Maxillary Incisors and Premolars Flashcards
3 incidences where delayed eruption of maxillary incisors requires investigation/ monitoring?
- Contralateral tooth erupted for 6 months.
- Both upper centrals missing 1 year after lower centrals erupted.
- Deviation from normal sequence of eruption (ex. laterals before centrals).
What is the most common cause of delayed maxillary incisor eruption?
TRAUMA.
7 hereditary causes of delayed incisor eruption?
- Supernumeraries.
- Cleft lip and palate.
- Cleidocranial disostosis.
- Odontomes.
- Abnormal tooth/tissue ratio.
- Gingival fibromatosis
- Generalized retarded eruption.
6 environmental causes of delayed incisor eruption?
- Trauma (root dilaceration).
- Early loss or extraction of deciduous tooth.
- Retained deciduous tooth.
- Cyst formation.
- Endocrine abnormalities.
- Bone disease.
4 things to look for during examination pf delayed incisor eruption?
- Retained deciduous teeth.
- Palpable mass palatally/buccally.
- Lack of space.
- Erupted mesiodens/supernumeraries
What is the radiographic assessment for the delayed eruption of maxillary incisors?
HORIZONTAL PARALLAX - 2PAs.
5 potential management methods for incisor impaction
- Conservative.
- Interceptive.
- Exposure.
- Removal.
- Transplantation
What is the interceptive technique? Success rate?
- Take out the deciduous tooth and expect the permanent successor to erupt spontaneously.
- When create and maintain space, 75% ERUPT SPONTANEOUSLY, 55% ALIGN SPONTANEOUSLY.
Success rate of interceptive technique?
When creating and maintaining space:
- 75% ERUPT SPONTANEOUSLY
- 55% ALIGN SPONTANEOUSLY.
What is the exposure technique? Success rate?
- Remove other obstruction (ex. supernumeraries) and expose tooth surgically.
- May require BRACKETS to align.
- 50-75% ERUPT in 16 MONTHS
Success rate of exposure technique?
- 50-75% ERUPT in 16 MONTHS
What type of incisors have no hope other than to be removed?
Severely dilacerated.
2 effects of supernumeraries on tooth positioning?
- Can impede eruption.
- Can impact alignment.
What kind of flap is cut for the surgical exposure of maxillary incisors?
Apically repositioned 3 sided flap.
What is the open technique for the surgical exposure of maxillary incisors (3)?
- APICALLY REPOSITIONED 3-SIDED FLAP.
1. Flap raised taking as much attached gingivae as possible.
2. Removal of bone/ fibrous tissue to expose the MAXIMUM CONVEXITY of the tooth.
3. Repositioned apically and packed, leaving thr CROWN EXPOSED.
What is the open technique for the surgical exposure of maxillary incisors (3)?
- APICALLY REPOSITIONED 3-SIDED FLAP.
1. Flap raised taking as much attached gingivae as possible.
2. Removal of bone/ fibrous tissue to expose the MAXIMUM CONVEXITY of the tooth.
3. Tooth is dried, etched and an ORTHODONTIC BRACKET with a GOLD CHAIN is bonded to its surface.
4. Repositioned back to original place, CROWN CANNOT BE SEEN..
What is an open technique suitable?
When the tooth is a SMALL DISTANCE FROM WHERE IT SHOULD ERUPT.
When is an open technique contraindicated? Why?
- NOT indicated for teeth that are HIGHLY IMPACTED.
- Can lead to POOR GINGIVAL AESTHETICS, ROOT SENSITIVITY AND TSL.
When is a closed technique indicated? What is an advantage of this technique?
- When the incisor is IMPACTED AT A HIGH POSITION
- BETTER GINGIVAL AESTHETICS.
When is incisor removal indicated?
Severely dilacerated incisor that cannot be aligned.
5 causes for mandibular premolar impaction?
- Crowding.
- Pathology.
- Ankylosed deciduous tooth.
- Supernumeraries
- Genetic disorders.
Where are premolars typically impacted?
LINGUAL/ PALATAL DISPLACEMENT!! Buccal displacement rare.
What is the incidence of impacted mandibular premolars? Mandible + maxilla?
- 0.2-0.3%.
- 0.5% overall.
What flap design is used to expose the mandibular premolars?
2 sided MP flap.
- Mesial relieving incision: ensure far away from mental foramen.
- Pericoronal incision.
Do you use open or closed technique when surgically exposing the mandibular premolar?
Can use EITHER depending on the position of the premolar.
What are supplemental supernumeraries? Where are they common?
- Healthy teeth that look exactly like the teeth they are replacing.
- Common in the MAXILLA in the PREMOLAR/THIRD MOLAR region.
What are conical supernumeraries? Where are they common?
- Peg shaped teeth.
- Commonly erupt in the MAXILLARY CENTRAL INCISOR POSITION.
- When a conical supernumerary erupts between the centrals it is termed MESIODENS.
How are mesiodens removed?
With LA and an elevator as roots are very small.
What is a mesiodens?
A conical supernumerary tooth that has erupted between the centrals.
What are tuberculate supernumeraries? Where are they common?
- Do not resemble a tooth/ MALFORMED TEETH.
- Often FAIL TO ERUPT
A condition that is associated with supernumerary teeth?
Cleidocranial disostosis
3 complications of odontomes?
- Can impede eruption of teeth (need to be surgically removed)
- Can erupt into the mouth (hygiene problematic - can become carious and have to be removed).
- Can develop pathology.
What are the two types of odontomes?
- Compound: proliferation of the dental lamina, thus consist of a number of denticles. CAN SEE INDIVIDUAL TEETH.
- Complex: do not resemble tooth (disordered aggregation of enamel, dentine, cementum and pulp).
Where are odontomes common?
- Complex: POSTERIORLY.
- Compound: ANTERIORLY.
What are odontomes? What else are they called?
- Genetic malformations called HEMARTOMA.
- Account for 22% of odontogenic tumors but are entirely BENIGN.
