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SHY CANINE
“Unveiling The Hidden”

Author: Theertha Sudhakaran (CRRI)
Guide: Dr. Ashwin Mathew George
Department of Orthod...
IMPACTION
• Impacted tooth is one that fails to erupt and will not
attain its anatomical position beyond the chronological...
• Canines play a role in functional occlusion and form the
foundation of an esthetic smile.

• As such, any factors that i...
IMPACTED CANINE
• Impaction of maxillary and mandibular canines is a
frequently encountered clinical problem.
• Maxillary ...
INCIDENCE
•

Maxillary canine impaction occurs in approximately 2%
of the population.

• Twice as common in females as it ...
• . The prevalence of impacted maxillary canines varies and is
reported as follows: 2%, 0.9% to 2%, 1% to 2%, 1.5% to
2%, ...
ETIOLOGY OF IMPACTED CANINE

•LOCALIZED
•SYSTEMIC

•GENETIC
LOCALIZED
Tooth size- arch length discrepancies

Failure of the primary canine root to resorb

Prolonged retention or earl...
LOCALIZED
Dilaceration of the root

Absence of maxillary lateral incisor
Variation in timing of lateral incisor root
forma...
SYSTEMIC
Endocrine deficiencies
Febrile diseases
Irradiation
GENETIC
Heredity
Malposed tooth germ
Presence of alveolar cleft
THEORIES OF CANINE
IMPACTION

GUIDANCE THEORY
GENETIC THEORY
GUIDANCE
THEORY

• Canine erupts along the root of
lateral incisors, which serve as a
guide, and if the lateral incisor is...
GENETIC
THEORY

• Genetic factors are primary origin
of palatally displaced maxillary
canine and include other possibly
as...
SEQUELAE OF IMPACTED
CANINE
Labial or lingual
malpositioning of
impacted tooth

Dentigerous cyst
formation

Migration of
n...
CLINICAL EVALUATION
Study model
analysis
Morphology of
adjacent tooth

• Amount of space available in dental arch
for impa...
RADIOGRAPHIC EXAMINATION
• Indicated in individual with unerupted and non-palpable
canines after the age of 11 years.
• IN...
INTRAORAL VIEWS

IOPA
• Clark’s rule tube shift technique.
• Locates canine positioned buccally or palatally to
other teet...
EXTRAORAL VIEWS

OPG
• Used to localize impacted teeth in all
three planes.

LATERAL CEPHALOMETRICS
• Realtionship of impa...
3 DIMENTIONAL IMAGING
• 3-dimensional imaging modalities provide a volume of
information that can be used to assess and lo...
CT
• Superior diagnostic tool.
• Early detection of root resorption.
• Accurate localization of impacted canine and
visual...
CBCT
• Identify and locate the position of impacted canine
accurately.
• Dentists can assess any damage to adjacent tooth
...
DETERMINING THE PROGNOSIS
• FACTORS INFLUENCING THE TREATMENT DECISION OF AN
IMPACTED CANINE

Age of patient

Availability...
POSITION OF CANINE
•

CANINE ANGULATION TO MIDLINE.

•

VERTICAL HEIGHT OF IMPCATED CANINE.
•

POSITION OF THE CANINE APEX RELATIVE TO THE ADJACENT TEETH.

•

MESIODISTAL POSITION OF CANINE TIP TO ADJACENT TOOTH.
MANAGEMENT OF
IMPACTED CANINE
Interceptive treatment.
Treatment of labial impaction.
Treatment of palatal impaction

Metho...
INTERCEPTIVE TREATMENT
• When the clinician detects early signs of ectopic
eruption of canines, an attempt should be made ...
LABIAL IMPACTION OF UPPER
CANINE
• Due to ectopic migration of canine crown over the root
of lateral incisor or insufficie...
Labial
impaction

Initial orthodontic treatment was aimed
at creating space in the maxillary arch
with fixed appliance the...
SURGICAL EXPOSURE
• Indicated when tooth does not erupt spontaneously
after creating space in the arch.
• Attempted 6 mont...
OPEN TECHNIQUE
Canine crown
coronal to
mucogingival
junction

• Excisional approach

Canine crown
apical to
mucogingival
j...
CLOSED ERUPTION TECHNIQUE
• Indicated if tooth is impacted in the centre of the
alveolus.
Flap is elevated
Attachment plac...
PATIENT 1
PRE OP

POST OP

PRE OP
POST OP
PERIODONTAL CONSIDERATION
• Excisional technique must be parformed only when
sufficient gingiva is present, to provide atl...
PALATAL IMPACTION OF UPPER
CANINE
CLOSED
ERUPTION

• Crown is surgically exposed, an attachment is bonded
during the expos...
PATIENT 2
PRE OP

POST OP

PRE OP

POST OP
METHODS OF APPLYING
TRACTION
•

Force elements
Ligature wire
Rubber bands
Elastomeric chains
Elastic threads
• Ballista springs (mouse trap loops)

• Magnetic forces
• Eyelet attachment

• TMA sectional arch wire
• Miniimplants

• Elastic traction using lower fixed or removable
appliance as anchorage.
TUNNEL TRACTION TECHNIQUE
• For aligning deep infraosseous impacted
canines.
• Osseous tunnel provided towards the centre ...
RETENTION CONSIDERATION
Relapse of rotations and spacing may occur after completion of the
orthodontic treatment of an imp...
CONCLUSION
• Various surgical and orthodontics techniques may be used to
recover impacted maxillary canines.
• Proper mana...
ACKNOWLEDGEMENT
• GUIDE Dr Ashwin Mathew George, Professor & Head
:

•

Dr. V. Sudhakar, Reader

•

Dr Shrinivaasan N. R, ...
canine impaction
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canine impaction

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canine impaction

  1. 1. SHY CANINE “Unveiling The Hidden” Author: Theertha Sudhakaran (CRRI) Guide: Dr. Ashwin Mathew George Department of Orthodontics Sathyabama University Dental College & Hospital
  2. 2. IMPACTION • Impacted tooth is one that fails to erupt and will not attain its anatomical position beyond the chronological eruption date even after its root completion.
  3. 3. • Canines play a role in functional occlusion and form the foundation of an esthetic smile. • As such, any factors that interfere with the normal development of canines and their eruption can have serious consequences
  4. 4. IMPACTED CANINE • Impaction of maxillary and mandibular canines is a frequently encountered clinical problem. • Maxillary canines are the most commonly impacted teeth, second only to third molars.
  5. 5. INCIDENCE • Maxillary canine impaction occurs in approximately 2% of the population. • Twice as common in females as it is in males. • The incidence of canine impaction in the maxilla is more than twice that in the mandible. • Of all patients who have impacted maxillary canines, 8% have bilateral impactions.
  6. 6. • . The prevalence of impacted maxillary canines varies and is reported as follows: 2%, 0.9% to 2%, 1% to 2%, 1.5% to 2%, 1% to 3%, with a palatal location 85% of the time and a labial location 15% of the time. • Unlike buccal displacement of maxillary canines, palatal displacement of maxillary canines, and the frequent ensuing impaction, most often occurs in cases in which adequate perimeter arch space exists.
  7. 7. ETIOLOGY OF IMPACTED CANINE •LOCALIZED •SYSTEMIC •GENETIC
  8. 8. LOCALIZED Tooth size- arch length discrepancies Failure of the primary canine root to resorb Prolonged retention or early loss of primary canine Ankylosis of permanent canine Cyst or neoplasm
  9. 9. LOCALIZED Dilaceration of the root Absence of maxillary lateral incisor Variation in timing of lateral incisor root formation Iatrogenic factors Idiopathic factors
  10. 10. SYSTEMIC Endocrine deficiencies Febrile diseases Irradiation
  11. 11. GENETIC Heredity Malposed tooth germ Presence of alveolar cleft
  12. 12. THEORIES OF CANINE IMPACTION GUIDANCE THEORY GENETIC THEORY
  13. 13. GUIDANCE THEORY • Canine erupts along the root of lateral incisors, which serve as a guide, and if the lateral incisor is absent or malformed, the canine will not erupt.
  14. 14. GENETIC THEORY • Genetic factors are primary origin of palatally displaced maxillary canine and include other possibly associated dental anomalies, such as missing or small lateral incisor.
  15. 15. SEQUELAE OF IMPACTED CANINE Labial or lingual malpositioning of impacted tooth Dentigerous cyst formation Migration of neighbouring teeth and loss of arch length Infection particularly with partial eruption Internal resorption or external root resorption of impacted or neighbouring tooth Referred pain
  16. 16. CLINICAL EVALUATION Study model analysis Morphology of adjacent tooth • Amount of space available in dental arch for impacted canine is assessed in model. • Gives clue of position of impacted tooth. Contours of adjacent • Canine bulge present buccally or palatally. alveolar bone Mobility of adjacent tooth • Root resorption.
  17. 17. RADIOGRAPHIC EXAMINATION • Indicated in individual with unerupted and non-palpable canines after the age of 11 years. • INTRA ORAL RADIOGRAPHS • IOPA • Occlusal • EXTRAORAL RADIOGRAPHS • OPG • Lateral cephalometric • DIGITAL IMAGING • CT • CBCT
  18. 18. INTRAORAL VIEWS IOPA • Clark’s rule tube shift technique. • Locates canine positioned buccally or palatally to other teeth in the arch. OCCLUSAL RADIOGRAPHS • Determining position of canines relative to the midline. A periapical, panoramic, or occlusal view will not reveal the presence of a canine that is outside their fields of view.
  19. 19. EXTRAORAL VIEWS OPG • Used to localize impacted teeth in all three planes. LATERAL CEPHALOMETRICS • Realtionship of impacted canine with other facial structures can be studied. superimposition in the anterior and palatal regions of the maxilla may mask the presence of a canine. In addition, the canine may not be adequately visualized with conventional imaging to correctly identify its position.
  20. 20. 3 DIMENTIONAL IMAGING • 3-dimensional imaging modalities provide a volume of information that can be used to assess and localize teeth within the entire maxilla and adjacent regions without the limitation of visualization with superimposed structures.
  21. 21. CT • Superior diagnostic tool. • Early detection of root resorption. • Accurate localization of impacted canine and visualization of associated structures.
  22. 22. CBCT • Identify and locate the position of impacted canine accurately. • Dentists can assess any damage to adjacent tooth roots and amount of bone surrounding each tooth .
  23. 23. DETERMINING THE PROGNOSIS • FACTORS INFLUENCING THE TREATMENT DECISION OF AN IMPACTED CANINE Age of patient Availability of space Favourable position of canine Presence of adequate width of attached gingiva
  24. 24. POSITION OF CANINE • CANINE ANGULATION TO MIDLINE. • VERTICAL HEIGHT OF IMPCATED CANINE.
  25. 25. • POSITION OF THE CANINE APEX RELATIVE TO THE ADJACENT TEETH. • MESIODISTAL POSITION OF CANINE TIP TO ADJACENT TOOTH.
  26. 26. MANAGEMENT OF IMPACTED CANINE Interceptive treatment. Treatment of labial impaction. Treatment of palatal impaction Methods of applying traction. Retention consideration.
  27. 27. INTERCEPTIVE TREATMENT • When the clinician detects early signs of ectopic eruption of canines, an attempt should be made to prevent their impaction and its potential sequelae. • Selective extraction of the deciduous canines as early as 8 0r 9 years of age. • Normalize the eruption of ectopicaly erupting permanent canine.
  28. 28. LABIAL IMPACTION OF UPPER CANINE • Due to ectopic migration of canine crown over the root of lateral incisor or insufficient space in the arch caused by midline shift of dental origin. • Arch length- tooth material discrepancy is the most common cause. • Extraction of deciduous canine at early age of 8 or 9 years will enhance eruption and self correction of labial impaction.
  29. 29. Labial impaction Initial orthodontic treatment was aimed at creating space in the maxillary arch with fixed appliance therapy. Surgical exposure and orthodontic traction.
  30. 30. SURGICAL EXPOSURE • Indicated when tooth does not erupt spontaneously after creating space in the arch. • Attempted 6 months after the root formation • Flap designs should preserve the band of attached gingiva and should guide tooth to erupt through its natural path of eruption.
  31. 31. OPEN TECHNIQUE Canine crown coronal to mucogingival junction • Excisional approach Canine crown apical to mucogingival junction • Apically positioned flap
  32. 32. CLOSED ERUPTION TECHNIQUE • Indicated if tooth is impacted in the centre of the alveolus. Flap is elevated Attachment placed on impacted tooth Ligature or chain placed over the attachment to activate after a week Raised flap is repositioned in its original location Permit eruption of impacted canine in normal direction
  33. 33. PATIENT 1
  34. 34. PRE OP POST OP PRE OP POST OP
  35. 35. PERIODONTAL CONSIDERATION • Excisional technique must be parformed only when sufficient gingiva is present, to provide atleast 2-3mm of attached gingiva over the canine crown after it has erupted. • If crown is positioned mesially and over the root of the lateral incisor, the crown should be exposed completely with an apically positioned flap.
  36. 36. PALATAL IMPACTION OF UPPER CANINE CLOSED ERUPTION • Crown is surgically exposed, an attachment is bonded during the exposure, flap is sutured back, leaving a twisted ligature wire passing through the mucosa to apply orthodontic traction. OPEN WINDOW ERUPTION TECHNIQUE • A flap is raised, bone covering crown is removed, small window or fenestration is made, orthodontic attachment is bonded and flap is sutured in to place.
  37. 37. PATIENT 2
  38. 38. PRE OP POST OP PRE OP POST OP
  39. 39. METHODS OF APPLYING TRACTION • Force elements Ligature wire Rubber bands Elastomeric chains Elastic threads
  40. 40. • Ballista springs (mouse trap loops) • Magnetic forces
  41. 41. • Eyelet attachment • TMA sectional arch wire
  42. 42. • Miniimplants • Elastic traction using lower fixed or removable appliance as anchorage.
  43. 43. TUNNEL TRACTION TECHNIQUE • For aligning deep infraosseous impacted canines. • Osseous tunnel provided towards the centre of the alveolar ridge. • Socket of deciduous canine can be used as tunnel, for movement of impacted canine.
  44. 44. RETENTION CONSIDERATION Relapse of rotations and spacing may occur after completion of the orthodontic treatment of an impacted canine.  SUPRACRESTALFIBROTOMY  FIXED RETAINERS  REMOVAL OF HALF MOON SHAPED WEDGE OF TISSUE ( To prevent lingual drift of palatally impacted canine)
  45. 45. CONCLUSION • Various surgical and orthodontics techniques may be used to recover impacted maxillary canines. • Proper management of these teeth requires appropriate surgical techniques to apply forces in a favourable direction and to have complete control for efficient correction, thereby avoiding damage to the adjacent teeth. • The management of impacted canine is a complex procedure requiring a multidisciplinary approach. • The clinician should communicate with each other to provide the patient with an optimal treatment plan based on scientific rationale.
  46. 46. ACKNOWLEDGEMENT • GUIDE Dr Ashwin Mathew George, Professor & Head : • Dr. V. Sudhakar, Reader • Dr Shrinivaasan N. R, Senior lecturer • Dr Xavier, Senior lecturer • Dr Navaneetha, Senior lecturer DEPT OF ORTHODONTICS.

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