Canines guide the teeth into proper bite, and have therefore specific functions in chewing and in excursive
movements of the mandible...canines present proprioceptive and reflexive fibers which protect and stabilize
occlusion. Due to their position they; they provide an aesthetic and harmonious transition between the
anterior and posterior segments of the dental arch. Canines have the longest roots and are the most
resistant teeth and thus are often displaced or impacted.(1)
movements of the mandible...canines present proprioceptive and reflexive fibers which protect and stabilize
occlusion. Due to their position they; they provide an aesthetic and harmonious transition between the
anterior and posterior segments of the dental arch. Canines have the longest roots and are the most
resistant teeth and thus are often displaced or impacted.(1)
Dealing with an impacted is not just about saving that individual tooth or not, there is also
consequences for the neighboring teeth and the alveolar ridge, the bone that teeth are sitting in and
that prevents them from falling out, and the gum around the teeth.
Impacted canines is a time sensitive issue. The success of interventions are oftentimes dependent on the age of the patient, degree of root formation, the periodontal ligament and the surrounding alveolar bone. Delaying specific interventions such as apicotomy and transplantation will diminish the risk of success.
Any surgery to the tooth is also in itself a trauma and carries the risk of damage to the periodontal ligament.
Below is an article citing some problems with palatally impacted canines and the problems, and the risk for orthodontists getting sued:
First, the overall length of orthodontic treatment is increased when the patient has a palatal
impaction. Second there are often problems of alveolar bone loss around the adjacent lateral
incisor and premolars as well as the canine. Third, root resorption of the adjacent lateral incisor
is a common aftermath of treating a palatally impacted canine. Finally gingival recession on the
labial or palatal surfaces can accompany treatment of these teeth.(2)
consequences for the neighboring teeth and the alveolar ridge, the bone that teeth are sitting in and
that prevents them from falling out, and the gum around the teeth.
Impacted canines is a time sensitive issue. The success of interventions are oftentimes dependent on the age of the patient, degree of root formation, the periodontal ligament and the surrounding alveolar bone. Delaying specific interventions such as apicotomy and transplantation will diminish the risk of success.
Any surgery to the tooth is also in itself a trauma and carries the risk of damage to the periodontal ligament.
Below is an article citing some problems with palatally impacted canines and the problems, and the risk for orthodontists getting sued:
First, the overall length of orthodontic treatment is increased when the patient has a palatal
impaction. Second there are often problems of alveolar bone loss around the adjacent lateral
incisor and premolars as well as the canine. Third, root resorption of the adjacent lateral incisor
is a common aftermath of treating a palatally impacted canine. Finally gingival recession on the
labial or palatal surfaces can accompany treatment of these teeth.(2)
Impacted canines is a time sensitive issue. Moving them works better in younger patients. You can't just pull forever, after 3-4 months if there is no positive movement you need to analyze the problem.
You don't want time to pass because your orthodontist is at a loss what to do.
You don't want time to pass because your orthodontist is at a loss what to do.
Lingo
Impacted
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'Impacted' means that a tooth has not erupted into the arch of teeth in a timely manner, it is 'stuck', as in the bone of tooth has fused to the bone of the jaw. It is also called 'ectopic', meaning it is in the wrong spot. (Timely' can be defined as not erupted within 6 months of their complete root formation.) It should be out by 13.9 years for girls and 14.6 for boys.
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Ankylosed
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As it is used, it can either mean that the tooth is stuck, or the orthodontist is 'stuck'.
From Dr Adrian Becker's January 2015 Newsletter: Strictly, according to Orphaned Journal of Rare Diseases, ankylosis is '...a rare disorder characterized by the fusion of the tooth to the bone, preventing both eruption and orthodontic movement' and '...the periodontal ligament is obliterated by a bony bridge' and the tooth root is fused to the alveolar bone.' ... We orthodontists permit ourselves to use a broader definition of ankylosis, which is influenced to a degree by the lawyers whom we suspect are watching us, when we look over our shoulders! For us, ankylosis is an all-inclusive term we like to employ when a particular impacted tooth has resisted our efforts to erupt it. Ankylosis is banded about willy-nilly, to avoid admission of failure and its possible legal consequences. This broader definition conveniently encompasses an array of errors of clinical judgement which include imprecise positional diagnosis, inappropriate directional traction, poorly designed or impotent biomechanics and inadequate anchorage preparation - after all, nobody can prove that the tooth was not truly ankylosed without doing the histology! Radiographs are singularly unreliable diagnostic aids in this respect and the use of CBCT in the determination of ankylosis has yet to be documented. |
Location
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The upper (= maxillar) canine can be stuck sitting in the front of the mouth = buccally/ vestibular, it can sit high up and horizontal, or on the inside = palatally, which is more common, 85%.
It has the longest way to travel of all teeth, about 22 mm. (An Indian paper (2), though, says that buccal impactions are more common than palatal in Asia.) The lower (=mandibular) canine gets stuck less frequently. |
Prevalence
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Often cited as 1-2% in a general population. Seems to be ethnic differences, more prevalent in Iceland, less prevalent in Japan (0.27%), 0.92% in the white American population, 2.4% in Italy. It is twice as common in girls as in boys.
(Molars are the most common impaction, and the one that is in most people's awareness, that seems to be the main occupation of oral surgeons.) |
Different kinds of impacted canines
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Different types of impacted canines and complications:
1. There is a distinction between palatally (on the palate side - 85% of impacted canines) and labially (on the front, 'lip side', 15%) mislocated canines. 2. Another definition of location is 'the height of the impacted canine to the occlusal plane' (p 235)(23); that is how high up the tooth is compared to where it is supposed to end up. 3. The angle of the tooth. 4. The degree of root formation. 5. An aggravating factor with impacted teeth is the possibility of resorption of the root of adjacent teeth just by crowding each other. 6. Treating the impacted canines can negatively affect the other teeth. Usually you are trying to change the whole bite as one piece |
Diagnosis
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Some impacted canines are missed, because the deciduous baby tooth is sitting there.
Impacted canines are seen on the panorama that are recommended for all children as a step in following their dental development. |
Cause
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Not clear, probably different reasons. Some heredit
Canines have the longest roots, and they have a long way to go. Cause can be: - systemic disease (cleidocranial dysplasia, Gardner's syndorme, Golin-Goltz syndrome) - trauma - some abnormality like dilacerated roots, infections, inflammations |
Importance
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Canines, 'eye teeth', have a critical position in the arch of teeth, and guides the bite
and how the lower jaw works together with the upper jaw. (Just imagine an arch an what it would be like to not have the corner stone!). The have the longest roots and are meant to tear food. The maxillary canines erupyt after the premolars and has to squeeze in between its neighbors. The mandibular canines usually come before the premolar. |
Treatment
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• 'Interceptive treatment' means to avoid impaction by acting early. If the permanent canines is not in place at 10-13 years of age, the baby tooth is taken out, and usually, that will be enough to have the tooth erupt, if the angle of the canine isn't too extreme.
• Surgery: - exposure for spontaneous eruption - exposure for orthodontic traction - transplantation - apicoectomy as done by Dr Puricelli - osteotomy - extraction and implant when fully grown jaw, age 21 for boys • Leaving the canine impacted where it is could lead to: - eventually erupts - periodontitis - spontaneous resorption (8%) - migration - follicular/dentigerous cyst (2-9%) |
Duration
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Average treatment time to erupt with braces, at least 2 years for one, almost 3 years if bilateral.
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(23) Chaushu S, Chaushu G. Skeletal Implant Anchorage in the Treatment of Impacted Teeth - A Review of the
State of the Art. Seminars in Orthodontics, Vol 16, No 3 (September), 2010: pp 234-241.
(2) Singh R. et al. Management of Impacted Dilacerated Maxillary Canine. Asian Journal of Oral Helath &
Allied Sciences
State of the Art. Seminars in Orthodontics, Vol 16, No 3 (September), 2010: pp 234-241.
(2) Singh R. et al. Management of Impacted Dilacerated Maxillary Canine. Asian Journal of Oral Helath &
Allied Sciences
(1) Edela Puricelli. Apicotomy: a root apical fracture for surgical treatment of impacted upper canines. Head
Face Med. 2007; 3:33.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2045087/?tool=pubmed
(2) David P. Mathews, Vincent G. Kokich. Palatally impacted canines: The case for preorthodontic uncovering
and autonomous eruption. AJO-DO April 2013. Vol 143. Issue 4.
Face Med. 2007; 3:33.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2045087/?tool=pubmed
(2) David P. Mathews, Vincent G. Kokich. Palatally impacted canines: The case for preorthodontic uncovering
and autonomous eruption. AJO-DO April 2013. Vol 143. Issue 4.