Management of palatally ectopic canines Flashcards
(41 cards)
The maxillary canine is second in its frequency of impaction with a prevalence of 1.5%. What tooth is the first?
mandibular 3rd molar
What position do ectopic canines occur most frequently in?
Palatally (85%)
they occur with twice the frequency that they occur buccally (15%)
The cause of ectopic canines are likely to be ______ and ______ despite remaining unclear
polygenic and multifactorial
What kinds of lateral incisors are palatally ectopic maxillary canines usually associated with?
- absent
- malformed
- diminutive (extremely small)
Assuming a normal eruption pattern, when should the majority of canines be palpable in the buccal sulcus?
by 10- 11 years
What is the approximate age of eruption of maxillary canines in girls?
12.3 years old
What is the approximate age of eruption for the maxillary canines in boys?
13.1 years old
What is the main risk of ectopic maxillary canines ?
resorption of the maxillary permanent incisors
CBT has detected root resorption in % of permanent lateral incisors adjacent to ectopic maxillary canines.
66.7%
When has it been postulated that root resorption due to ectopic canines most frequently occurs?
between 11 and 12 years old
(rarely starts after the age of 14)
State other possible consequences of palatally ectopic canines
- root resorption of the coronal aspect of the root
- cystic changes
When should practitioners suspect ectopia of the canine?
- if it is not palpable in the buccal sulcus by the ages of 10-11 years
- if palpation indicates assymmetrical eruption pattern
- if adjacent teeth implies malposition of the permanent canine
What radiographic technique has been deemed reliable for localising unerupted canines?
horizontal parallax
(deemed more reliable than vertical parallax in this instance)
However, more recently, computed tomography technology has become available for imaging maxillofacial region and can be used for localisation of impacted teeth
What is a horizontal parallax technique?
it involves taking 2 radiographs at two different horizontal angles but with the same vertical angulation
State two ways in which you can achieve a horizontal parallax technique
- anterior occlusal and periapical
- two periapicals
What is the vertical parallax technique?
increasing the vertical angulation of the X-ray tube from 60-65% to 70-75%
State two ways you can achieve the vertical parallax technique
- anterior occlusal (70-75 degrees) and optical projection tomography (OPT)
- periapical and OPT
What is the current disadvantage to the use of computed tomography technology over the use of conventional radiograph?
it has a higher overall effective dose
What interceptive treatment option may result in improvement of the position of an ectopic canine?
extraction of deciduous canine may result in improvement of position in selected cases
What considerations should be made prior to extraction of deciduous canines to improve the position of an ectopic canine?
- patient should be aged between 10 and 13 - better results are reported in the absence of crowding
- the need to maintain space or create additional space required consideration
- if radiographic examination reveals no improvement of the ectopic canines position 12 months following extraction of deciduous canine, alternative treatments should be considered
When interceptive extraction of deciduous canine is contraindicated, what alternative treatment options are available?
- surgical exposure and orthodontic alignment
- surgical removal of palatally ectopic canine
- transplantation
- no active treatment/leave and observe
What considerations must be made for surgical exposure and orthodontic alignment of a palatally ectopic canine ?
- patient should be willing to wear fixed orthodontic appliance
- patient should be motivated and have good OH
- degree of malposition should not be so great that orthodontic alignment is impractical
Give examples of instances where the degree of malposition of palatally ectopic canines deters candidacy for orthodontic alignment
- close proximity to midline
- above apices of adjacent teet
- horizontal angulation
When should surgical removal of palatally ectopic permanent canines be considered as a treatment option?
- if patient declines active treatment
- if patient is happy with their dental experience
- if there is radiographic evidence of early root resorption of adjacent incisor teeth
- if canine is severely malpositioned
- when alignmend and transplantation are not being considered
- in cases where there are pathological changes
- in cases where retention would impede otthodontic appliance use
