Missing or Ankylosed Teeth (Tufecki) Flashcards
What are 2 things to be done before initiating therapy on a paired ortho / restorative case?
- Establish realistic objectives
2. Determine sequence of treatment
In a paired ortho / restorative case, how are the teeth to be positioned by the ortho?
Positioned to facilitate restorative treatment
When are gingival esthetics assessed during a paired ortho / rest case?
During orthodontic finishing
What else should be done during finishing of the ortho in an ortho / rest case?
Radiographs
During treatment planning, what should be ideal endpoint of treatment be compared to?
Patient’s current condition
When is ortho / restorative treatment indicated?
When the desired end point and current condition do not match
What are 3 goals of the treatment plan in an ortho / restorative case?
- Esthetics
- Function
- Stability
What are 7 factors determining treatment?
- Predictability of esthetics
- Preservation of tooth structure
- Preservation of bone and periodontal tissue
- Optimal function
- Finances
- Longevity
- Biocompatibility
When a patient requires ortho / restorative treatment, what type of treatment objectives must be established?
Realistic, not idealistic treatment
Economically, occlusally, and restoratively realistic
Who makes the restorative decisions in an ortho / rest case?
Restorative dentist
What guides the orthodontist’s positioning of teeth in an ortho / rest case?
Restorative dentist’s plan
What are 2 times when restorative dentist should be involved in the ortho treatment in an ortho / rest case?
- The beginning, to determine the treatment plan
2. The final 6 months of treatment (finishing phase)
What patient type would gingival height be a consideration?
Patient with high smile line
What is the ideal gingival height of contour relationship, with respect to the facial gingival margin of anterior teeth?
The height of central incisors is equal to height of canines with lateral incisors slightly below this line
Is an equal gingival height of contour, i.e. the facial gingival margins of all anterior maxillary teeth on the same line, acceptable esthetics?
Yes
What is the least desirable gingival height of contour esthetics for anterior maxilla?
Lateral incisors have highest gingival contour and Central incisors and canines are below this line
Why is a radiograph important during finishing stages of ortho in a pt who will be receiving an implant in their restorative phase?
Require adequate space between roots of teeth adjacent to implant site for proper implant placement
What are 4 common problems with maxillary lateral incisors?
- Congenitally missing
- Laterals with incorrect mesiodistal width
- Peg laterals
- Poor gingival height of contour
What are 2 treatment options for missing teeth?
- Orthodontic space closure
2. Replace missing tooth with FPD, resin-bonding bridge, implant, RPD
What are the results from the fusion of some portion of the cementum of the root, no matter how small, to some portion of the adjacent alveolar bone?
Ankylosis
What are 6 etiologies for ankylosis?
- Changes in local metabolism
- Trauma
- Injury
- Chemical or thermal irritation
- Local bone growth failure
- Abnormal tongue pressure
What is a common complication with the replantation of an avulsed tooth?
Ankylosis
What tooth is most often replanted after avulsion?
Maxillary incisor
When is the only time when the clinical diagnosis of ankylosis can be made?
When the affected tooth gives positive evidence of an inability to move
What are 2 instances where a tooth gives positive evidence of inability to move and can be diagnosed as ankylosed?
- Dental infraocclusion
2. Failure to move under orthodontic forces
What is dental infaocclusion?
Uneven occlusal plane due to tooth failing to move with normal vertical dental alveolar growth
What are 3 other diagnostic means leading one to believe a tooth is ankylosed?
- Metallic sound on percussion
- Lacks normal mobility
- Absence of radiographic PDL space
How long is an ankylosed tooth in the primary dentition maintained?
Until an interference with eruption or drift of other teeth begins to occur
What is done with the space left by an extracted ankylosed tooth in the primary dentition?
Some type of space maintenance (LLHA, band and loop, Nance)
What will be indicated if adjacent teeth have already tipped over the ankylosed tooth?
They will need to be repositioned to regain space
Should vertical bony discrepancies be a concern after the extraction of an ankylosed tooth and why?
No, because erupting succedaneous tooth brings bone with it during eruption
What is indicated if a primary tooth is ankylosed and radiography shows no permanent successor and why?
Extract ankylosed tooth to avoid a large vertival occlusal discrepancy
If an ankylosed tooth is extracted and there is no permanent successor, what can be done to maintain that bone in the edentulous space until some restorative treatment (e.g. a FPD) can be placed?
Move teeth partially into the edentulous space
Can space maintenance in the primary dentition be sometimes contraindicated?
Yes, in the instance of wanting to move teeth into a space left by ankylosed tooth with no successor in order to avoid a large vertical occlusal discrepancy
What are 4 characteristic clinical and radiographic appearances of ankylosed permanent teeth?
- Reduced height of occlusal table
- Tilting of neighboring teeth
- Supereruption of opposing dental units
- Lack of associated alveolar process development
What are 6 treatment options for ankylosed permanent teeth?
- No treatment
- Prosthetic buildup
- Extraction
- Decoronation
- Ortho-surgical
- Segmental osteotomy
What will occur if an ankylosed tooth is bracketed an ortho treatment?
It will not move and / or will intrude the anchor teeth
What must be done to keep and ankylosed tooth and move it orthodontically?
Luxate it and immediately apply ortho forces
What is ortho-surgical treatment of anklosed teeth?
Surgically luxating ankylosed tooth and applying extrusive orthodontic forces
How many times can ortho-surgical treatment of an ankylosed permanent tooth be done and at what interval?
2 times, wait 6 months after each
What is indicated after 2 failed laxations of ankylosed teeth?
Extraction
Is it common for an ankylosed tooth that was luxated and had immediate ortho forces applied to re-ankylose?
Yes
What can be done with an ankylosed tooth and its associated born to move the tooth to a new position?
Distraction
What is the moth commonly impacted tooth?
Mandibular 3rd molars (78%)
What is the second most commonly impacted teeth?
Maxillary canines (13%)
How many times more common is a maxillary canine impaction than a mandibular canine impaction?
Ten times
What percentage of ortho patients have impacted canines?
2%
Which direction of maxillary canine impaction is more common: palatal or labial?
Palatal (85%)
Which is more common with maxillary canine impaction: unilateral or bilateral impaction?
Unilateral
At what age should you be looking radiographically for maxillary canine impaction?
9-10 years old
What clinical finding usually indicates a favorable eruption position of a maxillary permanent canine?
A buccal bulge apical to the primary canines
What should be expected if there is an absence of canine buccal bulge?
Eruption disturbance of maxillary permanent canines
What is indicated if maxillary canine impaction is confirmed?
Extract the corresponding primary canines
Why extract primary canines if the permanent canines are impacted?
Primary canine root will not resorb and will be an obstacle to normal permanent canine eruption
What is the percentage and time of eruption of palatally displaced canines that spontaneously erupt?
78% have normal eruption position and erupt over a 6-12 month period
62% of cases have normal eruptive position
Is extraction of primary canine alone an effective procedure to increase the rate of normal eruption of palatally displaced canines?
No
If the cusp tip of an unerupted permanent canine is mesial to the long axis of the erupted lateral incisor root, will canine palatal eruption occur?
Yes
If the cusp tip of the unerupted permanent canine overlays the distal half of the erupted lateral incisor root, will palatal impaction usually occur or not occur?
Usually will occur
What percent of unerupted canines in ideal eruptive position (canine cusp tip on the distal border of the erupted lateral incisor root) still were impacted?
22%
What modifies the success rate of orthodontic treatment for palatally impacted maxillary canines?
Age
>30 yrs old, 60% success rate <20 yrs old, 100% success rate
What is increased in adult pts having orthodontic treatment of palatally impacted maxillary canines versus younger pts having the same procedure?
The treatment time is longer (30 months or more)
What arch wire is required to pull down and impacted canine?
Heavy archwire
What should an adult patient with an impacted tooth be informed or before treatment?
- Possibility of failure
- Increased treatment time
- Alternative options: implant, bridge, tooth substitution
What must be considered when planning pulling down an impacted canine?
Is there space for the tooth in the arch?
Will pulling it down damage adjacent roots?
Is there a tooth to anchor for pulling it down?
How long will it take?
What is required after diagnosis of impaction has been made what must be done and why?
- Prompt treatment
2. Avoid ankylosis or dentigerous cyst formation
When are orthodontic appliances placed when the decision is made to surgically expose the canine and provide an attachment for traction: before exposure or after exposure?
Before exposure
