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F - SCR > BDS4 Seminar 2 -Unerupted maxillary incisors and Unerupted Ectopic canines > Flashcards

BDS4 Seminar 2 -Unerupted maxillary incisors and Unerupted Ectopic canines Flashcards

1
Q

what are options for unerupted ectopic canines

A
  1. Accept the malocclusion - leave
  2. If c still present consider interceptive XLA of c
  3. surgical removal of canine
  4. surgical exposure and ortho alignment
  5. autotransplantation
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2
Q

what is tx aims?

A
  1. Facilitate eruption of 23
  2. Align upper and lower arches
  3. Correct Class skeletal II relationship
  4. Produce Class I incisor relationship, ( i.e. reduce the overbite and correct the interincisal angle )
  5. Produce class I molar relationship
  6. Consider restorative treatment for 12, 22
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3
Q

what is intra oral assessment for ectopic canines

A
  • palpate buccally palatally
  • ‘c’ - moblie and colour
  • ‘2’ - position and mobility
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4
Q

special investigatons for ectopic canines and incisors?

A
  • OPT and AOM - vertical
    or
  • 2 - PAs - horizontal
  • cbct
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5
Q

aetiology and incidence of ectopic canines?

A

 Long path of eruption
 Genetic link - Association with other dental anomalies, (class II/II malocclusion, missing
or diminutive upper lateral incisors), females
more commonly affected
 Crowding – canine often last tooth to erupt
 Ectopic position of the tooth germ

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6
Q

what are things to consider when accepting malocclusion for unerupted ectopic canines?

A
  • Extn ‘c” unlikely to make much difference?
  • is it distal to the midline of the lateral?
  • is patient 13 years
  • is there sufficient space for canine
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7
Q

what are risks of leaving canine unerupted?

A
  • Resorption of the roots of adjacent teeth
  • Resorption of the canine crown
  • Ankylosis of the unerupted canine
  • Eventual loss of primary canine and complex restorative solutions may be required in the future
  • Cystic change of canine (rare)
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8
Q

when might canine to be surgically removed?

A
  • not deemed alignable
  • can extract without damaging other teeth
  • patient happy appearance - good long term prognosis of ‘c”
  • radiograph evidence early root resorption adjacent teeth
  • Patient does not want to wear orthodontic appliances
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9
Q

when might canine not be alignable?

A
  • too high – above apical third of incisor roots
  • too close to dental midline
  • angle greater than 55 degrees to midsagittal plane
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10
Q

how would a removabe appliance affect unerupted canines?

A
  • Removable appliance alone for this patient is not going to be able to comprehensively treat the malocclusion
  • Removable appliance could be used at the start of treatment to aid overbite reduction
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11
Q

why might use growth modification for this patient?

A
  • Functional Appliance - Twin block
  • Converts class II division II incisor relationship to class I
  • Facilitates mandibular growth
  • Aids overbite reduction
  • Headgear to restrain maxillary growth –
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12
Q

what is fixed applainces and surgical exposure option? canine

A
  • Make sufficient space for the tooth. A deciduous canine if retained, may require removal.
  • Surgically expose the canine . Open or closed exposure depending on site of canine.
  • Orthodontic traction - gold chain (closed exposure) or a traction hook for an open exposure
    *Upper and Lower fixed appliances.
    *Highly anchorage demanding may -need palatal arch
  • Fixed and removable retainers
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13
Q

when would autotransplantation be indicated

A
  • Malposition of the tooth is too great for orthodontic alignment to be possible.
  • There is no evidence of ankylosis of the canine
  • The canine root development is ideally 2/3 to 3/4 length root
  • Patient is looking for a quicker treatment option
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14
Q

what are additional risks to autotransplantation

A
  • Patient may need to undergo root canal treatment of the transplanted tooth
  • Patient needs to accept risk of ankylosis or external root resorption of the
    transplanted tooth
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15
Q

what should you warn this particular patient in regards to routine ortho tx risks - canine

A
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16
Q

when to start palpating for canines?

A

10-11 years

17
Q

what are aetiology of maxillary incisors?

A

▪ Unerupted supernumerary – most common reason for a delayed upper central incisor
▪ Retained primary tooth
▪ Early loss of primary tooth
▪ Trauma to the deciduous tooth leading to dilaceration of the unerupted tooth
▪ Crowding
▪ Ectopic position of the tooth germ

18
Q

what are options of unerupted maxillary incisors?

A
  1. Accept
  2. bring central into line of arch
  3. surgical remove unerupted central
19
Q

problems with accepting unerupted maxillary incisor?

A
  • large anterior space affect aesthetics and social development
  • drifting make future tx harder
  • risk of root resoprtion adjacent teeth
  • risk of cyst formation
20
Q

how to bring incisor into line of arch?

A
  • make space for tooth - URA or fixed
  • (if 9 years and position of unerupted tooth favoured may wait once space for potential sponetanous eruption)
  • surgically expose tooth
    *closed exposure gold chain - palatal surface upper central
  • apply traction by gold chain + ortho appliance
    *traction start 2 weeks after exposure
21
Q

risks of bring incisor into line of arch?

A
  • Tooth fails to erupt and / or move
  • Ankylosis of the central incisor
  • External root resorption of the central
    incisor
  • Poor resulting gingival aesthetics
22
Q

what are indications of surgically removing unerupted incisor?

A
  • Patient not keen on extensiveness of tx
  • If the unerupted tooth fails to respond to the orthodontic traction (i.e. ankylosed)
  • Severe dilaceration so not possible to align tooth within the bone
23
Q

what are risks with surgically removing unerupted incisor?

A
  • Damage to adjacent tooth roots
  • Loss of space within the arch for a future
    prosthetic tooth if not correctly managed
  • Loss of alveolar bone in the area may
    complicate future prosthesis ( especially
    with implants)
24
Q

if surgically remove unerupted central incisor what are tx options?

A
  • ortho fixed move ‘2’ to beside ‘1’ and restore as a central
  • ortho fixed open space for
    *implant
    *RBB
    *RPD
  • do nothing allow mesial drift of ‘2’ and ‘1’
    *if patient <9 years get more space closure
    *space could be reopened later
  • autotransplantation if poor prognosis
25
Q

what are general causes/syndromes associated with delayed eruption?

A

▪ Down Syndrome
▪ Cleidocranial dysostosis
▪ Cleft lip and palate
▪ Hereditary gingival fibromatosis
▪ Turner syndrome
▪ Rickets

26
Q

what is primary failure of eruption?

A

Failure of eruption with no identifiable local or systemic cause.

27
Q
  1. what might ortho force do to teeth of primary failure eruption?
  2. what are features of it?
  3. what mutation is it associated with?
A
  1. ankylosis
    • Unilateral or bilateral
      * Lateral open bites
      * Posterior teeth most frequently
      affected
  3. parathyroid hormone 1 receptor (PTH1R)
28
Q

how to recognise unerupted exctopic incisors early?

A
  • Asymmetrical eruption pattern ( > 6 months since contra-lateral tooth erupted )
  • Disturbance of the normal sequence of eruption ( e.g both upper laterals erupted before an upper central )
29
Q

what are management principles of unerupted maxillary central incisors?

A
30
Q

what is patient communication for ortho risks of unerupted maxillary incisors?

A

F - SCR (32 decks)

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