DOI: 10.14260/jemds/2014/3902

REVIEW ARTICLE

CANINE IMPACTIONS: AN ORTHODONTIST’S PERSPECTIVE

V. Harikrishna1, Arindom Banerjee2, I. Anil Kumar3, V. Akhila4

HOWTOCITETHISARTICLE:

V. Harikrishna, Arindom Banerjee, I. Anil Kumar, V. Akhila.“Canine Impactions: An Orthodontist’s Perspective”.JournalofEvolutionofMedicalandDentalSciences2014;Vol.3,Issue65,November27;Page:14210-14213,

DOI:10.14260/jemds/2014/3902

ABSTRACT:Impactedteetharethosewhicharenotpredictableanddonoteruptabsolutelybasedonclinicalandradiographicassessment.Certainimpactionscanbecomplicatedandtheoutcomeunpredictableifthetoothispositionedunfavourablyeitherhorizontallyorverticallyinthealveolarbone.Presenceofcaninesbuccally,palatallyorlinguallycanbeseenusingvariousdiagnosticmethods.Factorsthatinterferewithitsdevelopmentanderuptionhaveinfluenceonaesthetics’,functionandstability.Adetailedunderstandingofthemanagementofimpactedteethisessentialforastableandaestheticresult.So,weputforththemostcommonprocedureswhichcanbecarriedoutbygeneraldentistsinmanagingimpactedmaxillarycanines.

KEYWORDS: (Impactedteeth),(maxillarycanines).

INTRODUCTION:Inadditiontostraighteningteeth,Orthodontistsarealsoartistsincreatingasmile.Althoughitismoreofascience,Orthodonticsisstillverysubjective.Inorthodontics,certaintimetestedrequirementsforlongtermstabilityshouldbeaddressedduringtreatmentplanning.Thegoalistoplacetheteethinaparticularpositionthatwillgivethemostfunctionalestheticandstableresultspossible.

Impactedteetharethosewithdelayederuptiontimeorthatarenotpredictedtoeruptabsolutelybasedonclinicalorradiographicassessment.Permanentmaxillarycaninearethesecondmostfrequentlyimpactedteeth(mandibularthirdmolarsbeingfirst).Theincidenceoftheirimpactionis1-2%ingeneralpopulation.Thisisthemostprobablyduetoaprolongeddevelopmentperiod(i.e5months-12years)andthelong,convolutedpathoferuptionbeforethecanineappearsintofullocclusion.1 Aboutonethirdofimpactedmaxillarycaninesarepositionedlabiallywithinthealveolusandtwothirdlocatedpalatally.2Familyhistoryvisualandtactileclinicalexaminationbytheageof9-10yearsandthoroughradiographicassessmentarethemethodsofdiagnosisthatmayallowforearlydetectionandpreventionofimpactedcanines.

Theoutcomeofcertaincanineimpactionscanbeunpredictableandchallengingifnotdiagnosedproperly.Eruptionprocesscanbesimplifiedwithproperdiagnosis.

DIAGNOSIS:Diagnosisplaysanimportantroleforeveryclinicianindecidingwhethertheimpactionisfavorableornot.Thisisdonebasedonproperclinicalandradiographicassessmentofthesubject.Clinicalassessmentiscarriedoutbyinspectionandpalpationofalveolarprocess.Presenceofproclinedlateralincisorsandpegshapedlateralincisorshelpsassessthepresenceofimpactedteeth.

RADIOGRAPHIC METHODS INCLUDE:

1)IntraoralPeri-apicalRadiographs. (Fig:1)

2)Verticalruleofthirds. (Fig:2)

3)Horizontalruleofthirds. (Fig:3)

Inorthopantamogram(OPG)medio-lateralassessmentofthecaninecanbedonebyusinghorizontalruleofthirdsorverticalruleofthirds.(Fig:23)

MANAGEMENT:

Therearefive(5)treatmentoptionsforthemanagementofimpactedteeth:

a)Observation.

b)Interceptive.

c)Intervention.

d)Relocation.

e)Extraction.

a)Observation:Itimpliesnotreatmentforaspecificperiod.Itgenerallyinitiateswiththecompletionofdeciduousdentitioneruptionandendswiththeeruptionorremovalofanimpactedtooth.Forthistobeaviabletreatmentoption,aclinicianshoulduseclinicalandradiographicevaluationwhichinmostcasespredictstoothimpactions.3

b)Interceptive:itisaprocedurewhichiscarriedoutinordertopreventimpactionofteeth.Thisisdonebytheearlyremovalofprimarycanines.Thisprocedureiscarriedoutwhen:

  • Clinicalbulgeisnotpalpableat9years.
  • Whenthereisamedialtiltoflingaxisofcanineradiographically.
  • Lingualpositionofcanineinrelationtoincisors.
  • Whenthereishorizontaloverlapofcanineradiographically.

c)Intervention:Itisaprocedurewhichiscarriedoutwhenthereisobstructiontotheeruptionofcanine.Itcanbeduetopresenceofsupernumeraryteeth,tissueobstructionandankylosisoroverretaineddeciduousteeth.Morethan90%ofthesupernumeraryteethcanleadtothenormaleruptionofthepermanentcanines.3,4

TISSUE OBSTRUCTION:itcausesdelayinpermanenttootheruptionandunexceptionalfindingsofclinicalandradiographicassessment,subsequentlycliniciansshouldconsiderasofttissueoranosseousinterference.3

OVER RETAINED DECIDUOUS TEETH:Maxillarydeciduousteetharemorecommonlyankylosedthanmandibulardeciduousteeth.ThisleadstodelayedornonResorptionofdeciduousrootswhichresultinimpaction.5

d)RELOCATION:itreferstotherepositioningofanimpactedtoothfirstsurgicallyandthenorthodontically.6 Surgicalexposureandorthodonticeruptionofanimpactedtoothisidealwhenitsapexiscompletelyformed.Duringsurgicalexposurethecrownshouldbeuncovereduptothecement-enameljunction(CEJ).7Spacemustbeorthodonticallycreatedbeforetheexposureandorthodonticeruptionofimpactedteeth.Iftoothmovementisnotdetectedwithreasonabledigitalforceandorthodonticforcesareunsuccessful,thenthetoothisankylosed.Whentoothmovementisapparentwithreasonabledigitalforce,butthereisnoresponsetoorthodonticforces,thenprimaryfailureoferuptionmustberuledout.Theorthodonticappliances[Includingcements,bands,bracketsandotherauxiliaryattachments]andpooraccesstothecrownoftheimpactedtoothcompromiselocalhygienepractice.

Duetothepossibilityofcontaminationoforalfluids,bondinganattachmenttotheimpactedtoothiscomplicated.Newerbondingmaterialswithanaffinityformoisturecanenhancetheplacementofattachmentsonimpactedteeth.Thesematerialshavesimplifiedproceduresforbondingandboneremoval.8

e)EXTRACTION:impactedteethwhichcannotberepositionedgoinforextraction.Unfavorablypositionedimpactedcaninescannotberepositionedandhencegoinforextraction.

CONCLUSION:Inconclusion,caninesplayavitalroleinestheticsandfunction.Hence,treatmentofimpactedcaninesisessential.Surgicalexposureandorthodonticcorrectionisthemostpreferabletreatmentmode.Orthodontictreatment,ofimpactedcaninescanbeveryrewardingifdoneonthebasisofasoundproblemlistandtreatmentgoals.

REFERENCES:

  1. Richardson.G,Russell.K.A.Reviewofimpactedpermanentmaxillarycuspids_Diagnosisandprevention.JCanDentAssoc.2000;66(9):497-501.
  2. Kokich.V.GSurgicalandOrthdonticmanagementofimpactedmaxillarycanines.AmJOrtho-DentofacialOrthop.2004;126(3);278-283.
  3. FrankC.ATreatmentoptionsforimpactedteeth.JAmDentAssoc.2000;131(5);623-632.
  4. Nazit M.M, Ruffalo R.C, Zullo. T. Impacted supernumerary teeth: A survey of 50 cases. JADA. 1983; 106: 201-204.
  5. BjerklinK.,Kurol.J.Ectopiceruptionormaxillaryfirstpermanentmolar:Etiologicfactors.AmuOrthod.1983;84;147-155.
  6. Schatz JP, Joho JP. Indications of auto-transplantation of teeth in orthodontic problem cases. Am J Ortho DentofacialOrtho. 1994; 106: 351-357.
  7. KokichV.G,MathewsD.P.Surgicalandorthodonticmanagementofimpactedteeth.DentclinNorthAm.1993;37:181-204.
  8. BisharaSE.ImpactedMaxillaryCanines:areview.AmJ.OrthoDentofacialOrthop.1994;86:483-192.

J of Evolution of Med and Dent Sci/ eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 3/ Issue 65/Nov 27, 2014 Page 1