ectopic maxillary canine Flashcards
What does the normal maxillary canine look like?
Starts developing 4-5 months
Longest path of eruption
Palpable at 9-10 yrs
Erupts 11-12 yrs
Width 7-9mm
What is the prevalence of displaced maxillary canines?
1-3%
85% palatal, 15% buccal
8% bilateral
Associated w missing/peg laterals
What is the aetiology of ectopic canines?
Familial/genetic
Long path of eruption
Guidance theory- guided by roots of laterals? So if missing/peg- no clear route
Crowding- chronology of eruption, canine comes later
Lack of resorption of C
Follicular disturbance
What are traits/links with ectopic canines?
More female
Hypodontia
Peg shaped laterals
Transposition
Ectopic position of other teeth
Impacted 6
Intra occlusion deciduous teeth
Delayed eruption of permanent
What is infra occlusion?
Teeth are found w their occlusal surface below adjacent teeth long after they should have reached occlusion
How do you locate a canine clinically?
Palpate around sulcus
Mobility of C
Space for tooth
Angulation of lateral
How do you locate a canine radiographically?
Parallax
-OPT (8 degrees)
-upper standard occlusal (65 degrees)
SLOB (same lingual, opposite buccal)
CBCT- exact location, 3D, higher dose
What are complications of ectopic canines?
Root resorption
Ankylosis
Cysts (rare)
Eruption under bridge/denture
How do you manage an ectopic canine?
Leave alone
Intervention/interceptive
Extract
Ortho alignment
Transplant
What is intervention/interceptive tx for ectopic canines?
Extract C before 11 years old
91% improvement if crown distal to lateral midline
64% if mesial to lateral midline
Not strong conclusions
How can you assess the prognosis of the ectopic canine?
1. Overlap of incisor
2. Vertical height (how far up compared to roots)
3. Angulation
4. Position of apex (above which tooth)
How can you aline the canine?
Open exposure- surgery to expose, pack with special gauze to prevent gum healing over and then attach and traction (apically repositioned flap)
Closed exposure- surgery to access tooth, bond gold chain, gum stitched back
Create space- encourage natural eruption
No difference between open/closed
How do you manage a palatal impaction?
1. Leave in situ, monitor
2. Extract
3. Expose and align
4. Transplant
What are indications for transplantation?
If canine is ankylosed
Pt not suitable for ortho
Poor prognosis of C
Adequate space
No over eruption of opposing tooth
Too misaligned for ortho
What are problems w transplantation?
Nerve doesn’t like tooth to be dragged
So will cause radiolucencies
Tooth needs to be root treated
Can still cause generalised resorption
