Download e-copy - Smile Dental Journal

Flow chart of the sequence of management of impacted maxillary canines
Clinical Examination at Age 10
Absence of Buccal Bulge and Presence of Palatal Bulge
Radiographic Localization
Line of Arch
Buccally Ectopic
Palatally Ectopic
Monitor Eruption
of Canine / Space
Creation
Monitor Eruption of Canine
Extract Deciduous Canines / Space Creation
Canine not Erupting in 1 year
Radiographic Localization: Beneficial Change in Position
YES
NO
Canine Buccally or Palatally Impacted
Surgical Exposure & Orthodontic Alignment
NO
Surgical Removal or Auto-Transplantation
NO
No Treatment and continuous Monitoring
2. Vertical parallax involves taking either:
• An upper occlusal (70–75°) and an
orthopantomogram (OPG) or
• A periapical and an orthopantomogram (OPG). 1,4
3. Advanced three-dimensional (3D) imaging
techniques: Cone-beam computed tomography
(CBCT) 1-4
Radiographic features
• Either non-vertical or no resorption of the deciduous
canine root. 3
• Canine crown overlapping adjacent incisor roots. 3
• Resorption of adjacent incisor roots. 2,3
• Magnification of the permanent maxillary canine
crown on a panoramic radiograph. 3
Management
Interceptive treatment by extraction of the
deciduous canine
• The patient should be aged between 10-13 years. 1,4
• Better results are achieved in the absence of
crowding. 1,4
• Position of the canine in the dental arch and in
its relationship to the adjacent lateral decides the
outcome of the interceptive treatment. 1,4
• The need to maintain space (or even create additional
space) requires consideration. 1,4
• If radiographic examination reveals no improvement
in the impacted canine’s position 12 months after
extraction of the deciduous canine, alternative
treatment should be considered. 1,4
Surgical exposure and orthodontic alignment
• The patient should be well motivated and willing to
wear fixed orthodontic appliances. 1,4
• The patient should have good medical and oral health,
and maintain proper oral hygiene. 1,4
• The patient is considered to be unsuitable for
interceptive treatment. 1,4
• The degree of malposition of the impacted canine
should not be too great to preclude orthodontic
alignment. 1,4
• Exposure and alignment of the impacted canine is
indicated in cases when severe root resorption of an
incisor tooth has occurred necessitating its extraction. 4
• The optimal time for surgical exposure and orthodontic
alignment is during adolescence. 4
• Open communication between the orthodontist and
oral surgeon is essential for the choice of appropriate
surgical techniques.
• Careful selection of surgical and orthodontic
techniques is essential for the successful alignment of
impacted maxillary canines.
• Measured orthodontic forces in a favorable direction
leads to successful alignment.
Surgical removal of the palatally impacted
permanent canine
• This treatment option should be considered if the
patient declines active treatment and/or is happy with
their dental appearance. 1,4
• Surgical removal of the impacted canine should be
considered if there is radiographic evidence of early
root resorption of the adjacent incisor. 1,4
Smile Dental Journal | Volume 6, Issue 4 - 2011| 41 |