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
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.for more details please visit
www.indiandentalacademy.com
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
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.for more details please visit
www.indiandentalacademy.com
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
presentation about impacted canine incidence, prevalence,classification,diagnosis, localization and treatment options including surgical and non surgical modalities
Buccolingual malrelationship of upper and lower
teeth.Anterior or posterior (unilateral or bilateral) with or
without mandibular displacement.
Buccal crossbite: Lower teeth occlude buccal to
corresponding upper teeth .
Lingual crossbite (scissors bite): Lower teeth occlude
lingual to palatal cusps of upper teeth.
Description :
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.
presentation about impacted canine incidence, prevalence,classification,diagnosis, localization and treatment options including surgical and non surgical modalities
Buccolingual malrelationship of upper and lower
teeth.Anterior or posterior (unilateral or bilateral) with or
without mandibular displacement.
Buccal crossbite: Lower teeth occlude buccal to
corresponding upper teeth .
Lingual crossbite (scissors bite): Lower teeth occlude
lingual to palatal cusps of upper teeth.
Description :
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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 / 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
Maxillary canine impaction 02 /certified fixed orthodontic courses by Indian ...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
0091-9248678078
The maxillary canine is the second most impaction of the oral cavity and this presentation I describe some etiology the interfere of normal eruption path of the maxillary canine.
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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
Dr. William Roth
Introduction
The Roth Rx
Reasons For Modification
Treatment Philosophy
Treatment Goals
Roth Rationale
Selection Of Treatment Mechanics
Roth Set-up
Sequencing Of Treatment Objectives
Treatment Mechanics
Anchorage Considerations
Detailing Of Tooth Position
Advantages
Comparisons
Conclusions
Introduction
History
Indications and contraindications
Timing of distalization
Second molar extraction
Mandibular molar distalization
Rickett’s criterion
Classification and various distalization appliances
References
Introduction.
Umbrella concept
Principles of Bioprogressive therapy.
Visual treatment objective.
Orthopedics in Bioprogressive therapy.
Forces used in Bioprogressive therapy.
Sectional and utility arches.
Synopsis of extraction and non-extraction treatment mechanics.
Bioprogressive therapy appliances
Conclusion
Introduction
Historical Perspectives
Creation of tip-edge
Tip –edge concepts
Bonding and setting up
Treatment stages
Stage I
Stage II
Torque in tip-edge
Stage III
Advantages
Disadvantages
Case reports
Articles
Conclusion
References
Airway analysis and its relevance in orthodonticsMiliya Parveen
Introduction
Anatomy
Naso – respiratory function and craniofacial growth
Methods of analysis
Clinical examination
Otorhinolaryngology tests for upper airway
Supplementary examinations
LC
CBCT
Airway and skeletal patterns
Obstructive Sleep Apnoea
Mouth breathing
Effect of orthodontics on airway
Extraction cases
Expansion
Mandibular advancement
Orthognathic surgery
Adenoidectomy or tonsillectomy
Role of orthodontist
Conclusion
Molecular and ultracellular basis of orthodontic tooth movementMiliya Parveen
Contents -
Introduction
Response to normal function
Response to Continuous Pressure
Force for Orthodontic Tooth Movement
Modes of Orthodontic Tooth Movement
Hyalinization
Role of Piezoelectric Current
Theories of orthodontic mechanisms
Phases of tooth movement
Pathways of tooth movement
Signaling molecules and metabolites in orthodontic tooth movement
Role of Cytokines, Growth Factors and Transcription Factors
Role of Prostaglandins
Cellular networking in tooth remodeling
The intracellular second-messenger systems
Role of Vitamin D and diacylglycerol
RANK RANKL/OPG pathway
Sequence of events after force application
Changes in PDL
Changes in Gingiva
Markers For Orthodontic Tooth Movement
Conclusion
Treatment of class 3 malocclusion using MBT bracket prescription/system.
Contents -
Introduction
Accurate Record-taking
Mandibular Prognathism or Maxillary Retrognathism
Timing Of Class III Treatment
Surgical/Non-surgical Decision In Class III Treatment
The Posterior 'Squeezing Out' Effect
Class III Mechanics
Four-stage Treatment Planning Process
Orthognathic treatment of Class III malocclusion
Surgical treatment of Class III malocclusion
Case reports
A quick overview of all components that make up the aesthetic considerations during orthodontic treatment.
Contents -
Introduction
History
Records for studying esthetics
Smile design wheel
Macro-aesthetics
Mini-aesthetics
Deep Overbite correction
Treatment of gummy smiles
Micro-aesthetics
Elements of a balanced smile
Six horizontal lines
Canine to lateral incisor
Premolar to canine
Influence of extractions on smile esthetics
Conclusion
Introduction
Essential Diagnostic Aids
Supplemental Diagnostic Aids
Study Cast Analysis
Dental Arch Width
Pont’s Index
Anterior Dental Arch Length
Korkhaus’ Analysis
Intramaxillary Symmetry
Palatal Height
Analysis Of Supporting Zones
Space Analysis
Nance Analysis
Lundstrom Segmental Analysis
Analysis In The Vertical Plane
Bolton Analysis
Analysis Of The Apical Base
Examination Of Occlusion
Overview of Diagnostic Aids
Case History and Clinical Examination- General examination
Extra-oral examination
Functional examination
Photographic Analysis
Overall description of bone metabolism.
Introduction
Types of bone tissue
Composition of bone
Cells of bone
Regulators of bone metabolism
Calcium and phosphate balance
Calcium and phosphate
Parathyroid hormone
Calcitonin
Vitamin D
Fibroblast growth factor
Growth hormone and IGF-1
Thyroid hormone
Estrogens, progesterone and androgens
Cortisol and related glucocorticoids
Disorders of bone metabolism
Orthodontic considerations
Growth rotations in relation to Orthodontics.
Determining rotational growth changes
Mandibular rotations
Clinical significance of Rotation :
Relationship between Condylar growth and Rotations
Relationship between Dentition and Rotations
Relationship between Chin position and Rotations
Prediction of Rotation
Prediction by the structural method
Reliability of prediction
Maxillary rotations
Maxillary Rotational Patterns:
Cranial base rotations
Interrelationship between rotation of skeletal components
Orthodontics and Rotation
Treatment protocol
Embryology is necessary to understand the growth of various anatomical structures pertinent to orthodontics and will help understand the anomalies associated with its maldevelopment.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. CONTENTS
• 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
3. INTRODUCTION
• An impacted tooth is defined as tooth whose roots are 2/3rd or fully
developed but nevertheless expected to erupt spontaneously.
• According to Shafer, Hine and Levy, impacted teeth are those which
are prevented from erupting by some physical barrier in the eruption
path.
• An impacted or unerupted canine tooth is usually easy to diagnose,
but the skill and expertise of the general practitioner, the
pedodontist, the oral surgeon, the periodontist as well as the
orthodontist are needed, to bring it, to its proper position.
4. INCIDENCE
• Mandibular third molar -- Maxillary canine -- mandibular second
premolar.
• Impacted maxillary canines are seen in 2% of the population
• Palatal canine impaction is more common (85%) than buccal canine
impaction.{Jacoby 3:1}. A ratio of twelve palatably impacted canines
for one labially impacted canine (Jaloby)
• It is twice as more common in females than males.
• Of all patients with impacted maxillary canines, 8% have bilateral
impactions.
• Incidence of maxillary canine impaction : 1.7% (Ericson)
• Incidence of mandibular canine impaction 0.35% (Dachi)
5. DEVELOPMENT
According to Broadbent, AO 1941-
• Canine develops at 4 – 5 months of age between the roots of
deciduous 1st molar.
• Calcification of canine - around 12 months of age.
• Calcification takes place far above the roots of deciduous molar,
allowing development of the first premolar between the deciduous
molar roots.
6. ERUPTION OF CANINE
• Dewel (1949) stated that “no tooth is more
interesting from the development point of
view than the maxillary canine”
• Canine develops in deepest area of maxilla
has the most tortuous course and longest path
of eruption (22mm) during its course or
eruption and has longest period of
development.
• During their course of development, the
crowns of the permanent canines are
intimately related to the roots of the lateral
incisors.
7. • A periapical view shows the unerupted
permanent canine crowns, of each side,
pointing mesially towards the lateral incisor
apical area - causing the apical convergence
of the incisor roots and the median diastema
doesn’t close completely.
• The permanent canine alters its relationship
as it moves downwards along the distal side
of the root of the lateral incisor, uprighting
the long axis of that tooth – it then becomes
more vertical as it progresses and as the root
of the deciduous canine becomes resorbed.
8. • With the shedding of the deciduous canine, it finally erupts with a
slight mesial inclination, taking up its place in the arch by moving
the crowns of the incisors towards the midline, to close off the
diastema completely.
• Throughout the period of its downward progress, the permanent
canine is conspicuously palpable on the buccal side of the alveolar
ridge, from as early as 2-3 yrs period to its normal eruption, which
normally occurs at the age of 11-13 yrs.
9. ETIOLOGY
• Becker Concept:
Becker (1984) hypothesized two processes in the palatal impaction of
the maxillary canine - Absence of initial early guidance from an
anomalous lateral incisor, and later failure of buccal movement of the
canine at an unspecified age {9 years}.
• Moyer’s etiology of Maxillary Canine Impaction (Multifactorial):
Bishara summarised Moyer's theory that the causative factors may be -
1. Primary (Localized)
(a) Tooth size-arch length discrepancies.
(b) Prolonged retention or early loss of deciduous canine.
(c) Abnormal position of the tooth bud (rotation of tooth buds).
(d) Trauma to the deciduous tooth bud.
10. (e) Disturbances in the tooth eruption sequence.
(f) Presence of an alveolar cleft.
(g) Ankylosis
(h) Cystic or neoplastic formation
(i) Dilaceration of the root
(j) Premature root closure
(k) Iatrogenic
(l) Idiopathic
2. Secondary (Generalised)
(a) Abnormal muscle pressure
(b) Febrile diseases
(c) Endocrine disturbances
(d) Vitamin D deficiency
(e) Irradiation.
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
• Vonder Heydt Concept:
Total arch length of permanent teeth is initially established very early in
life at the true of eruption of first permanent molars. Canine is larger
and later erupting and considering like a musical chair situation it may
get impacted.
Reason for eruption of canine labially is arch length deficiency.
12. MC Bridge Concept:
Canine formed at high in the anterior wall at antrum, below the floor
of orbit, its long tortous path of eruption is the reason for impaction.
Peck and Peck Concept:
Characteristics of palatally impacted canines include,
1) Occurrence of other dental anomalies - 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
They concluded palatally impacted canine as dental anomaly of
genetic origin.
13. Guidance Theory – Miller:
Canines usually have a more mesial development path, which is guided
downwards apparently along the distal and aspect of the lateral incisor
roots.
- FIRST STAGE IMPACTION: If there is a loss of guidance due to missing
lateral incisors or late developing laterals, canines will have a mesial
and palatal path of eruption. In this event there is no vertical movement
of canine into the alveolar process, resulting in a more horizontal
impaction.
FIRST STAGE IMPACTION AND SECONDARY CORRECTION: Once it has
reached the palatal alveolar process, canine is redirected to a more
favorable path of eruption.
- SECOND STAGE IMPACTION: Self correction is prevented by, late
developing lateral incisors (peg laterals) which re-deflect 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. LABIAL CANINE IMPACTION
In Arch length deficiency,
1. Canine will have contact with crown or root at lateral incisors, first
premolar and deciduous canine.
2. Canine is surrounded by anterior wall of maxillary sinus, and nasal
cavity.
So it is impossible for canine to jump in to or behind tooth or
penetrating to nasial cavity or sinus - impacted labially.
PALATAL CANINE IMPACTION
Canine can be palatally positioned if extra space available in maxillary
bone space due to,
1. Excessive growth in the base of maxillary bone
2. Agencies of lateral incisors
3. Peg shaped lateral incisors
4. Stimulated eruption of lateral incisors or 1st premolars.
15. SEQUELAE OF IMPACTION
• The normal sized and early developing lateral incisor root obstructs the
deviated eruption path of canine - damaged by resorption.
• Anomalous lateral incisors (peg shaped & or small mesiodistal crown
width) have small and late developing roots - more easily bypassed
18. • 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
• Archer’s canine impaction classification -
19. • 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
• Class V:
Edentulous maxilla
• Class VI:
Aberrant position
20. • Classification of palatally impacted canine
• Based on two variables:
(1) Transverse relationship of the crown of the tooth to the line of
dental arch which may be -
(a) Close
(b) Distant (nearer the midline)
(2) Height of the crown of the teeth in relation
to the occlusal plane which may be
(a) High
(b) Low
21. • Group 1
Proximity to the line of arch – close.
Position in the maxilla – low.
• Group 2
Proximity to the line of arch – close.
Position in the maxilla – forward , low & mesial to
the lateral incisor root.
22. • Group 3
Proximity to the line of arch – close.
Position in the maxilla – high.
• Group 4
Proximity to the line of arch – distant.
Position in the maxilla – high.
23. • Group 5
Canine root apex mesial to that of lateral
incisor or distal to that of first premolar.
• Group 6
Erupting in the line of arch in place and
resorbing the roots of incisors.
24. DIAGNOSIS
IMPACTED OR PREMATURLEY ERUPTED?
• Gron(1962) stated that under normal circumstances a tooth erupts with a
developing root and with approx. three quarters of its final root length.
• The mandibular central incisors and first molars have marginally less
root development and mandibular canines and second molars marginally
more when they erupt.
• Thus should an erupted tooth have less root development, it would be
appropriate to label it as prematurely erupted.
• At the opp. end of the scale, we find the un-erupted tooth that exhibits a
more completed developed roots, the normal eruption process of this
tooth must be presumed to be impeded.
25. CLINICAL EVALUATION:
The following signs might be indicative of canine impaction.
1. Delayed eruption of the permanent canine or prolonged retention of
the deciduous canine beyond 14 to 15 years of age.
2. Absence of a normal labial canine bulge.
3. Presence of a palatal bulge.
4. Delayed eruption, distal tipping or migration(splaying) of the
lateral incisor.
26. RADIOGRAPHIC EVALUATION:
1. Periapical films:
The first, simplest and most informative X-ray.
- Advantages,
1) Root development, pattern and integrity
2) Crown resorption
3) Root resorption of adjacent tooth
4) Minimun of surrounding tissue is exposed which increases accuracy
and resolution.
5) Minimal radiation exposure
- Disadvantages,
1) Two dimensional representation which gives no information
regarding buccolingual plane
2) Overlapping structures cannot be differentiated as to which is lingual
and which buccal.
27. a) Tube Shift Technique
- Two periapical films are taken of the same area with the horizontal
angulation of the cone changed when the second film is taken. If the
object in question moves in the same direction as the cone - lingually
positioned. If the object moves in the opposite direction it is situated
closed to the source of radiation - buccally located.
- Disadvantage: In cases when canine is highly placed, and periapical
film shows no superimposition of canine with the roots of erupted tooth
or when superimposition is only in the periapical region, the result may
be misleading.
28. b) Buccal Object rule
If the vertical angulation of the cone is changed by approximately
20o in two successive periapical films, the buccal object will
move in the direction opposite to the source of radiation. On the
other hand, the lingual object will move in the same direction as
the source of radiation. The basic principle of this technique
deals with the foreshortening and elongation of the images of the
films.
29. 2. Occlusal films
- To determine the buccolingual position of the impacted canine
(provided the image of the impacted canine is not superimposed on the
other teeth)
- In this view the central ray of X-ray beam runs parallel to long axis of
central incisors. Exposure is done through the vertex i.e 110º to the
occlusal plane.
- When the radiograph is viewed the anteriors are seen as small tiny
concentric circles. If the impacted tooth is not parallel to neighbouring
tooth, depend on angulation of long axis of the tooth it will be elliptical
or oblique in cross section.
- If tooth is horizontal, its full length will be seen.
30. 3. Extra Oral films:
- Frontal and lateral cephalograms for
determining the position of the impacted
canine, particularly its relationship to other
facial structures (eg. Maxillary sinus and the
floor of the nose)
- Panoramic films to localize impacted teeth in
all 3 planes of space (much the same as with 2
periapical films in the tube shift method, with
the understanding that the source of radiation
come from behind the patient , thus the
movements are reversed for position)
31. - In OPG, when mesiodistal width of canine crown was 1.5 times larger
(i.e. 15% larger) than the adjacent central incisor, then the canine is
palatally placed.
- This is only true in cases where canine should not be at a higher level.
[Reliability of a method for localisation of displaced maxillary canines using a
single panoramic radiograph. Chaushu et al; clin orthod res 1999; 2: 194-9]
32. 4. CT Scanning:
- Clear radiograph can taken at graduated depth in any part of the human
body. By viewing serial radiograph slices of the maxilla, the relationship
of the impacted tooth to adjacent teeth in all the three plane of space can
be accurately assessed.
- Root resorption can be assessed.
- Superimposition of structures doesn’t obscure the image.
Disadvantage: Expensive, large dose of radiation to be justified.
33. 5. Rapid prototyping:
- Comprises several technologies that
use data from computer-aided design
files to produce physical models and
devices by a process of material
addition.
- This made possible the fabrication
of an attachment for forced canine
eruption.
- Rapid prototyping dental modeling
might become the diagnostic
procedure of choice in the evaluation
of impacted maxillary canines
34. • Ericson and Kurol in EJO 1988 defined number of
sectors to denote different types of impaction -
i. Sector 1: if the cusp tip of the canine is
between the interincisor median line and the
long axis of the central incisor;
ii. Sector 2: if the peak of the cuspid of the canine
is between the major axes of the lateral and
central;
iii. Sector 3: if the peak of the cuspid of the canine
is between the major axis of the lateral and the
first premolar.
RADIOGRAPHIC PREDICTION
35. • They used angle “α” to represent the angle formed between the
interincisor midline and long axis of canine.
The risk of resorption of the root of the lateral incisor increases by
50% if the cusp of the canine belongs to sector 1 or 2 and if α
angle is greater than 25°.
The duration of treatment is longer if the canine is found in sector
1, shorter if it belongs to sector 3, with respect to sector 2.
The necessity of treatment and the degree of treatment difficulty
increases as this angle increases.
36. • Modification of Ericson & Kurol’s definition of sectors used:
i. Sector I: Located distal to a tangent to the distal crown & root of the
lateral incisor.
ii. Sector II: The area from the tangent on the distal surface to a midline
bisector of the lateral incisor tooth.
iii. Sector III: The area from the midline bisector to a tangent to the
mesial surface of the lateral incisor crown & root.
iv. Sector IV: All areas mesial to sector III.
Steven Lindauer et al. JADA March 1992. Canine Impaction identified early with
Panoramic Radiographs
37. • Study done by Stivaros and Mandall to investigate the radiographic
factors that influence the orthodontists decision to expose align or
remove an impacted tooth panoramic radiographs. (JO 2000)
38. 1. Canine angulation to the midline
- Grade 1: 0–15°
- Grade 2: 16–30°
- Grade 3: >31°
2. Vertical Canine Crown Height
- Grade 1: Below the level of the CEJ
- Grade 2: Above the CEJ, but less
than half way up the root.
- Grade 3: More than half way up the
root, but less than the full root length.
- Grade 4: Above the full length
of the root.
39. 3. Position of Canine Root Apex Antero-
posteriorly
- Grade 1: Above the region of the canine
position.
- Grade 2: Above the upper first premolar
region.
- Grade 3: Above the upper second premolar
region.
The vertical height from canine tip to the
occlusal plane ( > 15mm - poor prognosis).
4. Canine Overlap of the Adjacent Incisor
Root
- Grade 1: No horizontal overlap.
- Grade 2: Less than half the root width.
- Grade 3: More than half, but less than the
whole root width.
- Grade 4: Complete overlap of root
width or more.
40. PROGNOSIS
• Before the treatment decision was made, a number of diagnostic
patient and radiographic factors would have to be considered
including:
(1) Patient age - The upper age limits suggested for successful
alignment of an ectopic canine include 16 (McSherry, 1996) and
20 (Nordenram, 1987) years of age.
(2) General dental health and oral hygiene
(3) Whether space is available in the arch or can be made available
for alignment of the permanent canine - In 85 per cent of subjects
with palatal displacement of a canine there is adequate space in
the arch (Jacoby, 1983), whilst in crowded arches the canine is
more likely to erupt in a buccal position (Oliver et al., 1989).
41. (4) Suitability of the first premolar to replace a permanent canine
(5) Patient motivation for orthodontic appliances
(6) Medical contra-indications for surgery.
(7) Position of canine –
As canine angulation to the midline
increases so does the likelihood of
removal rather than attempted
alignment.
Palatally impacted canines more
likely to be exposed, and those in
the line of the arch or buccally
positioned more likely to be
removed (increased problems of
managing the attached gingivae)
Higher above the occlusal plane the
canine is positioned, the poorer the
prognosis for alignment
42. PREVENTION OF MAXILLARY
CANINE IMPACTION
• When the clinician detects early signs of ectopic eruption of the
canines, an attempt should be made to prevent their impaction and its
potential sequelae.
• Selective extraction of the deciduous canines as early as 8 or 9 years of
age has been suggested by Williams as an interceptive approach to
canine impaction in Class I uncrowded cases.
• Ericson and Kurol suggested that removal of the deciduous canine
before the age of 11 years will normalize the position of the ectopically
erupting permanent canines in 91% of the cases if the canine crown is
distal to the axis of the lateral incisor. Success rate is only 64% if the
canine crown is mesial to the midline of the lateral incisors.
43. • Vertical canine angulation exceeding 31° relative to the midline
decreased success rates significantly.
• After extraction of the primary canines only 65% of the palatally
displaced canines have been found spontaneously erupted.
• The success rate would improve to 88% by the addition of forces to
prevent mesial migration of the maxillary posterior teeth after
extraction, i.e., the use of cervical-pull headgear.
44. (1) If it is ankylosed and cannot be transplanted
(2) If it is undergoing external or internal root resorption
(3) If its root is severely dilacerated,
(4) If the impaction is severe (e.g., The canine is lodged between the
roots of the central and lateral incisors and orthodontic movement will
jeopardize these teeth)
(5) If the occlusion is acceptable, with the first premolar in the
position of the canine and with an otherwise functional occlusion with
well-aligned teeth
(6) there are pathologic changes (e.g., cystic formation, infection), and
the patient does not desire orthodontic treatment.
EXTRACTION OF IMPACTED CANINES
45. TREATMENT ALTERNATIVES
1. No treatment if the patient does not desire it. In such a case, the
clinician should periodically evaluate the impacted tooth for any
pathologic changes but long term prognosis for retaining the
deciduous canine is poor, regardless of its present root length and
the esthetic acceptability of its crown.
2. Auto transplantation of the canine. Due to a high possibility of
pulp necrosis, endodontic treatment of fully developed transplanted
teeth should be undertaken. Recipient socket should be prepared to a
size that is slightly larger than the root of the donor tooth.
3. Extraction of the impacted canine and movement of a first
premolar in its position.
46. 4. Extraction of the canine and posterior segmental osteotomy to
move the buccal segment mesially to close the residual space, which
is a tedious surgical procedure.
5. Prosthetic replacement of the canine, not amenable for juvenile
patients.
6. Transalveolar transplantation of maxillary canines was reported by
Soren Sagne et al., in AJODO ’86 - during this procedure it is
important to minimize trauma to the tooth, remove a great amount of
bone, to loosen the tooth gently from its impacted positions and not to
force it into its new site with hard bone contact.
7. Surgical exposure of the canine with/without orthodontic treatment
to bring the tooth into the line of occlusion - most desirable approach.
47. GENERAL PRINCIPLES OF
MECHANO-THERAPY
• Leveling and Alignment of the
erupted teeth.
• Creating enough space for the
impacted canine and maintaining it.
• Conversion of the arch into a rigid
anchorage unit.
• Surgical exposure of the crown of the
impacted canine and attachment
bonding.
• Application of low force (60gm)
traction from rigid anchorage unit.
48. METHOD OF CREATING SPACE
A) Existing incisor space -
Becker showed incisor spacing was due to
failure of completion of ugly duckling
stage of development. During final stage
these existing spaces will be closed by
mesial movement of lateral incisor.
B) Improving arch form -
Improving arch form after extraction of
deciduous canine will add 2-3 mm of
space.
49. C) Increasing arch length -
In mild crowding cases distalization of molar is recommended which
increases the arch length.
D) Extraction as means of prevention (Mixed dentition period) -
i. Deciduous canine
Patient with age of 10-13 years 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 of
permanent canine.
50. ii. First Premolar
I) Crowding of maxillary arch
II) Bimaxillary protrusion
III) Class II relation
iii. Lateral Incisor
Peg shaped or severely malformed lateral incisor (dens invaginatus) can be
extracted instead of healthy premolars.
iv. Central Incisor
When there is advanced resorption of central incisor roots more than 23rd
and canine erupting close to the long axis of the incisor, extraction of
incisor is indicated.
51. • Micro implant anchorage
- The microscrew should be placed in the labial cortical alveolar
bone, at an angle of 10-20° to the bone surface and as parallel to the
tooth's long axis as possible.
- This keeps the apex of the microscrew on the buccal side and
reduces the likelihood of its contacting the root.
- The head of the microscrew should be located as incisally as
possible to maximize the vertical component of force.
52. ANCHORAGE CONSIDERATION AND
SPACE MAINTENANCE
• Use of full dimension stainless steel
rectangular wire in edgewise brackets.
• Use of 0.022 / 0.020 wires with
uprighting springs or torquing springs to
act as brakes if necessary in beggs and
tip-edge appliance.
53. • Mandibular Anchorage
- Lingual arch is fabricated with
0.036 inch SS wire
- Vertical hooks (5-6mm in length)
- Elastic force should not exceed 40-
60 gm
Advantages
- Simplicity in appliance design and
application
- Reduced overall treatment time
54. SURGICAL METHODS
The goal is to choose a technique that exposes the canine within the
zone of keratinized mucosa without involvement of CEJ.
1. Surgical exposure with spontaneous eruption
2. Surgical exposure with packing only – prevent rehealing in deep
impaction cases predicting spontaneous eruption
3. Surgical exposure with packing and delayed bonding of an
auxiliary – when spontaneous eruption fails, attachment can be
bonded under direct vision after 1 week post-op (2-step technique)
4. Open eruption technique
5. Closed eruption technique
55. SURGICAL EXPOSURE TO ALLOW
NATURAL ERUPTION
• Useful when the canine has a correct axial inclination and does not need
to be uprighted during its eruption.
• Clark recommended that a polycarbonate crown be placed over the
impacted tooth after its surgical exposure.
• The crown should be made long enough to extend through a window
cut in the palatal tissue.
• Often, 6 months to 1 year may elapse before the impacted tooth has
erupted sufficiently to permit removal of the polycarbonate crown and
its replacement with an orthodontic attachment.
• If the tooth fails to erupt, clark recommends the removal of any tissue
surrounding the crown.
Clark D. The management of impacted canines: free physiologic eruption. J Am Dent Assoc 1971;82:836-40.
56. ONE STEP VS TWO STEP
Two approaches are generally recommended with regard to the timing
of placing the attachment.
1. Two-step approach: Canine is surgically uncovered and the area is
packed with a surgical dressing to avoid the filling in of tissues around
the tooth. After 3 to 6 weeks, the pack is removed, and an attachment is
placed on the impacted tooth.
57. 2. One-step approach: attachment is
placed on the tooth at the time of
surgical exposure and a periodontal
pack placed.
- The pack minimizes patient
discomfort and prevents the
granulation tissues from covering
the attachment.
- Recommended for palatably
impacted teeth.
Advantages - the clinician is able to
visualize the crown of the tooth and to
have better control over the direction of
tooth movement, prevents moving the
impacted tooth into the roots of the
neighboring teeth.
58. TYPES OF FLAPS FOR
IMPACTED CANINE
Labially impacted tooth
1. A circular incision - done by removing mucosa over the crown to
expose the impacted tooth.
59. Advantages:
a) Easy to perform
b) Suitable access can be provided for bonding of the attachment
c) Reduction of impaction is rapid.
Disadvantages:
a) Tooth will be invested on labial side with thin oral mucosa
rather than attached gingiva.
b) Typical soft tissue contour aggravates plaque accumulation
which leads to gingivitis.
Inflammation will prevent regeneration of the periodontal ligament
which leads to apical movement of the epithelial attachment.
60. 2. Apically repositioned surgical flap –
A split thickness pedicle reflected from the edentulous area.
i. Incisions extend vertically into the vestibule and split thickness
flap is reflected.
ii. Bone covering the enamel is removed.
iii. Two thirds of the crown exposed, and the connective tissue
follicle, curetted from the periphery of the exposed portion of the
crown.
iv. The flap is sutured to the periosteum, leaving one half to two
thirds of the crown uncovered.
v. A surgical dressing is placed on the enamel to prevent overgrowth
of the adjacent tissue.
vi. The dressing is removed 1 week, post operatively and the
attachment placed on the uncovered tooth.
61. 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 till it comes to
occlusion
Disadvantages:
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.
62. 3. Full flap closure –
- 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.
- A twisted thread is tied to the bonded tooth and then drawn inferiorly
and through the sutured ends of the replaced flap, through the crest of
the ridge or through the socket vacated by the extracted deciduous
canine.
63. 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
64. 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: due to buccal prominence of the tooth, lack of buccal
bone and relative tightness of the replaced flap, damage to the
mucogingival tissue is due to the bulk of wide and high profile bracket,
which may leads to a breakdown of the overlying tissue causing dehiscence
65. Palatally impacted tooth
1. Closed technique –
- The canine was surgically uncovered with a full-thickness
mucoperiosteal flap dissected off the bone.
- The bone covering the canine was removed with a punch or bur;
NaCl irrigation.
- Attachment with a chain was bonded to the exposed tooth.
- Swab gauze 1.5 × 1.5 cm and tranexamic acid (Cyklokapron 5%)
could be used to get a dry operation field.
- The palatal flap was repositioned and sutured back with the chain
extending through an incision in the palatal flap.
66. 2. Open technique –
- The canine is surgically uncovered with a full-thickness mucoperiosteal
flap dissected off the bone.
- The bone covering the canine is removed with a punch or bur; NaCl
irrigation.
- Polyacrylic acid and then conventional, light cured glass ionomer
cement are applied on the surface of the crown of the impacted canine,
to the level of intact mucosa.
- Swab gauze 1.5 × 1.5 cm and tranexamic acid (Cyklokapron 5%) could
be used to get a dry operation field.
- The palatal flap is repositioned and sutured back, and a window of
mucoperiosteal tissue overlying the tooth was removed with a punch or
a scalpel.
67.
68.
69. ATTACHMENTS
1. Lasso wires: It is twisted lightly around the
neck of the canine.
Disadvantages:
₋ Irritation of the gingiva
₋ Poor control over direction ofmextrusion
₋ Prevents reattachments of the healing tissues in area of CEJ
(cemento-enamel junction).
₋ May produce areas of external resorption & ankylosis in
areas of CEJ.
So, it is rarely used now.
70. 2. Threaded Pins: Provides the attachment for an
impacted tooth.
Disadvantages:
- Dentaly invasive.
- Requires a subsequent restoration.
- Difficult to place along the long axis
of the tooth because of smaller surgical exposure.
- The drilled hole may inadvertently enter the
pulp(unerupted teeth may have large pulp chambers).
Also rarely used.
71. 3. Orthodontic bands:
They largely replaced the
lasso wires & threaded pins.
Advantage:
They are compatible with the health of periodontal tissues.
Disadvantage:
- Large surgical field required.
- Requires extensive bone removal
- Inadequate moisture control may hamper with the cement-band bond.
72. 4. Standard orthodontic brackets:
Any edge-wise, Begg’s, PAE brackets
can be used with composite.
Disadvantages:
- As the bracket base is wide, it is difficult to adapt to any other tooth
surface except for the buccal surface.
- The bracket’s shear bulk creates irritation as the tooth is drawn the soft
tissues.
- Interferes with the investing tissues & leads to inflammation &
periodontal damage.
- As the impacted tooth advances into the arch the exuberant gingival
tissues bunches in front of it & causes punching between the bracket &
tissues.
73. 5. A simple eyelet:
Advantages:
- An eyelet welded to band material with a mesh
backing is soft & easy to contour - adaptation to
bonding surface more accurate - superior retentive
properties.
- Because of small size they can be placed in more
awkwardly placed teeth.
- Less irritating to the surrounding tissues.
74. 6. Elastic ties and modules:
Advantages
- Application of light forces
- Good range of action
- Easier to tie
Disadvantages
- Tends to loosen
- High degree of force decay
75. 7. Magnets:
It is made up of rare earth lanthanide
alloys .
Disadvantage - corrosion.
8. Cast Canine Cap:
Requires extensive crown preparation
9. Lingual button with ligature
chain or gold chain:
Most commonly used.
76. METHODS OF TRACTION
1. Active palatal arch
(Becker1978)
• It consists of a 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 downward activation of
palatal arch wire and hooking the pigtail
ligature around it.
77. 2. Light Auxiliary Labial Arch
(Kornhauser1996)
• Fabricated with a 0.014" round SS,
formed in a archform with a loop
having a small helix.
• Wire is tied with the basal
arch wire in piggyback
fashion.
• If a basal arch wire is not used
it will leads to extrusion of
adjacent tooth and cause
alteration of occlusal plane.
78. 3. TMA Box Loop
• TMA .017 X .025 wire used.
• Produces sagittal and horizontal
corrections while continuing vertical
eruption.
• Used in select cases.
Alignment of Impacted Canines with Cantilevers and Box Loops;
Surendra Patel; JCO 1999 volume 33 : 2 : 82-85
79. 4. Cantilever Spring
• TMA .017 X .025 wire used
• Initial extrusion mechanics with
a cantilever.
• Use of a box loop to continue
canine extrusion and to make
1st- and 2nd-order corrections.
• Incorporation of the canine into
a continuous archwire for finishing.
• The reactionary force and the
moment are dissipated on the molar,
which can be controlled by using a
palatal arch and or ligating the molar
to the rest of the arch.
80. 5. Australian Helical Archwire
• Made in special plus .016” arch wire
• Activation by twisting the steel ligature wire every
two weeks.
• The Australian wire is bent with helices that serve as
stops against the brackets of the adjacent teeth to
maintain space for the erupting canine.
• An additional incisal helix increases the resilience of
the system and anchors the SS ligature running to the
canine attachment.
• The force vector for canine can be altered by
changing the transverse position of the incisal helix.
81. 6. Two Archwire Technique
• Surgical procedure involves apically positioned flap for superficial
impaction and full thickness mucoperiosteal flap with a crestal
incision for deeper impactions.
• Orthodontic procedure consists of placement of preadjusted 0.022 x
0.028 brackets.
• An 0.014" NITI arch wire is cut so that it passes through 2 or 5
brackets on either side of impacted tooth.
• Eyelet chain activated every 4 - 6 weeks.
82. 7. Piggy-back technique:
• Consists of double wires (auxiliary and base wire), the auxiliary wire -
segmented or continuous.
• Rigid stainless steel base archwires with significantly higher elastic
modulus, e.g. 0.018-inch or 0.019X0.025- inch SSW, are preferred to
limit unwanted effects on anchor units and an auxiliary super elastic
NiTi (including thermal NiTi) archwire of 0.012- inch or 0.014-inch
to continue the eruptive process of tooth.
83. • Advantages
- Relatively constant, light force with high flexibility and range allowing
engagement of significantly displaced teeth.
- Realigning of the teeth avoided.
- Reciprocal forces reduced – single archwire affects the other teeth in
the arch - an iatrogenic open bite, canted occlusal plane, crossbite, etc.
• Disadvantage
- Increased friction due to the doubled archwires.
84. 8. The K-9 Spring
• Designed by Dr.Varun Kalra
• The K-9 is made of 0.017" x 0.025" TMA
• The TMA can be activated twice as far as
stainless steel before it undergoes permanent
deformation, while producing less than half
the force.
• Designed on the principle of reciprocal
torqueing.
• To activate the spring after it is engaged in
the buccal segment, the vertical arm is swung
upward and ligated to the bonded attachment
on the canine.
• The force needed to distalize the canine is
achieved by inching the spring back about
2mm after it has been ligated to the canine.
85. 9. Ballista Spring (Jacoby 1979)
• A ballista loop is a simple, convenient, unobtrusive method of applying
a vertical vector of force to a palatally impacted tooth to erupt the
crown into the center of the alveolus.
• Exposure of the crown facilitates attachment of an elastomeric chain
directed toward the center of the edentulous alveolar ridge to gradually
guide the canine crown into the dental arch.
86. • 0.018-inch continuous SS archwire used to form the spring.
• The impacted tooth is retracted by a spring that accumulates a
continuous force from being twisted on its long axis.
• With this technique, the crown typically erupts into the center of the
alveolar ridge, similar to a naturally erupting tooth.
87. 10. Kilroy Spring (2003)
• A constant force module of .016SS
that delivers slow and continuous
force on a rectangular archwire.
• In the passive state, the vertical
loop of the Kilroy Spring extends
perpendicularly from the occlusal
plane.
• To activate the spring, a stainless
steel ligature is guided through the
helix at the apex of the vertical
loop, and the loop is directed
toward the impacted tooth.
• The ligature is then tied to an
attachment that has been direct-
bonded to the surgically exposed
tooth
88. • The amount of force generated by the Kilroy Spring can be
increased or decreased by bending the vertical loop toward or
away from the impacted tooth.
• The direction of force is also adjustable.
• Because of the inherent flexibility in its design, the Kilroy
Spring will typically fit the available arch space whether the
final destination of the impacted tooth is wider or narrower than
the tooth itself.
• The vertical loop of the Kilroy Spring can be adjusted to
produce a light force to assist in closing, maintaining, or
opening space.
89. 11. Kilroy II Spring
• Designed to produce more vertical than lateral eruptive forces for
eruption of buccally impacted teeth.
• Its multiple helices increase its flexibility, but also increase the
likelihood of impingement on the soft tissue.
• More frequent progress checks are recommended
90. 12. Modified Kilroy Spring
• The modified Kilroy I Spring that can be
applied without removal of the deciduous
canine, thus improving the patient’s esthetic
appearance and helping to maintain the canine
space.
13. The Monkey Hook
• It is a simple auxiliary with an open loop on
each end for the attachment of intra oral elastic
or elastomeric chain or for connecting to a
bondable loop button.
• A combination of monkey hooks and bondable
loop-buttons allows the production of a variety of
different direction force such as
91. 14. Tunnel - Traction of Infraosseous Impacted Maxillary Canines
• Deep infraosseous canines associated with persistent deliduous teeth
may be successfully and safely treated by repositioned flap and tunnel
traction toward the center of the alveolar Ridge.
• Cortical bone removed to provide access to crown and button bonded
with ligature chain.
• The chain passes through the bone tunnel and emerges from the
socket of the deciduous tooth.
• Traction phase started after one week when sutures are removed and
directed to the center of the alveolar ridge.
Advantages
- No attachment loss and no recession are observed
at the end of active therapy or 3 years later.
92.
93.
94. • Not much is present in literature about mandibular canines as its
occurrence is a rare condition.
• For lingually placed canine, attachment has to be bonded on buccal
surface only, buccal surgical exposure preferred.
MANDIBULAR CANINE IMPACTION
95.
96. ROOT RESORPTION AND
CANINE IMPACTION
• Resorption of roots stops when canine
impaction has been solved.
• Subsequent orthodontic movement of
resorption affected teeth does not generate
further resorption.
• Incisors with severely resorbed roots have
high survival rate.
• Teeth remain vital, and retain their color,
and appearance.
• Teeth show very low degree of mobility
and an improvement in periodontal bone
support following post treatment retention.
• Splinting is not usually necessary.
Long-term follow-up of severely resorbed maxillary
incisors after resolution of an etiologically associated
impacted canine. Adrian Becker; AJODO
2005;127:650-4
97. IMPACTED CANINE AND
PERIODONTIUM
• A study was done to evaluate the periodontal health and tooth vitality
of palatally impacted and buccal ectopic maxillary canines after
completion of orthodontic treatment.
• Conclusion: All ectopic canines had increased plaque and gingival
bleeding index, greater pocket depths, reduced attached gingival
width, higher gingival levels, increased crown lengths, higher electric
pulp testing scores, and reduced bone levels compared to their
contralaterals.
Periodontal status of ectopic canines after orthodontic treatment. AO 2014 Aysegu lDalkılıc¸ Evrena S¸ Irin Nevzatog,
Tulin Arunc Ahu
98. RETENTION
• To minimize rotational relapse, options available are -
1. Fiberotomy
2. Bonded fixed retainer
• Clark’s suggestion for palatally impacted canine:
Lingual drifting can be prevented by removal of half moon-shaped wedge
of tissue from lingual aspect of canine.
• Becker et al. evaluated the posttreatment alignment of the impacted
canines in patients who had completed their orthodontic treatment.
They observed an increased incidence of rotations or spacings on the
"impacted" side in 17.4% of the cases, whereas on the control side the
incidence was only 8.7%. The control side had ideal alignment twice as
often as did the impacted side.
99. • Devitalization, ankylosis or loss of vitality, recurrent pain, cystic
degeneration, invasive servical root resorption, external root
resorption of the canine and adjacent teeth may be seen.
• Loss of periodontal bone support, gingival recession, sensitivity
problems or combinations of these factors may be observed.
• No movement of the impacted canine is observed,
- inappropriate positional diagnosis of the impacted teeth and its
relationship with the roots of the adjacent teeth
- a lack of considerably anchorage requirement will lead to inefficient
mechanotherapy and unnecassarily longer treatment
- anyklosis might have afflicted the impacted tooth either a priori or as
the result of the earlier surgical or the orthodontic maneuers.
- scar tissue might have blocked the wire chain
COMPLICATIONS OF TREATMENT
100. COMPLICATIONS OF UNTREATED
IMPACTED CANINE
1) Crown resorption followed by replacement resorption - resorption of
enamel and its replacement by bone
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)
- Potential complications of dentigerous cyst,
a) ameloblastoma
b) Epidermoid Carcinoma
c) MucoEpidermoid carcinoma
6) Resorption of lateral incisor root
101. CONCLUSION
• The management of impacted canines is important in terms of esthetics
and function and, requires a qualified experience of a number of
clinicians.
• Various surgical and orthodontic techniques may be used to uncover
impacted maxillary canines related to its position.
• Accurate localization, conservative management of the soft tissues,
selection of appropriate surgical approach, rigid anchorage unit, and the
direction of the orthodontic traction are the important factors for the
successful management of impacted canines.
102. • Adrain Becker, Orthodontic treatment of Impacted Teeth, Third edition
• Kumar, S. (2015). Localization of Impacted Canines. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH.
• Stivaros, N., & Mandall, N. A. (2000). Radiographic Factors Affecting the Management of Impacted Upper
Permanent Canines. Journal of Orthodontics, 27(2), 169–173.
• Reliability of a method for localisation of displaced maxillary canines using a single panoramic radiograph.
Chaushu et al; clin orthodres 1999; 2: 194-9
• Early treatment of palatally erupting maxillary canines by extraction of the primary canines. Ericson S. & Kurol
J.; European Journal of 161 Orthodontics 1988;10: 283-295
• Prediction of maxillary canine impaction using sectors and angular measurement. Warford J. Jr et al AJO-DO
2003; 124(6): 651-655
• Localization of Impacted Canines: A Review. Kumar S. Journal of Clinical and Diagnostic Research 2015; 9(1)
• Vishnoi P, Keshubhai KJ, Surendra SS, Bandi N, Jingar J, Rutvik T. Maxillary Canine Impactions: Orthodontic
and Surgical Management. Ann. Int. Med. Den. Res. 2016;2(3):2-10.
• Clark D. The management of impacted canines: free physiologic eruption. J Am Dent Assoc 1971;82:836-40.
• Uncovering labially impacted teeth: apically positioned flap and closed eruption technique. Vermette et al; AO
1995; 65: 23-32.
• Shapira Y, Kuftinec MM. Treatment of impacted cuspids: the hazard lasso. Angle Orthod 1981; 51: 203–207.
• Alignment of Impacted Canines with Cantilevers and Box Loops; Surendra Patel; JCO 1999
• Incisor Root Resorption Due to Ectopic Maxillary Canines A Long-Term Radiographic Follow-Up Babak Falahat;
Sune Ericson; Rozmary Mak D’Amico; Krister Bjerklin Angle Orthodontist, Vol 78, No 5, 2008
• Periodontal status of ectopic canines after orthodontic treatment. AO 2014. Ays¸egu¨ l Dalkılıc¸ Evrena; S¸ irin
Nevzatog˘ lub; Tu¨ lin Arunc; Ahu Acard
REFERENCES