Management of Ectopic Teeth Flashcards
What are the potential effects of ectopic teeth
can cause function, aesthetic issues as well as resorption of adjacent teeth roots
Which parallax technique is more reliable when trying to locate impacted canines?
- Horizontal technique is more reliable
(USO and LCPA or two LCPAs) - Vertical (USO and DPT or two LCPAs)
Treatment options for ectopic teeth (not M3M)
- Factors depend on pt age, location of tooth (depth of impaction and angulation) and minimal to no crowding
1. Interceptive treatment (xla of primary canine aged 10-13 years with minimal crowding)
2. Surgical exposure of canine and orthodontic alignment (± bracket and gold chain for traction)
3. Surgical removal of canine and orthodontic alignment (deciduous canine crown and root are sound, first premolar contacts the lateral incisor)
4. Surgical removal of canine with no further tx (if pt happy with appearance and function)
5. Transplantation of the canine (canine is surgically accessed and there is sufficient space in the arch)
6. No tx/monitor
What are the clinical features and effects of conical supernumerary teeth?
- Occur in midline of palate (Mesiodens)
- Normally remain unerupted
- Delay in the eruption/displacement of permanent incisors
What are the clinical features of tuberculate supernumeraries
- Usually palatal to the central incisors
- Prevents eruption of permanent tooth
When do supernumerary teeth need extraction?
- Impeding eruption of permanent dentition
- Displacement of permanent tooth/crowding
- Causing resorption of adjacent teeth roots (rare)
- Prevent orthodontic alignment
- involved in pathology (cyst/tumour/fracture)
Guidelines for M3M removal
prophylactic, therapeutic interventions, interventional extractions and surveillance
- Prophylactic
- Medical indication for pts undergoing treatments that may complicated likely surgery including Bisphosphonates, antiangiogenics or chemotherapy or radiotherapy
- Necessary surgery in the M3M site including mandibular fractures, orthognathic surgery and excision of disease including neoplasia and cystic lesions - Therapeutic interventions
- pericoronitis of M3M (when eruption is unlikely)
- caries of M2M or M2M to assist rotation
- periodontal disease compromising prognosis of M2M or M3M
- resorption of M3M or M2M
- Dental trauma resulting in poor prognosis of M3M - Interventional extractions for non-functional M3Ms communicating with the oral cavity
- pericoronitis: remove vertical teeth before 25y
- Bone defects: removal horizontal teeth before 25-39y
- Nerve injury: remove all close to canal before root completed before 19-21y
- Caries: remove partially erupted - Surveillance is recommended for those pts with unerupted or functional M3M that are asymptomatic and disease free
Risk Assessment of M3Ms before xla
a. tooth
- Tooth position, angulation/rotation, depth of impaction
- Condition: caries, restored?, periodontal status
- Crown width to root ratio
- Root morphology: dilaceration, divergence, size, shape, number
- Adjacent structures: ID canal, antrum
- Presence of infection, associated disease and other local bone diseases
- Ankylosis of tooth
b. Status of adjacent teeth: periodontal disease, restoration present, fractured crown, function as bridge abutment
c. Limited access to oral cavity: trismus, muscular disorder, constrictive oral orifice
d. Bone density: ethnicity
e. Bulk of supporting bone in maxilla and mandible
Which drugs cause pts to be at risk of haemorrhage
- Anti-thrombotics:
a. Check INR on day of surgery
b. If 4 and below: routine xla OK
c. If more than 4, no xla. Need coagulant clinic - Anti-platelet drugs
a. Commonly used to prevent morbidity from AV disease IHD, PVD and CVA
b. Includes aspirin, diprymidole, clopidogril
c. SSRI impair platelet aggregation - Sodium valproate
a. Anticonvulsant used for bipolar disorders
b. High incidence of thrombocytopenia
What is the surgical management of Mesio-angular M3Ms
Buccal approach ± flap
- Bone removal if necessary for exposure of crown and application point
- Split tooth vertically if not close to canal
- Decorate if close to IAN canal, elevate roots ± separation
What is the surgical management of disto-angular M3Ms
Buccal approach ± flap
- Bone removal if necessary for exposure of crown and application point for roots
- Decorate if close to IAN canal
- Oblique section preferable
- Elevate roots ± separation
- Work out severity of distoangulation by looking at the proximity of 8 roots to 7
What is the surgical management of horizontal deeply impacted M3Ms
Buccal approach ± flap
- Buccal bone removal if necessary for exposure of crown and application point for roots
- Decoronate
- Elevate roots ± separation
What is the technique for coronectomy
- Section at CEJ because bone does not heal over enamel. Removal of enamel therefore guarantees healing and no open wound
- Smooth the root surface down to at least 3mm below the level of alveolar crest. This gives space for bone to heal over the roots (bony infill in and around roots)
What are the requirements and contra-indications for coronectomy
Requirements
- Vital tooth, no pathology, close to vital structures, no displacement
Conta-indications
- Non-vital tooth
- Immunocompromised
- Caries: if close to nerves more likely to spread to the roots and get bacteraemia
- Pathology: cysts
What are the risks of coronectomy
- Intra-operative mobilisation of M3M roots (will then require removal, otherwise pain swelling and infection)
- Early post-op infection
- Late post-op infection (with eruption)
- Second surgery involving xla of roots (bony infill/good healing means less likely because roots will be stopped by bone barrier
- Complications: dry socket, intermittent IAN neuropathy, late eruption
