teeth away from the surgical site.
31
Q

What can be used to hold back a palatal mucoperiosteal flap?

A

Howarth periosteal elevator.

32
Q

Post op palatal window advise?

A
  • Keep dressing plate with copack soft tissue dressing undisturbed for a WEEK.
  • Clean using MOUTHWASH + BRUSH teeth away from the site.
33
Q

What is the best exposure and alignment technique? Why?

A

CLOSED TECHNIQUE.
- MIMICS THE PHYSIOLOGICAL ERUPTION OF THE CANINE, ERUPTS THROUGH ATTACHED GINGIVAE THUS HAS GOOD GINGIVAL CONTOUR.

34
Q

What kind of flap is done for closed technique exposure and allignment?

A
  • APICALLY REPOSITIONED FLAP.
  • Bond orthodontic bracket with chain onto the crown prior to attaching to an orthodontic device.
35
Q

Incisor root resorption prognosis?

A

IF MORE THAN 1/3RD OF THE INCISOR ROOT HAS BEEN RESORBED, THEY HAVE VERY POOR PROGNOSIS.

36
Q

6 indications for surgical removal of impacted canines?

A
  • Non compliant patient.
  • Patient happy with C.
  • Patient happy with 2 and 4.
  • Advanced resorption of incisors.
  • Canine malpositioned + poor root morphology.
  • Canine malpositioned + pathology.
37
Q

When would you need to section a canine during surgical removal (2)?

A
  • Horizontally impacted against incisors (take crown off to create space to elevate the roots).
  • Dilacerated tooth where path of withdrawal different from path of withdrawal of root.

May need BUCCAL approach for sectioning.

38
Q

What flap design is used for surgical removal of impacted canines?

A

LARGE ENVELOPE FLAP.

39
Q

Unilateral impacted canine?

A

Flap from CONTRALATERAL INCISOR to at least FIRST PREMOLAR.

40
Q

Bilateral impacted canine?

A

Flap from premolar to premolar.

41
Q

Anatomical structure involved in the flap design for surgical removal of maxillary canines?

A

NEUROVASCULAR BUNDLE through INCISIVE FORAMEN

  • Unilaterally: ok, enough stretch in the flap to put tension and allow access.
  • Bilaterally: may have to SEVER the neurovasculae bundle.
42
Q

What must do you place on the neurovascular bundle? Why?

A

SPENCER WELLS ARTERY FORCEPS to prevent bleeding before releasing it.

43
Q

Effect of severing neurovascular bundle?

A
  • Not an issue as PATIENTS DO NOT COMPLAIN OF NUMBNESS OF THE ANTERIOR HARD PALATE
  • INNERVATION IS TAKEN UP BY GREATER PALATINE NERVES OVER TIME.
44
Q

Where is the flap for a surgical removal of maxillary canines placed?

A

Commonly PALATAL, same flap as for exposure.

45
Q

5 steps to surgical XLA of maxillary canines?

A
  1. Raise flap.
  2. Take off overlying bone to expose the MAXIMUM CONVEXITY of the tooth.
  3. Defolliculize the tooth.
  4. Create a point of application.
  5. Use an ELEVATOR to elevate the tooth out of the socket.
46
Q

Where is follicular tissue attached? Why must this be removed?

A
  • Attached at the AMELO CEMENTAL JUNCTION.
  • Must be removed ENTIRELY or can undergo CYSTIC CHANGE.
47
Q

5 clinical indications for canine transplantation?

A
  • Poor patient compliance.
  • Limited treatment time desired.
  • Poorly positioned canine (too far to be surgically exposed but can still be surgically accessed) WITHOUT ANKYLOSIS.
  • Open apex desirable.
  • Need adequate space and bone.
48
Q

What other tooth can be transplanted?

A

Mandibular 3rd molar transplanted into 1st molar position.

49
Q

What is the failure rate for transplanted maxillary canines? 4 ways it fails?

A
  • 30% over 9 years often due to poor surgical technique.

Causes:
- Internal root resorption (perform RCT).
- External root resorption (excessive force on tooth in socket).
- Replacement root resorption (root replaced by bone until it exfoliates).
- Infection

50
Q

Why is an open apex desired for the transplantation procedure?

A

Some chances of re-establishment of blood supply to tooth.

51
Q

5 steps to transplantation procedure?

A
  1. Access as for removal.
  2. Atraumatic elevation avoiding contact with PDL/ root.
  3. Tooth “parked” in tissues to ensure it does not dehydrate.
  4. Prepare socket with burs or chisels - Socket “friction fit” avoiding heat generation.
  5. Immoblize with a SPLINT + ensure it is FREE OF OCCLUSAL LOADING.
52
Q

How quickly do we want the transplantation procedure to be completed?

A

Ideally in LESS THAN 10 MINUTES.

53
Q

What must be done post-op after transplantation (4)?

A
  • Immediately splint tooth.
  • Ensure it is free of occlusal loading.
  • Check vitality.
  • Check for resorption.

Module 6 - Oral Surgery (11 decks)

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