Treatment of canine mpactions

1. TREATMENT OF MULTIPLE
IMPACTIONS – ATTEMPT
ORTHODONTICALLY
GUIDED BY
DR.R.CHANDRSEKAR .MDS
HOD
DEPARTMENT OF ORTHODONTICS
AND DENTOFACIAL
ORTHOPAEDICS
Presented by
Dr.Sangeerthana.R
I-MDS

2. Contents
2
ACKNOWLEDGMENT
INTRODUCTION
INCIDENCE
ETIOLOGY
CLASSIFICATION
DIAGNOSIS
CLINICAL FEATURES
TREATMENT PLAN
CASE REPORT

3. 3
Acknowledgment
Dr.R.CHANDRASEKAR - HOD
Dr.A.S.APROS KANNA
Dr.INDRA ANNAMALAI
Dr.ARAVINTHRAJKUMAR
Dr.INDRA PRIYADHARSHINI
Dr.USHA NANDHINI

4. 4
Acknowledgment
DR.SRI HARI
HEAD OF THE DEPARTMENT
DEPARTMENT OF PERIODONTICS
DR.MINU KOSHI
HEAD OF THE DEPARTMENT
DEPARTMENT OF ENDODONTICS
DR. R.KANNAN
HEAD OF THE DEPARTMENT
DEPARTMENT OF ORAL AND
MAXILLOFACIAL SURGERY
DR.SIDRA BANO
HEAD OF THE DEPARTMENT
DEPARTMENT OF ORAL MEDICINE
AND RADIOLOGY

5. 5
 Impacted teeth are those that fail to erupt into
the dental arch within expected time because
of
• An adjacent teeth
• Dense overlying bone
• Excessive soft tissue
• Genetical abnormalities
• Ankylosed tooth ( retained deciduous)
• Supernumerary tooth
• Pathology
• ALD
Introduction :

6. 6
• Impactus : pushed against (latin)
• Impacted tooth is the one that is
completely or partially unerupted and
is positioned against another tooth,
bone, or soft tissue
• Ectopic eruption : the eruption of
tooth in a site away from its normal
location or position.
• Tooth transposition is a special type
of ectopic eruption.
Definition :

7. 7
• Labial or lingual malpositioning of the
impacted tooth
• Migration of the neighboring teeth and loss
of arch length
• Internal and External resorption
• Dentigerous cyst formation
• Infection particularly with partial eruption
• Referred pain
Sequelae of impaction:

8. 8
• 3rd molars
• Cuspids
• 2nd premolars
• Central incisors
• Lateral incisors
Most commonly impacted tooth

9. 9
• Incidence of 0.92%-2.12 % canine
impaction was reported in 7-13 years of
age.
• More common in women (1.17%) than in
men (0.51%) as a ratio about 2:1.4
• Incidence of 0.5 % second premolar
impactions were reported
• Incidence of 0.13 % central incisors
impactions were reported
• Bilateral impactions present in about 8%
• Palatally impacted canine occurs more than
labially impacted canine by the ratio of 2:1
to 3:1
Incidence :

10. 10
GENETIC
HEREDITY
GENERALIZED
ENDOCRINE
DEFICIENCES
FEBRILE
DISEASES
IRRADIATION
NUTRITIONAL
DEFICENCY
LOCALIZED
TOOTH SIZE ARCH DISCREPANCY
PROLONGED RETENTION OR EARLY
LOSS OF PRIMAY CANINE
ABNORMAL POSITION OF TOOTH BUD
ANKYLOSIS OF RETAINED DECIDIOUS
 SUPERNUMERARY TOOTH
CYSTIC OR NEOPLASTIC FORMATION
PRESENCE OF ALVEOLAR CLEFTS
DILACERATION OF ROOT
IOTROGENIC ORIGIN
IDOPATHIC WITH NO PRIMARY CAUSE
Etiology:

11. Classification
Presentation
Title
11
• In-situ / radiological
• Clinically visible

12. 12
Diagnosis:
CLINICAL
EVALUATION
RADIOGRAPHIC
EVALUATION

13. 13
 Delayed eruption of the permanent tooth or
prolonged retention of the primary tooth.
 Absence of a normal labial canine bulge or
Presence of a palatal bulge
 Delayed eruption, distal tipping, or
migration of the adjacent tooh
 Bimanual palpation
THE AMOUNT OF
SPACE REQUIRED
FOR ERUPTION
MORPHOLOGY
AND POSITION OF
ADJACENT TOOTH
CONTOUR OF THE
BONE
Clinical evaluation:

14. 14
 PERAPICAL
RADIOGRAPHS
 MAXILLARY
OCCLUSAL
RADIOGRAPHS
 Frontal/lateral
cephalograms
 CT/CBCT
 OPG
Radiographic evaluation:

15. 15
SURGICAL
INETERCEPTIVE
TREATMENT
OPERCULECTOMY
EXTRACTION
SURGICAL EXPOSURE
AND ORTHODONTIC
ALIGNMENT
TRANSPLANTATION
NON
SURGICAL
ORTHODONTIC
CONSIDERATIONS
Conservative
build up
Treatment plan :

16. 16
 ORTHODONTIC CONSIDERATION
• Depends on several factors, such as the location
and the angulation of the canine
• Initially, the arch should be leveled and aligned.
• Then enough space is should be created
• Allow natural eruption / forced eruption using
various tractions methods. (TADS)
• Allow and accept transposition with esthetic make
up.

17. 17
• A 11-year, old female patient named
Tharshika came to our department of
orthodontics with the chief complaint of
irregularly placed upper front teeth.
CASE REPORT :

18. 18

19. 19
Clinical examination was performed
Extraoral Findings:
• Mesocephalic head
• Mesoproscopic face
• Straight profile
Intraoral Findings :
• Class I molar relation
• multiple retained deciduous teeth

20. 20
INVESTIGATION :
 OPG

21. 21
LATERAL
CEPHALOMETRIC

22. 22
REMOVAL OF IMPEDIMENTS
(extraction of retained deciduous teeth)AND
ALLOWED SIMPLE NATURAL
ERUPTION OF PREMANENT TEETH.
Treatment plan :

23. Presentation
Title
23
By 1-1/2 year we found
natural eruption of
premolars and canine
except 13

24. Presentation
Title
24
Advised IOPA
Transposition of 13 in the
region of 12

25. 25
• Bond Maxillary Teeth
using MBT 0.022 X
0.028
• Placed open coil spring
between 11 and 12

26. 26
Opening of space between 11 and 12 with
open coil spring

27. 27
 Sufficient space between 11 and 12
created for natural eruption of 13

28. 28
• Canine erupted naturally
• Begg bracket bonded to 13
• Ligature wire tied from beg
bracket of 13
• Leveling of canine was done

29. 29
ACCEPTED TRANSPOSITION OF 13 IN 12 REGION

30. 30
Pre Finishing

31. Presentation
Title
31
Pre Finishing
Pre Treatment

32. 32
Pre Treatment Pre Finishing

33. CONCLUSION
33
 Early diagnosis and intervention could
save the time, expense and more complex
treatment in permanent dentition
 However interdisciplinary approach aids
successful in the treatment of impacted
teeth

34. THANK YOU
34