This document discusses maxillary canine impaction, including its classification, causes, diagnosis, and treatment options. It provides an overview of the development and eruption path of maxillary canines. Common causes of impaction include lack of guidance from lateral incisors and insufficient arch length. Diagnosis involves radiography such as panoramic x-rays and CT scans to determine the three-dimensional position. Treatment options discussed include surgical exposure and applying traction to erupt the canine either buccally or palatally depending on its position.
This document provides an overview of Class II malocclusions, including:
- Classification systems for Class II malocclusions described by Angle and Moyers.
- Common etiological factors like heredity and habits.
- Clinical features both intraorally and extraorally.
- Diagnostic tools and assessments including study models, photographs, and cephalometrics.
- Treatment modalities for Class II malocclusions in growing and non-growing patients, including functional appliances, headgear, fixed appliances, and orthognathic surgery.
Posterior crossbite can be caused by skeletal factors like a narrow maxilla or wide mandible, or dental factors such as teeth erupting in the wrong position. Treatment depends on the cause, but may involve rapid or slow palatal expansion using appliances to widen the maxilla. For skeletal crossbites, expansion appliances are cemented and activated to apply force across the midpalatal suture. For dental crossbites, lighter forces from things like elastic threads or springs are used to move individual teeth. Crossbites caused by jaw shifting are treated by eliminating interferences and expanding a narrow arch. Habit-induced crossbites are addressed by treating the underlying habit. Correcting crossbites early in the
This document discusses the treatment of deep bite malocclusions. It defines deep bite and provides descriptions from Graber and Nanda. It then discusses the prevalence based on racial groups. Treatment involves intrusion of incisors, extrusion of molars, and proclination of incisors. Stability depends on factors like growth, muscle strength, and retention. Extraction of premolars is generally not recommended for deep bites. The conclusion emphasizes early treatment and long-term retention for stability.
This document discusses the management of open bite malocclusions. It begins by defining open bite and classifying it as either skeletal or dental in nature. Skeletal open bite is caused by excessive vertical growth of the jaws while dental open bite is due to reduced incisor height. Common etiologies of open bite include thumb sucking habits, tongue thrusting, and abnormal skeletal growth patterns. The document outlines various treatment approaches for different open bite classifications and etiologies.
presentation about impacted canine incidence, prevalence,classification,diagnosis, localization and treatment options including surgical and non surgical modalities
This document provides an overview of class II malocclusion, including definitions, etiology, features, diagnosis, and treatment approaches. It describes class II division 1 and 2 malocclusions. Treatment may involve growth modification using functional appliances, orthodontic camouflage through tooth movement, or orthognathic surgery. Growth modification aims to stimulate mandibular growth using removable or fixed appliances. Camouflage involves non-extraction treatment with elastics, premolar extractions, or distal movement of upper teeth. Surgery includes procedures like sagittal split osteotomy, sliding genioplasty, and maxillary segmental osteotomies. Factors like a patient's age and facial appearance influence the definitive
Ackerman & proffit classification of malocclusionAli Waqar Hasan
This document describes the Ackerman-Proffit analysis system for orthodontic malocclusions. It evaluates malocclusions based on Angle's classification plus five additional characteristics: transverse and vertical discrepancies, crowding, asymmetry, and incisor protrusion. It also assesses the dental arch, profile, lip posture, incisor display, and presence of crossbites or open bites. Rotational deviations around transverse, antero-posterior, and vertical axes (pitch, roll, yaw) are also evaluated. Scoring is done on a scale of 0 to 5 based on severity of the malocclusion characteristics.
This document discusses the management of impacted maxillary canines. It defines impacted canines and outlines their epidemiology, embryology, clinical examination, treatment options, and complications. Impacted canines are most commonly caused by genetic factors or loss of tooth guidance. Clinical examination involves inspection, palpation, and radiographic evaluation to determine the position, direction, and state of the unerupted canine. Management is often multidisciplinary and involves orthodontic treatment or surgery to align or expose the impacted tooth.
This document provides an overview of Class II malocclusions, including:
- Classification systems for Class II malocclusions described by Angle and Moyers.
- Common etiological factors like heredity and habits.
- Clinical features both intraorally and extraorally.
- Diagnostic tools and assessments including study models, photographs, and cephalometrics.
- Treatment modalities for Class II malocclusions in growing and non-growing patients, including functional appliances, headgear, fixed appliances, and orthognathic surgery.
Posterior crossbite can be caused by skeletal factors like a narrow maxilla or wide mandible, or dental factors such as teeth erupting in the wrong position. Treatment depends on the cause, but may involve rapid or slow palatal expansion using appliances to widen the maxilla. For skeletal crossbites, expansion appliances are cemented and activated to apply force across the midpalatal suture. For dental crossbites, lighter forces from things like elastic threads or springs are used to move individual teeth. Crossbites caused by jaw shifting are treated by eliminating interferences and expanding a narrow arch. Habit-induced crossbites are addressed by treating the underlying habit. Correcting crossbites early in the
This document discusses the treatment of deep bite malocclusions. It defines deep bite and provides descriptions from Graber and Nanda. It then discusses the prevalence based on racial groups. Treatment involves intrusion of incisors, extrusion of molars, and proclination of incisors. Stability depends on factors like growth, muscle strength, and retention. Extraction of premolars is generally not recommended for deep bites. The conclusion emphasizes early treatment and long-term retention for stability.
This document discusses the management of open bite malocclusions. It begins by defining open bite and classifying it as either skeletal or dental in nature. Skeletal open bite is caused by excessive vertical growth of the jaws while dental open bite is due to reduced incisor height. Common etiologies of open bite include thumb sucking habits, tongue thrusting, and abnormal skeletal growth patterns. The document outlines various treatment approaches for different open bite classifications and etiologies.
presentation about impacted canine incidence, prevalence,classification,diagnosis, localization and treatment options including surgical and non surgical modalities
This document provides an overview of class II malocclusion, including definitions, etiology, features, diagnosis, and treatment approaches. It describes class II division 1 and 2 malocclusions. Treatment may involve growth modification using functional appliances, orthodontic camouflage through tooth movement, or orthognathic surgery. Growth modification aims to stimulate mandibular growth using removable or fixed appliances. Camouflage involves non-extraction treatment with elastics, premolar extractions, or distal movement of upper teeth. Surgery includes procedures like sagittal split osteotomy, sliding genioplasty, and maxillary segmental osteotomies. Factors like a patient's age and facial appearance influence the definitive
Ackerman & proffit classification of malocclusionAli Waqar Hasan
This document describes the Ackerman-Proffit analysis system for orthodontic malocclusions. It evaluates malocclusions based on Angle's classification plus five additional characteristics: transverse and vertical discrepancies, crowding, asymmetry, and incisor protrusion. It also assesses the dental arch, profile, lip posture, incisor display, and presence of crossbites or open bites. Rotational deviations around transverse, antero-posterior, and vertical axes (pitch, roll, yaw) are also evaluated. Scoring is done on a scale of 0 to 5 based on severity of the malocclusion characteristics.
This document discusses the management of impacted maxillary canines. It defines impacted canines and outlines their epidemiology, embryology, clinical examination, treatment options, and complications. Impacted canines are most commonly caused by genetic factors or loss of tooth guidance. Clinical examination involves inspection, palpation, and radiographic evaluation to determine the position, direction, and state of the unerupted canine. Management is often multidisciplinary and involves orthodontic treatment or surgery to align or expose the impacted tooth.
This document provides an overview of the classification of malocclusion. It begins with definitions of key terms like occlusion, ideal occlusion, normal occlusion, and malocclusion. It then reviews the historical development of classification systems. The need for a standardized classification is to aid in diagnosis, treatment planning, and communication between clinicians. The main types of malocclusion are described as intra-arch, inter-arch, and skeletal. Several historical classification systems are summarized, including Angle's classification which divides malocclusions into Classes I, II, and III based on molar relationships. Modifications to Angle's system by Dewey and Lischer are also briefly outlined.
Maxillary canine impaction is a common orthodontic problem that requires a multidisciplinary approach. Impacted canines can occur for localized reasons such as arch length discrepancies or systemic/genetic factors. Treatment involves surgical exposure followed by orthodontic alignment and may require prolonged retention. Factors such as canine position, available space, and patient age influence the specific treatment approach and prognosis.
This document discusses the definition, etiology, classification, clinical features, diagnosis, and management of cross bites. Cross bites can be anterior or posterior and can have dental, skeletal, or functional causes. Management involves correcting the cross bite through various appliances depending on the stage of dentition, from simple elastics in primary dentition to more complex appliances like face masks or orthognathic surgery in permanent dentition. The goal is to intercept and correct cross bites early to prevent progression to more severe malocclusions requiring prolonged treatment.
Orthognathic surgery and minor procedures like extractions are used in orthodontics to correct dental abnormalities. Major orthognathic surgeries like LeFort I osteotomies and sagittal split osteotomies reposition the jaws to correct dental malocclusions. Minor procedures include extractions of teeth like premolars, as well as surgical exposures of impacted teeth. The decision to use orthodontic camouflage versus surgery must be made early. Adjunctive facial procedures like rhinoplasty and genioplasty are also used to improve aesthetics beyond dental repositioning.
This document discusses the diagnosis and treatment of Class III malocclusions. It begins with definitions and features of Class III malocclusions, noting they involve a mesial relationship of the mandible to the maxilla. Treatment approaches are described for:
1. Intercepting Class III malocclusions during growth using myofunctional appliances, chin cups, or face masks to redirect growth.
2. Using fixed appliances in mixed dentition to retrocline lower incisors and procline upper incisors.
3. Addressing anterior and posterior crossbites.
4. Considering extractions for mild mandibular prognathism.
5. Surgical-orthodontic treatment
The document discusses preventive and interceptive orthodontics. Preventive orthodontics aims to preserve normal occlusion and involves procedures like patient education, caries control, space maintenance, and extraction of supernumerary teeth. Interceptive orthodontics is undertaken when a malocclusion has developed and involves procedures like serial extraction to correct developing issues. Serial extraction specifically refers to the planned removal of certain deciduous and permanent teeth to allow other teeth to align normally through physiologic tooth movement into extraction spaces.
This document discusses deep bite, including its definition, types, etiology, diagnosis, factors, and treatment. A deep bite is defined as excessive vertical overlap of the upper and lower incisors. It can be true, caused by infraocclusion of posterior teeth, or pseudo, with normal posterior eruption. Causes include genetic, acquired, and muscular factors. Diagnosis involves clinical exams, casts, radiographs, and cephalograms. Treatment aims to correct the underlying occlusion and may involve bite planes, fixed appliances, or intrusion/extrusion of teeth to reduce the overbite. Bite ramps are an effective option to help correct a deep bite over time through posterior development.
The document provides information on Twin Block appliances. It begins with describing the history, design, and mechanism of Twin Block appliances. Twin Blocks consist of separate upper and lower bite blocks with inclined planes. They were developed in 1977 to treat a class II malocclusion. The inclined planes guide the mandible forward into a class I occlusion. The document further describes the skeletal and dental changes caused by Twin Block therapy, as well as the standard construction and stages of treatment. It covers indications, contraindications and modifications of Twin Block appliances.
This document discusses interceptive orthodontics and serial extraction procedures. It defines interceptive orthodontics as recognizing and eliminating potential irregularities in the developing dentofacial complex. Serial extraction involves removing primary and permanent teeth in a planned sequence to correct crowding and guide teeth into improved positions. The document describes several popular serial extraction methods, including Dewel's three-stage method and Tweed's method of extracting primary molars and canines. Factors such as a tooth-size discrepancy or premature tooth loss help determine if serial extraction is appropriate for correcting a developing malocclusion.
The document discusses different types of anchorage used in orthodontics. It defines anchorage as the resistance used to overcome the reaction to an applied force. There are different factors that affect a tooth's resistance to force, as well as different types of anchorage including extra-oral anchorage like headgear and intra-oral anchorage that can be intra-maxillary or inter-maxillary. Examples of each type are provided. Temporary orthodontic micro anchorage systems are also discussed as a modern method to reinforce anchorage.
This document discusses several orthodontic appliances including the Nance appliance, transpalatal arch, quad helix, lip bumper, and tongue crib. It provides details on the design, indications, mechanisms of action, advantages and disadvantages of each appliance. The document is intended as an educational guide for orthodontic residents, as it is presented by several orthodontists and covers the key aspects of these common fixed functional appliances.
This document discusses the etiology and features of Class II division 1 malocclusion. Genetic and skeletal factors can contribute to a prognathic maxilla or retrognathic mandible. Soft tissue factors include incompetent lips and tongue thrusting. Habits like digit sucking can also play a role by causing proclined upper incisors. Features include a Class II molar and canine relationship with increased overjet. Treatment depends on the patient's age, with growth modification using appliances for younger patients and fixed appliances or surgery for older non-growing patients. Functional appliances are used to guide growth in mild-moderate cases.
This document outlines orthognathic surgery procedures. It discusses diagnosis and planning, including indications, contraindications, and special considerations. Presurgical orthodontics including decompensation and arch coordination are described. Surgical techniques for the maxilla include LeFort I, II, III osteotomies and segmental procedures. For the mandible, procedures include sagittal split and vertical subsigmoid osteotomies. Splint fabrication and post-surgical care are also covered.
Diagnosis and management of anterior crossbite .
The patients usually see the cross-bite as a severe aesthetical problem. The orthodontists see the problem as a severe functional and anatomical disturbance.
The problem “cross-bite” is a result of an anatomical or functional disturbance in the occlusion.
“The best time to treat a crossbite is the first time it is seen”
Or else it may grow into Skeletal Malocclusion
Many treatment modalities ranging from simple to complex means are available to correct anterior crossbite ; some use removable appliances and others use fixed appliances
Frankles appliance Is a myofunctional appliance
Functional appliance are removable or fixed appliances that aim to utilize eliminate or guide the forces arising from muscle function,tooth eruption and growth inorder to alter skeletal and dental relationship
This document summarizes Tweed's analysis of cephalometric landmarks and angles used in orthodontic diagnosis and treatment planning. It describes Tweed's diagnostic facial triangle formed by the Frankfort horizontal plane, mandibular plane, and mandibular incisor plane. Norms for the angles FMA, FMIA, and IMPA are provided based on Tweed's studies. Shortcomings of the ANB angle in assessing jaw relationships are discussed. The Wits appraisal method is introduced as an alternative for measuring anteroposterior jaw disharmony. Related studies validating the Wits appraisal are summarized.
The document discusses the Cervical Vertebral Maturation (CVM) method for assessing optimal treatment timing in dentofacial orthopedics. CVM uses the shape of cervical vertebrae on lateral cephalograms to determine skeletal maturity. There are 6 stages from pre-pubertal to post-pubertal. Treatment effects are greater if timed around pubertal growth spurts - class II treatment works best in CS3-CS4, class III works best before puberty, and vertical issues work best at CS3. Maxillary effects are greater before puberty while mandibular effects are greater during puberty.
RAPID MAXILLARY EXPANSION VS SLOW MAXILLARY EXPANSIONShehnaz Jahangir
This document provides an overview of rapid maxillary expansion (RME) vs slow maxillary expansion (SME). It discusses the historical perspective of maxillary expansion, articulation and ossification of the midpalatal suture, indications and contraindications for expansion, classifications based on activation and support, examples of RME and SME appliances, activation protocols, and the biomechanical aspects and effects of RME on skeletal and dental structures. Key differences between RME and SME include the rate of activation (rapid vs slow) and appliances used (tooth-borne vs tissue-borne).
This document summarizes Dr. Pratik Yadav's journal club presentation on Downs WB Analysis of the dento-facial profile. It discusses the 10 parameters in Downs analysis, which includes 5 skeletal and 5 dental measurements. The parameters are measured based on landmarks and reference planes on lateral cephalograms. Downs analysis is one of the most commonly used cephalometric analyses originally developed based on Caucasian patients with excellent occlusion.
Maxillary canine impaction 02 /certified fixed orthodontic courses by Indian ...Indian dental academy
This document discusses maxillary canine impaction and its management. It begins by defining impacted teeth and noting that maxillary canines are among the most commonly impacted teeth. It then covers the development and eruption path of canines, classifications of impaction, and various theories for the causes of impaction. The document discusses clinical and radiographic evaluation methods for diagnosing impaction. It outlines treatment options for impacted canines, including surgical exposure and orthodontic alignment.
Maxillary canine impaction / oral surgery courses /certified fixed orthodon...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
This document provides an overview of the classification of malocclusion. It begins with definitions of key terms like occlusion, ideal occlusion, normal occlusion, and malocclusion. It then reviews the historical development of classification systems. The need for a standardized classification is to aid in diagnosis, treatment planning, and communication between clinicians. The main types of malocclusion are described as intra-arch, inter-arch, and skeletal. Several historical classification systems are summarized, including Angle's classification which divides malocclusions into Classes I, II, and III based on molar relationships. Modifications to Angle's system by Dewey and Lischer are also briefly outlined.
Maxillary canine impaction is a common orthodontic problem that requires a multidisciplinary approach. Impacted canines can occur for localized reasons such as arch length discrepancies or systemic/genetic factors. Treatment involves surgical exposure followed by orthodontic alignment and may require prolonged retention. Factors such as canine position, available space, and patient age influence the specific treatment approach and prognosis.
This document discusses the definition, etiology, classification, clinical features, diagnosis, and management of cross bites. Cross bites can be anterior or posterior and can have dental, skeletal, or functional causes. Management involves correcting the cross bite through various appliances depending on the stage of dentition, from simple elastics in primary dentition to more complex appliances like face masks or orthognathic surgery in permanent dentition. The goal is to intercept and correct cross bites early to prevent progression to more severe malocclusions requiring prolonged treatment.
Orthognathic surgery and minor procedures like extractions are used in orthodontics to correct dental abnormalities. Major orthognathic surgeries like LeFort I osteotomies and sagittal split osteotomies reposition the jaws to correct dental malocclusions. Minor procedures include extractions of teeth like premolars, as well as surgical exposures of impacted teeth. The decision to use orthodontic camouflage versus surgery must be made early. Adjunctive facial procedures like rhinoplasty and genioplasty are also used to improve aesthetics beyond dental repositioning.
This document discusses the diagnosis and treatment of Class III malocclusions. It begins with definitions and features of Class III malocclusions, noting they involve a mesial relationship of the mandible to the maxilla. Treatment approaches are described for:
1. Intercepting Class III malocclusions during growth using myofunctional appliances, chin cups, or face masks to redirect growth.
2. Using fixed appliances in mixed dentition to retrocline lower incisors and procline upper incisors.
3. Addressing anterior and posterior crossbites.
4. Considering extractions for mild mandibular prognathism.
5. Surgical-orthodontic treatment
The document discusses preventive and interceptive orthodontics. Preventive orthodontics aims to preserve normal occlusion and involves procedures like patient education, caries control, space maintenance, and extraction of supernumerary teeth. Interceptive orthodontics is undertaken when a malocclusion has developed and involves procedures like serial extraction to correct developing issues. Serial extraction specifically refers to the planned removal of certain deciduous and permanent teeth to allow other teeth to align normally through physiologic tooth movement into extraction spaces.
This document discusses deep bite, including its definition, types, etiology, diagnosis, factors, and treatment. A deep bite is defined as excessive vertical overlap of the upper and lower incisors. It can be true, caused by infraocclusion of posterior teeth, or pseudo, with normal posterior eruption. Causes include genetic, acquired, and muscular factors. Diagnosis involves clinical exams, casts, radiographs, and cephalograms. Treatment aims to correct the underlying occlusion and may involve bite planes, fixed appliances, or intrusion/extrusion of teeth to reduce the overbite. Bite ramps are an effective option to help correct a deep bite over time through posterior development.
The document provides information on Twin Block appliances. It begins with describing the history, design, and mechanism of Twin Block appliances. Twin Blocks consist of separate upper and lower bite blocks with inclined planes. They were developed in 1977 to treat a class II malocclusion. The inclined planes guide the mandible forward into a class I occlusion. The document further describes the skeletal and dental changes caused by Twin Block therapy, as well as the standard construction and stages of treatment. It covers indications, contraindications and modifications of Twin Block appliances.
This document discusses interceptive orthodontics and serial extraction procedures. It defines interceptive orthodontics as recognizing and eliminating potential irregularities in the developing dentofacial complex. Serial extraction involves removing primary and permanent teeth in a planned sequence to correct crowding and guide teeth into improved positions. The document describes several popular serial extraction methods, including Dewel's three-stage method and Tweed's method of extracting primary molars and canines. Factors such as a tooth-size discrepancy or premature tooth loss help determine if serial extraction is appropriate for correcting a developing malocclusion.
The document discusses different types of anchorage used in orthodontics. It defines anchorage as the resistance used to overcome the reaction to an applied force. There are different factors that affect a tooth's resistance to force, as well as different types of anchorage including extra-oral anchorage like headgear and intra-oral anchorage that can be intra-maxillary or inter-maxillary. Examples of each type are provided. Temporary orthodontic micro anchorage systems are also discussed as a modern method to reinforce anchorage.
This document discusses several orthodontic appliances including the Nance appliance, transpalatal arch, quad helix, lip bumper, and tongue crib. It provides details on the design, indications, mechanisms of action, advantages and disadvantages of each appliance. The document is intended as an educational guide for orthodontic residents, as it is presented by several orthodontists and covers the key aspects of these common fixed functional appliances.
This document discusses the etiology and features of Class II division 1 malocclusion. Genetic and skeletal factors can contribute to a prognathic maxilla or retrognathic mandible. Soft tissue factors include incompetent lips and tongue thrusting. Habits like digit sucking can also play a role by causing proclined upper incisors. Features include a Class II molar and canine relationship with increased overjet. Treatment depends on the patient's age, with growth modification using appliances for younger patients and fixed appliances or surgery for older non-growing patients. Functional appliances are used to guide growth in mild-moderate cases.
This document outlines orthognathic surgery procedures. It discusses diagnosis and planning, including indications, contraindications, and special considerations. Presurgical orthodontics including decompensation and arch coordination are described. Surgical techniques for the maxilla include LeFort I, II, III osteotomies and segmental procedures. For the mandible, procedures include sagittal split and vertical subsigmoid osteotomies. Splint fabrication and post-surgical care are also covered.
Diagnosis and management of anterior crossbite .
The patients usually see the cross-bite as a severe aesthetical problem. The orthodontists see the problem as a severe functional and anatomical disturbance.
The problem “cross-bite” is a result of an anatomical or functional disturbance in the occlusion.
“The best time to treat a crossbite is the first time it is seen”
Or else it may grow into Skeletal Malocclusion
Many treatment modalities ranging from simple to complex means are available to correct anterior crossbite ; some use removable appliances and others use fixed appliances
Frankles appliance Is a myofunctional appliance
Functional appliance are removable or fixed appliances that aim to utilize eliminate or guide the forces arising from muscle function,tooth eruption and growth inorder to alter skeletal and dental relationship
This document summarizes Tweed's analysis of cephalometric landmarks and angles used in orthodontic diagnosis and treatment planning. It describes Tweed's diagnostic facial triangle formed by the Frankfort horizontal plane, mandibular plane, and mandibular incisor plane. Norms for the angles FMA, FMIA, and IMPA are provided based on Tweed's studies. Shortcomings of the ANB angle in assessing jaw relationships are discussed. The Wits appraisal method is introduced as an alternative for measuring anteroposterior jaw disharmony. Related studies validating the Wits appraisal are summarized.
The document discusses the Cervical Vertebral Maturation (CVM) method for assessing optimal treatment timing in dentofacial orthopedics. CVM uses the shape of cervical vertebrae on lateral cephalograms to determine skeletal maturity. There are 6 stages from pre-pubertal to post-pubertal. Treatment effects are greater if timed around pubertal growth spurts - class II treatment works best in CS3-CS4, class III works best before puberty, and vertical issues work best at CS3. Maxillary effects are greater before puberty while mandibular effects are greater during puberty.
RAPID MAXILLARY EXPANSION VS SLOW MAXILLARY EXPANSIONShehnaz Jahangir
This document provides an overview of rapid maxillary expansion (RME) vs slow maxillary expansion (SME). It discusses the historical perspective of maxillary expansion, articulation and ossification of the midpalatal suture, indications and contraindications for expansion, classifications based on activation and support, examples of RME and SME appliances, activation protocols, and the biomechanical aspects and effects of RME on skeletal and dental structures. Key differences between RME and SME include the rate of activation (rapid vs slow) and appliances used (tooth-borne vs tissue-borne).
This document summarizes Dr. Pratik Yadav's journal club presentation on Downs WB Analysis of the dento-facial profile. It discusses the 10 parameters in Downs analysis, which includes 5 skeletal and 5 dental measurements. The parameters are measured based on landmarks and reference planes on lateral cephalograms. Downs analysis is one of the most commonly used cephalometric analyses originally developed based on Caucasian patients with excellent occlusion.
Maxillary canine impaction 02 /certified fixed orthodontic courses by Indian ...Indian dental academy
This document discusses maxillary canine impaction and its management. It begins by defining impacted teeth and noting that maxillary canines are among the most commonly impacted teeth. It then covers the development and eruption path of canines, classifications of impaction, and various theories for the causes of impaction. The document discusses clinical and radiographic evaluation methods for diagnosing impaction. It outlines treatment options for impacted canines, including surgical exposure and orthodontic alignment.
Maxillary canine impaction / oral surgery courses /certified fixed orthodon...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
Introduction
Incidence
Development of canine
Eruption of canine
Etiology of canine impaction
Sequelae of canine impaction
Classification of canine impaction
Diagnosis
Radiographic Prediction
Prognosis
Prevention of maxillary impaction
Extraction of impacted canine
Treatment alternatives
General principles of mechanotherapy
Methods of gaining space
Anchorage considerations
Surgical Methods
Surgical exposure for natural eruption
One step vs two step
Types of flaps
Attachments
Methods of traction
Mandibular canine impaction
Canine impaction and resorption
Canine impaction and periodontium
Retention
Complications of treatment
Complications of untreated impacted canine
Conclusions
References
Canine Impaction and Its Importance in OrthodonticsAnalhaq Shaikh
Canine Impaction, Its Importance in Orthodontics, Etiology, Diagnosis and Management.
by Dr Analhaq Shaikh, 2nd year Postgraduate student, Sharavathi Dental College and Hospital, Shimoga, Karnataka
Canine Impaction can also be termed as Shy Canine.
Maxillary canine impaction is a common dental anomaly where the permanent canine tooth fails to erupt into the dental arch. There are several proposed theories for the causes of canine impaction, including lack of guidance from adjacent teeth, insufficient arch length, genetic factors, and systemic conditions. Canine impactions can be classified based on their position, depth, and angulation. Clinical examination and radiographs are used to diagnose impacted canines. Radiographic views like panoramic, periapical, and occlusal films provide information on tooth development and position to determine the appropriate treatment.
The document summarizes the development of occlusion from birth through adulthood in 5 phases:
1) From birth to eruption of primary teeth
2) From completion of primary teeth to eruption of the first permanent molar
3) Mixed dentition period from eruption of the first permanent molar to loss of primary teeth
4) Permanent dentition period beginning with eruption of the first permanent incisor
5) Occlusal development in young adults
It then provides details on the formation, eruption, and development of primary teeth and their occlusion, as well as the formation, eruption sequence, factors affecting eruption, arch development, and stages of developing occlusion for permanent teeth.
This document provides information about the maxillary canine tooth. It discusses the anatomy including tooth aspects, eruption timeline, functions, variations, anomalies, and treatment considerations for impacted canines. Specifically, it notes that the maxillary canine has the longest root and most tortuous eruption path of the anterior teeth. Factors like issues with the lateral incisor can affect canine eruption and cause impaction. Treatment may involve space maintenance, surgical exposure with orthodontic guidance, or repositioning of an impacted canine.
This document provides information about the maxillary canine tooth. It discusses the anatomy including tooth aspects, eruption timeline, functions, variations, anomalies, and treatment considerations for impacted canines. Specifically, it notes that the maxillary canine has the longest root and eruption path of the anterior teeth. Factors like issues with the lateral incisor can affect canine eruption and may result in impaction. Treatment options for an impacted canine include space maintenance, guided eruption after exposure, or surgical repositioning.
Canine impaction maxillary teeth part 2VilvaKarthick
This document discusses maxillary canine impactions. It begins by discussing the incidence, locations, and classifications of impacted canines. Several theories for the etiology of palatally and labially impacted canines are described, including the Beckers Concept, McBridge Concept, Moyers Concept, and Von Der Heyedt Concept. Indications and contraindications for removal of impacted canines are provided. Various classification systems for impacted canines including Fields and Ackerman, Archer, and Yamamoto are explained. Methods for localizing impacted canines including inspection, palpation, and different radiographic views are covered. Complicating factors and prognostic factors are also summarized.
Development of Occlusion is necessary for knowing the eruption sequence of teeth. By knowing the eruption sequence of teeth we can make our treatment plan. Development of occlusion gives us the knowledge of various malocclusion and we can correct them and give proper treatment plan to the patient.
This document discusses impacted teeth, including definitions, causes, classifications, and surgical management. It notes that the most commonly impacted teeth are the mandibular and maxillary third molars. Factors that can cause impaction include inadequate jaw size, heredity, and dietary habits. Impacted teeth are classified based on their angle, depth, and position relative to other teeth and structures. Complications from impacted teeth include infection and cysts. Indications for removal include preventing complications and facilitating treatment. Surgical removal involves raising flaps, removing bone using chisels, and sometimes dividing the tooth. Proper technique and suturing help reduce risks of damage or injury.
Class I malocclusion is the most common type of malocclusion, accounting for 60% of cases. It is characterized by a Class I incisor relationship with the canine and molar relationships usually being Class I as well. Crowding is the most common problem associated with Class I malocclusion. Crowding can be due to the tooth size being larger than the jaw size (hereditary) or due to loss of arch length from premature loss of primary teeth or caries. Treatment of crowding depends on its severity and can include space maintenance, expansion, serial extraction, or orthodontic treatment with extraction of premolars.
Preventive and interceptive orthodonticsAyesha Abbas
This document discusses various orthodontic procedures including preventive, interceptive, and comprehensive orthodontics. It describes different types of orthodontic problems seen in children including non-skeletal (dental) problems and skeletal problems. Specific issues covered include natal teeth, occlusal relationship problems, eruption problems, space maintenance, traumatic displacement of teeth, and space-related problems. Treatment approaches are provided for each problem depending on factors such as the severity, timing, and underlying cause. Early intervention is emphasized to prevent the development or worsening of malocclusions.
Types of malocclusion
Malocclusion can occur singly or in combination as follows:
1- Dental mal-relationship.
2- Dento-alveolar, involving the teeth and alveolar process.
3- Dental arch mal- relationship
4- Basal arch discrepancy
5- Cranio-facial abnormalities.
1- Dental mal relationship
Including crowding, spacing, ectopism and other local malposition of the teeth that not affect the arch size, relationship and growth.
Causes of dental malposition:
1- genetic factors.
2- Prolonged retention or early loss of primary teeth.
3- Delayed eruption of permanent teeth.
4- Supernumerary teeth, missing teeth, either congenital or due to extractions.
5- Ectopic eruption and abnormal tooth morphology.
6- Abnormal development of the teeth.
Frequency:
=The most frequently malposed teeth in permanent dentition are the 3rd molars, maxillary lateral incisors, mandibular incisors, 2nd premolars and 2nd molars, the less frequently malposed teeth are the 1st molars and 1st premolars.
= spacing is predominating in deciduous dentition while crowding is common in permanent dentition.
= Irregularities due to local pot natal causes will manifest themselves clinically and will requires corrective treatment.
= rotation of the teeth in most cases is a sequlea of crowding but sometimes occurs with spacing due to loss of proximal contact between the erupting and adjacent teeth.
= crowding and spacing of the same arch may be expected in deciduous dentition but if occurs in permanent dentition, it will represent a symptoms of tooth shifting and detective eruption due to local interfere.
Spacing of permanent teeth:
In the permanent dentition, spacing in the maxillary arch is usually localized from canine to canine.
The median diastema in maxillary arch may be caused by:
1- Abnormal labial Frenum or presence of mesiodense
2- Dwarfed or congenitally absent lateral incisors.
3- Or as a part of generalized spacing.
Spacing in the mandibular arch is less common but may occurs due to:
1- Abnormal large tongue and bi dental protrusion.
2- Abnormal lingual Frenum ----- median diastema.
3- As a part of generalized spacing.
Loss of space or space closure:
a- In mixed dentition:
= In children with well-developed arches, there is little or no space loss after extraction of primary molars, this may be due to the cuspal interlocking of U and L 6
= There will be more space loss after extraction of E then after extraction of D
= loss of UE before the eruption of UB causes the U6 to erupt far mesially toward UD occupying the space required for eruption of U5------ impaction of U5.
= in the mandibular arch the forward shifting of L6 is less great and space loss is less marked.
= the order of eruption of permanent teeth has some effect on determining the space closure. For example: the maxillary canine may block out labially because it erupts after U4, the mandibular 2nd bicuspids may block out lingually because it is the last tooth erupt in the front of L6.
b- In permanent
1. Occlusion refers to the relationship between the teeth of the upper and lower jaws during normal function and parafunction. An ideal occlusion involves perfect interdigitation of the teeth as a result of developmental processes including jaw growth, tooth formation, and eruption.
2. Over time, humans evolved to have fewer cranial and facial bones to allow for synchronized development of teeth and bones and the formation of a functional occlusion.
3. Occlusal development occurs in stages including the neonatal, primary dentition, mixed dentition, and permanent dentition periods. Each period involves specific eruption sequences and shifts in the jaw and tooth relationships.
This document provides an overview of impacted teeth and their surgical management. It begins with definitions of impacted, unerupted, and malposed teeth. It then discusses the etiology, theories of impaction, indications for surgery, classifications, and assessments needed prior to surgery. Surgical management involves raising a flap, removing overlying bone, and extracting the tooth. Potential complications during and after surgery are also reviewed.
The management of impacted canines is important in terms of esthetics and function. Clinicians must formulate treatment plans that are in the best interest of the patient and they must be knowledgeable about the variety of treatment options. When patients are evaluated and treated properly, clinicians can reduce the frequency of ectopic eruption and subsequent impaction of the maxillary canine. The simplest interceptive procedure that can be used to prevent impaction of permanent canines is the timely extraction of the primary canines. This procedure usually allows the permanent canines to become upright and erupt properly into the dental arch, provided sufficient space is available to accommodate them. In the present article, an overview of the incidence and sequelae, as well as the surgical, periodontal, and orthodontic considerations in the management of impacted canines is presented.
Opportunity for Dentists (BDS/MDS )to relocate to United kingdom -Register as a DENTAL HYGIENIST/ DENTAL THERAPIST without Board exams and after approval you can register in GDC as a DH/DT and start working as a DH/DT Immediately and get paid.
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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This document discusses dental occlusion concepts and philosophies for complete dentures. It introduces key terms like physiologic occlusion and defines different occlusion schemes like balanced articulation and monoplane articulation. The document discusses advantages and disadvantages of using anatomic versus non-anatomic teeth for complete dentures. It also outlines requirements for maintaining denture stability, such as balanced occlusal contacts and control of horizontal forces. The goal of occlusion for complete dentures is to re-establish the homeostasis of the masticatory system disrupted by edentulism.
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This document discusses dental casting investment materials. It describes the three main types of investments - gypsum bonded, phosphate bonded, and ethyl silicate bonded investments. For gypsum bonded investments specifically, it details their classification, composition including the roles of gypsum, silica, and modifiers, setting time, normal and hygroscopic setting expansion, and thermal expansion. It provides information on how the properties of gypsum bonded investments are affected by their composition. The document serves as a comprehensive overview of dental casting investment materials.
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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Level 3 NCEA - NZ: A Nation In the Making 1872 - 1900 SML.pptHenry Hollis
The History of NZ 1870-1900.
Making of a Nation.
From the NZ Wars to Liberals,
Richard Seddon, George Grey,
Social Laboratory, New Zealand,
Confiscations, Kotahitanga, Kingitanga, Parliament, Suffrage, Repudiation, Economic Change, Agriculture, Gold Mining, Timber, Flax, Sheep, Dairying,
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
This presentation was provided by Racquel Jemison, Ph.D., Christina MacLaughlin, Ph.D., and Paulomi Majumder. Ph.D., all of the American Chemical Society, for the second session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session Two: 'Expanding Pathways to Publishing Careers,' was held June 13, 2024.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
Beyond Degrees - Empowering the Workforce in the Context of Skills-First.pptxEduSkills OECD
Iván Bornacelly, Policy Analyst at the OECD Centre for Skills, OECD, presents at the webinar 'Tackling job market gaps with a skills-first approach' on 12 June 2024
2. Introduction
Maxillary canine
Classification of canine impaction
Reason for canine Impaction
Diagnosis
Treatment options
Methods of Creating Space
Attachments For canine
Methodolgy of Approach
Surgical Exposure of impacted canine
Impacted tooth and Periodontium
Retention
Complication of untreated impacted canine
Time to extract canine
Conclusion
3. Introduction
Impacted tooth is defined as tooth whose roots are 2/3rd or
fully developed but nevertheless expected to erupt.
Mandibular third molar -- Maxillary canine -- mandibular
second premolar.
In maxillary canine impaction ,palatal canine impaction is
more common than buccal canine impaction.{Jacoby 3:1}.
Females affected more than males.
Oliver 1989 showed Asians affected from buccally
impacted canines more frequently than from palatally impacted
canines.
4. Maxillary canine
Development of canine : It develops at 4 – 5
months of age between the roots of decidious Ist molar.
Calcification of canine : It begins to calcify
around 12 months of age.
Eruption of canine : Its left behind the roots of
deciduous molar , allowing development of the first premolar
between the deciduous molar roots. At this stage the permanent
canine is located immediately above both the first premolar and the
first deciduous molar.
5. As the deciduous teeth erupts towards the occlusal plane, the
permanent incisor and canine crypts migrate forward in the jaws at a
greater rate than the forward movement of the deciduous teeth
themselves .
Around 6-7 years of age canine calcification will be completed .
At the age of 7 years, the canine crown is medial to the root
of its deciduous Predecessor ,and there is a vertical overlap of
approxiamtely 3mm.
Williams, 1981 showed the positional changes between 8 and
10 years of age need careful observation for detection of potential
impaction. During this stage of development the canine normally
migrates buccally from a position lingual to the root apex of the
deciduous precursor. However, some canines do not make the
transition from the palatal to the buccal side of the dental arch and
6. remain palatally unerupted.
With sufficient increase in the size of the subnasal area, the
maxillary canine normally moves downward, forward and laterally
away from the root end of the lateral incisor.
Between 8 and 12 years of age, the ‘uglyduckling’stage,
there is insufficient space at the apical base to permit the axis of the
lateral incisor to shift into the more erect alignment of young
adulthood until the canine approaches its place in the dental arch .
In the final phase of eruption, canines drive their way
between the lateral incisors and first premolars,forcing these teeth to
become more upright. Thus the maxillary canine follows a longer,
and more tortuous path of eruption than any other tooth
7. Classification of canine impaction:
Class I:
Impacted cuspids located in palate.
a) Horizontal
b) Vertical
c) SemiVertical
Class II:
Impacted cuspids located in Labial or buccal surface
of maxilla
a) Horizontal
b) Vertical
c) SemiVertical
8. Class III:
Impacted cuspids located in palatine and maxillary bone
e.g.crown is on the palate and root passes through the root of
the adjacent teeth and ends in the labial or buccal surface of
maxilla.
Class IV:
Impacted cuspids located in the alveolar process,usually
vertically between incisor and first bicuspids
9. Reason for canine Impaction
Becker Concepts :
Becker (1984) hypothesized two processes in the
palatal impaction of the maxillary canine:
I) Absence of initial early guidance from an anomalous
lateral incisor.
II) Failure of buccal movement of the canine at an
unspecified age .
MC Bridge Concept
Canine formed at high in the anterior wall at antrum,
below the floor of orbit, long tortous path of eruption.
10. Moyers Concept: Summarized by Bishara
A)Primary cause:
1) Trauma to decidious tooth bud
2) Rate of Resorption of decidious tooth
3) Availability of space in the arch
4) Disturbance in tooth Eruption Sequence
5) Rotation of tooth buds
6) Canine Erupt in Cleft area in Person with Cleft
7) Premature root Closure
B)Secondary cause:
1) Abnormal muscle pressure
2) Febrile diseases
3) Endocrine disturbances
4) Vitamin D deficency.
11. Berger Concept :{Systemic cause of impaction}
1) Malnutrition
2) Tuberculosis
3) Syphilis
4) Rickets
5) Anemia
6) Progeria
7) Syndromes:
a) Cleidocranial dysplasia
b) Achondraplasia
c) Down syndrome
12. Vonder Heydt Concept
Total arch length of permanent teeth is initially
established very early in life at the time of eruption of first permanent
molars. Canine is larger and later erupting and considering like a
musical chair situation it may get impacted.
Guidance Theory - Miller
Normal Eruption: Canine usually have a more mesial development
path,which is guided downwards apparently along the distal aspect of
the lateral incisor roots.
13. First stage Impaction:If there is a loss of guidances due to missinig
lateral incisors or late developing laterals, canine will have mesial and
palatal path of eruption.In this event there is no vertical movement of
canine into the alveolar process,results in more horizontal impaction.
First stage impaction and secondary correction:Once it reached the
palatal alveolar process,canine is redirected to more favorable path of
eruption.
Second stage Impaction:Self correction is prevented by, late
developing lateral incisors (peg laterals) which redeflect the tooth
further palatally
Second stage Impaction and secondary correction:Extraction of
deciduous canine or even extraction of lateral incisors leads to
spontaneous eruption of the impacted tooth.
14. Peck and Peck Concept:
1) Occurrence of other dental anomalies:
Palatally impacted canine is an inherited trait occurs in
combination with tooth agenesis,tooth size reduction,supernumery
tooth and other ectopically positioned tooth.
2) Bilaterally occuring Phenomenon (17%)
3) Females affected more than males (1:3.2)
4) Familial occurence
So they concluded palatally impacted canine as dental
anomaly as GENETIC ORIGIN.
15. CLINICAL EVALUATION:
1) Prolonged retention of deciduous canine
2) Delayed eruption of permanent canine
3) Presence of palatal bulge
4) Absence of labial canine bulge
5) Delayed eruption, persistent distal tipping and
migration of lateral incisors.
DIAGNOSIS
16. RADIOGRAPHIC EVALUATION
I) INTRA-ORAL RADIOGRAPH:
1) IOPA: The first, simplest and most
informative X-ray film is the periapical view.
Advantages;
1) Root development,paternn and integrity
2) Crown resorption
3) Root resorption of adjacent tooth
4) Minimun of surrounding tissue is exposed which
increase accuracy and resolution.
5) Minimal radiation exposure
30. But in some cases this space is not sufficient to guide
permanent canine in to occlusion.In these cases extaction is
necessary.
E ) Extraction as a mean of prevention (Mixed dentition period)
a) Decidious Canine
Canine with an mild palatal displacement will
undergoes spontaneous eruption and alignment despite first
stage displacement after extraction of decidious canine.
Erickson and kurol concluded that patient with age of
10-13 years preferably with delayed dental age, palatal
displacement of canine with apex confirmed in line of arch
requires extraction of deciduous canine for good prognosis for
eruption o f permanent canine.
33. d) Perforation of canine tips -- Fournier
1) Chances for non vitality of the tooth
2) Needs restoration of the tooth at the end of treatment
e) Direct Bonding -- Jacoby,Nielson
1) Easy to perform
2) More reliable method
Methodolgy of Approach
A) Early extraction of deciduous tooth:
When early extraction was performed due to caries,the
immature tooth bud will be deep in the bone and unready for
eruption.After healing permanent tooth felt difficulty in penetrating
thickened mucosa.
34. Treatment: Removing fibrous mucosal covering and apically
repositioned flap was done , tooth will erupt spontaneously.
b) Retained decidious tooth:
Retained deciduous teeth is defined as tooth which is
retained even after the permanent successors have reached the
stage of development.
Treatment: Extraction of deciduous tooth.
Usally permanent successors are low in the alveolus,
so after exposing the crown a periodontal pack is placed for 2-3
weeks.This will encourage epithelization down the socket and
generally prevent the reformation of bone over the unerupted tooth.
35. C) Highly buccaly impacted canine:
These tooth are usually ankylosed and difficult to respond
to orthodontic traction.
Treatment: Tooth should be luxated with extraction forceps
such that it is not removed from the socket nor to tear the
periodontal fibers.Accordingly this approach will be quite
successful only if a continuous force is applied to the tooth from
the time of subluxation.If the range of force is small and loses its
potency between visit of adjustments,reankylosis will result.
D) Retained decidious tooth with deep infraosseus impacted
canine:
These condition are difficult to manipulate.Usually tooth
will be placed more than 17mm above the occlusal plane. So tooth
have to take a long journey to come to occlusion.
36. Treatment: CRESCINI approached a method called as TUNNEL
TRACTION.
Procedure:
a) Extract deciduous canine
b) Full thickness mucoperiosteal flap is elevated to expose the
cortical plate.
c) Drill with bur until exposing crown of canine
d) Tooth was bonded and ligature wire tied
e) Traction force given after 1week of surgery
Advantage:
a) No buccal or palatal access
b) No loss of supporting tissue
Disadvantage:
a) Post operative discomfort will be more.
37. Thus tooth can be guided in normal physiological
eruption pattern through the crest of the ridge .
E) Palatally impacted canine:
When crown of canine is more palatally displaced,surgery on
the buccal side needs to become more radical,rendering a palatal;
approach preferable.
Usually palatally impacted tooth is guided to occlusion in two
stages.
I) Guiding tooth to oral enviroment
II) Guiding tooth to line of arch
38. Guiding tooth to oral enviroment
I) Active palatal arch (Becker1978)
It consist of fine 0.020 inch removable palatal arch wire
carrying an omega loop on each side. End of the wire is doubled
for Frictionless fit in lingual sheath.It is activated by elevating
downward activated palatal arch wire and hooking the pigtail
ligature around it
39. 2) Ballista Spring (Jacoby 1979)
It is made of rectangular wires. It proceeds forward untill
it is opposite to canine space and bent vertically downwards and
terminate into a small loop.With slight finger pressure ,spring is tied
to pigtail ligature. By this it provide an extrusive force for the canine
to erupt.If the impacted tooth is resistant to movement or if the
distance for the tooth to move is more it will leads to lingual molar
root torque leads to loss of anchorage.To overcome this feature TPA
is used.
40. 3) Light Auxiliary Labial Arch (Kornhauser1996)
It is made up of 0.014 inch round SS wire with vertical
loops in the area of impacted canine on both sides.This loop has a
small helix.This wire is tied with the basal arch wire in piggyback
fashion.If basal arch wire is not used it will leads to extrusion of
adjacent tooth and cause alteration of occlusal plane .
41. 4) Mandibular removable appliance (Orton1996)
It consist of clasps through which elastic is applied from
clasp to the pigtail ligature wire. This provide the necessary
extrusive force for the eruption of canine
For all the aforementioned methods the position of the
attachment is immaterial and bonding is done on the most
convenient surface available because no adverse rotation of tooth
will occur while it is moving vertically downwards.
Guiding tooth to line of arch
Once the tooth is moved to the oral enviroment,bonding
attachment is placed on the midbuccal aspect to prevent iatrogenic
rotation of canine and guided to the line of arch.
42. a) If the root apex of canine is close to the line of arch and
crown related to the roots of incisors,pure buccal tipping will bring
the crown to desirable position and inclination.
b) If the root apex is distant to the line of arch and crown
not related to the roots of the incisors,usually it will be impacted deep
and may even crosses the mid palatal suture.These tooth can be
directly guided to occlusion through labial arch wire since there is no
inteference of roots of incisors.
c) If there is an horizontal impaction,downward tipping
should be cautiously applied.Force application should be like the
fulcrum of the canine to be at the root end ,so that root apex don’t
alter following the canine tipping movement.
43. Unfortunately ,fulcrum is usually located short away
from the apical portion of the root, leads to concomitant palatal
displacement of root apex of canine. This requires buccal root
torquing after alignment of canine in the arch.
d) If the root apex mesial to lateral incisor or distal to
premolar , tooth is considered as TRANSPOSED.
I) Incomplete transposition: Roots will be in line of arch in its
position and crown tipped due to path of eruption.(uprighting of
tooth will align the tooth in arch).
II) Complete transposition: Both crown and root together will
be completely interchanged.In these sutiation its better to align tooth
to their respective position ,i.e canine between premolars or mesial
to lateral incisors depends on type of transposition..
44. If we tried to align this tooth to their respective position,following
will occur,
I) If canine is palatal to line of arch,secondary effect of root
contact will rotate the root apex both mesially and palatally across
the palate in a wide sweeping motion.the tooth will be laid down
beneath the periosteum with huge dehiscence.
II) If canine is buccal to the line of arch ,secondary effect of
root contact will cause further buccal displacement of root with gross
dehiscence of buccal periodontium.
e) If canine is erupting in line of arch and in place of lateral
incisors and resorbing the roots,canine should be guided in distal
direction without extrusion in horizontal plane in a direct line
towards the maxillary molars.
45. Once canine is moved away from the lateral incisor root, the
resorption process stops completely.
If roots of lateral incisor is resorbed more than 2/3 rdit is
more reasonable to remove incisor and to draw the canine down
in to the place.
Surgical Exposure of impacted tooth
Circular incision or open approach :
This is done by removing mucosa over the crown to expose
the impacted tooth.
Advantages:
a) Easy to perform
b) Suitable access can be provided for bonding of the attachment
c) Reduction of impaction is rapid.
46. Disadvantages:
a) Tooth will be invested on labial side with thin oral
mucosa rather than attached gingiva.
b)Typical soft tissue contour aggravates Plaque
acclumation which leads to gingivitis.Inflammation will prevent
regeneration of the Periodontal ligament which leads to apical
movement of the epithelial attachment
47. Apically Repositioned Flap:
This method was proposed by Vanarsdall and corn in 1977.
Procedure:
In cases without deciduous canine, Mucoperiosteal flap is
elevated from the crest of the ridge that includes attached gingiva.
In cases with deciduous canine ,tooth was extracted and
the flap was designed to include the entire area of buccal gingival
that invest it.
In either cases, Split thickness Flap is elevated by incision
made vertically into the vestibule someway up into the sulcus,to
expose the canine.
2/3rd
of bone covering the crown was removed.
Connective tissue follicle was curreted from periphery of
the exposed portion of the crown.
48. Flap is then sutured to the labial side of the crown of the
permanent canine,to cover the denuded periosteum and overlying
cervical portion of the crown.,while remainder portion of the crown
is exposed.
Surgical dressing was placed on enamel to prevent
overgrowth of adjacent tissue. Dressing was removed 1 week post
operatively.After 2 weeks,orthodontic traction was started.
49. Advantages:
a) Maintain the width of attached gingiva
b) Easy access for bonding of the attachment
c) Tooth can be visualized from the time of exposure
still it come to occlusion
Disadvantages: Vermette 1995
a) Uneven and unesthetic gingival margin
b) Increased Clinical crown length
c) Some degree of attachment and bone loss on the
labial surface,which was considered as possibly related to an
increased potential for plaque accumulation.
50. d) Vertical orthodontic relapse:After apical repositioning
the gingival tissue heals to the adjacent mucosa, producing
soft tissue band of gingival scarring. As the tooth is pulled incisally
this mucosa get stretched down with it,toward the alveolar
crest.Thus it tend to relapse once the force is released .
Full Flap Exposure:
This method was proposed by MCBride in 1979.This method
is more effective for buccal and palatally impacted tooth.
Procedure:
A full buccal surgical flap is raised to expose the
canine.An attachment is bonded to the tooth and the flap is sutured
back to its former place itself.
51. Then a Twisted thread is tied to the bonded tooth and then
drawn inferiorly and through the sutured ends of the replaced flap, or
through the crest of the ridge or through the socket vacated by the
extracted deciduous canine.
Advantages:
a) Tooth can be erupted towards and through the attached
gingiva which maintains the width of the attached gingiva
b) No gingival scarring and good periodontal attachment is
established
c) No vertical relapse
d) Conservative bone removal
e) Immediate traction possible
f) Less discomfort and good post operative Haemostasis
52. Disadvantage:
a) Placement of the bonding attachment is necessary at the time
of exposure
b) If there is a bond failure it needs re-exposure
c) Difficulty in gaining dry field
d) Buttonholing: This occurs because of the buccal
prominence of the tooth, lack of buccal
bone and relative tightness of the
replaced flap.The damage to the
mucogingival tissue is due to the bulk
of wide and high profile conventional
53. Dentigerous Cyst:
Dentigerous cyst is a well defined radiolucent lesion of
alveolar bone and inhibit the eruption of the involved tooth.
Treatment:
Marsupialization is the procedure consists of
fenestrating the outer wall of the cyst, and relieving the intracystic
pressure. With this early decompression, the size of the cavity slowly
decreases, enabling the surrounding bone to regenerate around the
impacted tooth, which eventually will erupt into the dental arch.
Thus Marsupialization has the advantage of reducing
the cystic cavity and preserving the involved tooth.Average time to
erupt after Marsupialization is 109 days,without any traction.
Orthodontic traction is necessary if it delays later..
54. Hyomoto 2003 showed Tooth will erupt after marsupilazation only it
fulfill the following criteria
1) Less than 2/3rd
root formation.
2) Less than 80º to tooth axis angulation to occlusal plane
3) Less than 9mm deep in bone
Impacted tooth and Periodontium
In 1984 Becker showed Exposure of the crown should be
sufficient to bond attachment rather than exposing upto
CementoEnamelJunction.Previously for placing bands surgeons
Deliberately and completely remove the follicle surrounding the
tooth.When these tooth erupt in to occlusion,these tooth will have
longer clinical crown and reduced alveolar height.
55. Kokich and Mathew showed that bone removal should not
be more than 2/3rd
of the impacted tooth crown.
Light orthodontic movement like tipping , extrusion, and
rotation have less periodontal breakdown than Heavy orthodontic
movement like root uprighting and torquing.
In 2002 Charles and Frank showed periodontal condition
depends on the type of surgery.Closed approach seems to be
preferable than open approach and apically repositioned flap.
Kokich showed Liquid etchants should not be used in the
exposed surgical field, since it is difficult to prevent the spread to the
exposed soft tissues,CEJ,tooth attachment area and bone
surfaces.This will aggravates periodontal breakdown. So it is better to
use GEL.
56. RETENTION
I) Rotation and spacing occurs in 17.4%. Fibrectomy and
fixed bonded retainer is Preferable in most cases.
II) Clark 1985 showed Lingual drift can be prevented by
removal of half moon shaped wedge of tissue from lingual aspect of
canine which further improves retention
COMPLICATION OF UNTREATED
IMPACTED CANINE
1) Crown Resorption:
With age reduced enamel epithelium surrounding the
completed crown will degenerate and its integrity will lost.This
leads to direct contact of bone and connective tissue with the crown
and
57. osteolytic activity will leads to resorption of enamel and its replaced
by bone ,a process called Replacement Resorption. This is seen
specially in adult patients who left untreated 2-3 decade of age.
2) Labial or lingual malposition of impacted tooth
3 ) Migration of neighboring teeth and loss of arch length
4) Internal resorption of impacted tooth
5) Cyst formation {Dentigerous cyst}
Trauma or carious lesion of deciduous canine will
cause periapical pathology which may leads to direct interconnection
between apical pathology and Follicular sac surrounding the impacted
canine.If the follicular sac enlarges more than 2-3mm,it represents
cystic changes
58. Dentigerous cyst orginates after the crown of the
tooth completely formed by acclumation of fluid between the
reduced enamel epithelium and the tooth crown.
Dentigerous cyst may enlarges at the expenses of
maxillary bone and displace canine higher in the maxilla.
Potential complication of dentigerous cyst
a) ameloblastoma
b) Epidermoid Carcinoma
c) MucoEpidermoid carcinoma
6) Resorption ofLateral incisor root:
This progress of undesirable phenomenon depends on
eruptive movement of the impacted canine. If the impacted tooth
is removed or redirected the resorption process usually ceases.
59. TIME TO EXTRACT CANINE
1. Ankylosed and cant be transplanted.
2. External and internal root resorption
3. Dilacerated root
4. If impaction is severe such that canine lodges between
the roots of central and lateral incisors and the orthodontic
movement will Jeopardizes adjacent teeth.
5. Occlusion is acceptable with 1st
premolar in canine
place.
6. If any severe pathologic changes {Cyst,Infection}
7. If patient does not desire orthodontic
60. Conclusion:
Thus management of the impacted canine is one of
the greatest challenge for orthodontist. Success of the treatment
depends upon patient cooperation, Age of patient, Proper
diagnosis, Level of canine impaction, Inclination and Depth of
impaction, Amount of root formation, Type of exposure of tooth,
Amount of bone removal, Type of attachment, Orthodontic
traction. All these parameter plays important role when managing
impacted canines to achieve good canine alignment in the arch
with canine guided occlusion, Gingival level, and Integrity of
periodontium.