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ortho year 4 > The unerupted maxillary canine > Flashcards

The unerupted maxillary canine Flashcards

1
Q

What is the prevalence of ectopic canines?

A
  • Low prevalence but high
    in risk for GDP
  • Prevalence 2%
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2
Q

What is the prevalence of ectopic canines bucally?

A
  1. 5 percent
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3
Q

Line of the arch?

A

34 percent

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4
Q

Palatal?

A

61 percent

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5
Q

What is the problem with ectopic canines?

A

Root resorption

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6
Q

Incidence using plane radiographs?

A

12 percent

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7
Q

Incidence of ectopic canines using CT?

A

48 percent

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8
Q

Incidence of ecoptic canines using CBCT?

A

67 percent

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9
Q

Why does root resorption occur?

A
  • Crowding/shortening of arch length
  • Adjacent lateral incisor missing or abnormal in shape or size
  • Long path of eruption
  • Palatal = genetic; buccal = inadequate arch space
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10
Q

Brin, Becker & Shavlav, 1986…

  • 2,500 patients with ectopic canines
  • 43% had absent or small lateral incisors

Study shows that?

A
  • Length of the root more critical than
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11
Q

What should you do if the canine is
not palpable buccally at 9-10 years?

A

Check – bulge, inclination and
colour of adjacent teeth.
Palpate – for the canine crown
buccally and palatally,
check for mobility of the
2 and C.
Radiographs – (parallax) Presence
Position
Pathology

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12
Q

What is parallax?

A

Physics / General Physics)
an apparent change
in the position of an object resulting from a
change in position of the observer

The principle of parallax can be used

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13
Q

The position of parallax can be used

A

to determine
the position of an unerupted tooth relative to its
neighbours.

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13
Q

When do we use it?

A

Palpate for canines when a patient is 9-10 years old

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14
Q

Index of suspicion is raised if?

A

the pt has a
missing, or abnormally shaped lateral
incisor;
has spaced arches, or
if palpation
indicates an asymmetrical eruption pattern

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15
Q

Clinical signs of a palatally impacted canine?

A
  • Delayed eruption of 3 or prolonged retention of
    the C
  • Absence of normal labial 3 bulge or presence
    of a palatal bulge in the 3 region.
  • Delayed eruption, distal tipping of migration of
    the lateral incisor.
  • Loss of vitality and increased mobility of the central or lateral incisor
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16
Q

Why do we use it?

A
  • Knowing the location of the ectopic canine
    allows us to treatment plan more
    accurately.
  • If not managed correctly an ectopic canine
    may resorb the root of the adjacent
    incisors. This may result in a medico-legal encounter
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17
Q

How do we do it?
Horizontal parallax?

A

2xIOPAs (at least 20 degrees of tube shift needed)

Anterior occlusal and IOPA

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18
Q

Vertical parallax

A

Anterior occlusal and OPT

IOPA and OPT

19
Q

How do we interpret it?

A

Tube movement for vertical from OPT to anterior occlusal the beam moves up

Tube movement for horizontal from IOPA to anterior occlusal the beam moves up

Pal with and buccal against

20
Q

Studies suggest that which paralax is most effective in locating palataly ectopic canines?
Percentages?

A

Horizontal (88 percent vs 69 percent with vertical)

21
Q

What about buccal ectopic canines and paralax?

A

Same effectiveness in being located with horizontal and vertical (63 percent)

22
Q

To conclude the Armstrong et al paper suggested what about. DPTs and horizontal paralax?

A

That DPTs shouldnt be used in the investigation of canine ectopic where radiographs that allow horizontal paralax should be taken

23
Q

Power and short study suggests- extraction of the deciduous canine in attempt to realign the palatally ectopic canine…

Success rate (in crowded dentitions)

A

62 percent

24
Q

What percentage improved indicating that crowding adversely affects the outcome?

A

19 percent

25
Q

How does crowding affect the prognosis for correction of palatally ectopic canine?

A

Crowding reduced the prognosis

26
Q

Leonardi et al 2004
Longitudinal prospective control study
Isolated extraction of C success rate?

A

50 percent success

27
Q

Untreated control group?

A

50 percent success

28
Q

Creation of more space plus extraction of C?

A

80 percent success

29
Q

Extraction of the deciduous canine should occur at what age

A

10-13

30
Q

What should you consider the need for in extraction of the deciduous canine?

A

Balancing extraction

31
Q

Better prognosis if?

A

No crowding

32
Q

Need to create space for?

A

URA or HG

33
Q

If no improvement in 12 months consider

A

Alternative treatment

34
Q

Extraction of the deciduous canine will often be a treatment of choice but

A

The decision should be left to a specialist orthodontist

35
Q

Why?

A

Why? – the ectopic canine may not be ‘alignable’ and you may have extracted a highly useful tooth

36
Q

Surgical exposure and orthodontic alignment- criteria for a patient?
(5)

A
  • Willing to wear fixed appliances
  • Well motivated and have good dental
    health
  • Unsuitable for interceptive treatment
    . Degree of malposition not too great
37
Q

What 3 things do you have to consider for the degree of malposition?

A

Apex position
Crown position
Angular ion

38
Q

Surgical exposure can be … or …

A

Open or closed exposure

39
Q

For long term perio health, 1-2 years after debond looking at attachment loss and pocket depth what is the conclusion?

A

There is no evidence that either method is superior

40
Q

Cost analysis for deciduous canine exposure (surgical)
Interceptive involves?

A

Extraction of C

41
Q

Surgical involves?

A
  • Oral surgeon
  • General anaesthetic
  • 18 months of fixed
    appliance treatment
42
Q

What are the treatment options for ectopic canines? (5)

A
  1. No treatment and observe long term for
    cystic change
  2. Interceptive treatment where
    appropriate
  3. Exposure and alignment
  4. Extraction
  5. Transalveolar transplant or surgical repositioning
43
Q

Orthodontic treatment risks?

A
  • Risk of root resorption to adjacent teeth
    (lateral incisor and first premolar)
  • Risk of pulpal obliteration to canine and
    adjacent teeth causing colour mismatch.
  • Risk of discontinued treatment due to
    prolonged treatment times.
  • Canine ankylosis.
    . High tendency to relapse
44
Q

Key points for ectopic canines
Age?

A

Palpate for canines at the appropriate age (9-10 yo)

45
Q

Horizontal vs vertical paralax

A

Horizontal paralax is more accurate than vertical

46
Q

What could be the result of missed ectopic canines

A

Root resorption

ortho year 4 (11 decks)

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