Unerupted Canines and Central Incisors

Question 1

at what age should you be concerned if maxillary canines cant be palpated

Answer 1

11 - take radiographs to investigate

Question 2

name 5 treatment options for unerupted canines

Answer 2

• interceptive extraction of Cs
• surgical exposure and orthodontic alignment
• removal of ectopic canines
• autotransplantation
• no active treatment, monitor7n6

Question 3

discuss extraction of Cs as a treatment option for unerupted canines

Answer 3

window of opportunity when patient ages 10-13
ideally canine should not have passed midline of lateral for the best chance of successful spontaneous eruption

Question 4

discuss surgical exposure and orthodontic alignment as a treatment option for unerupted canines

Answer 4

Pt must be willing to wear fixed appliances, be well motivated and have good oral hygiene
Degree of malposition should not be too great e.g close proximity to midline, above apices of adjacent teeth, too horizontal angulation
likelihood of success decreases with age

Question 5

discuss surgical removal of unerupted canines as
a treatment option

Answer 5

if patient declines active treatment and is happy with dental appearance this may be an option
Should be considered if damage occuring to roots of incisors (and cant expose and align)
Possible risk of damaging roots and neurovascular supply of other teeth during extraction

Question 6

discuss autotransplantation as a treatment option for unerupted canines

Answer 6

rarely an option
low success rate

Question 7

discuss the option of no treatment for unerupted canines

Answer 7

should be no evidence of root resorption of other teeth or any other pathology e.g cysts
ideally good contact between 4 and 2 or good prognosis of Cs
Canine left in situ should be continuously monitored

Question 8

Name 4 reasons for unerupted maxillary incisors

Answer 8

1. supernumerary in the way
2. trauma
3. crowding of upper labial segment
4. CLP
5. cleidocranial dystosis

Question 9

what supernumerary tooth is most likely to block the path of maxillary incisor eruption

Answer 9

tuberculate

Question 10

what consequence of trauma to developing tooth may divert its path of eruption

Answer 10

dilaceration

Question 11

name 4 potential treatment options for unerupted maxillary incisors

Answer 11

• removal of obstruction and spontaneous eruption
• surgical exposure and orthodontic traction
• removal of unerupted incisor
• autotransplantation

Question 12

discuss removal of obstruction as a treatment option for unerupted incisors

Answer 12

literature suggests up to 90% will spontaneously erupt after removal of obstruction (eruption can take up to 18 months)
May require creation/ maintenance of space in conjunction via URA or fixed appliance

Question 13

discuss removal of unerupted incisors as a treatment option

Answer 13

may need to be done if significant dilaceration or ankylosis
space should be maintained for replacement - fixed/ removable prosthesis possible implant in long term

Question 14

what tooth is most commonly auto transplanted in place of a maxillary central incisor

Answer 14

lower second premolar

Question 15

name 4 things that would be of note during an exam of a patient with delayed eruption of maxillary incisors

Answer 15

• palatal or labial swellings
• crowding of upper labial segment
• space loss due to drifted lateral
• retained primary tooth significantly longer than expected

Question 16

why should UEMI be treated

Answer 16

can have negative impacts on self esteem and social interaction

Question 17

what guidelines are followed for UEMI and palatally ectopic canines

Answer 17

royal college of surgeons