Which teeth normally are impacted?
U13 568
What are signs to look out for?
RR
>6 MONTH DELAY IN ERUPTION OF PERMANENT TEETH
What dental causes of impaction of teeth?
Delayed exfoliation of Deciduous teeth
Abnormal position of the tooth gem
- Ectopia
- supernumerray
Odontomes
Cyst
Trauma
Dilaceration
-ankylosis
Tumors
Systemic cause
Genetic
What are the risk of impacted teeth?
- root resorption
- Cyst formation
- Poor aesthetics
What do you look out for in CE?
- swelling in the buccal sulcus or palatal
- Angulation of lateral incisors
- Colour changes of deciduous teeth may indicate previous trauma or possible resorption from impacted tooth
- Palpation
When should palpation be carried out?
8-10
- Check mobility of Deciduous canines
- Lateral incisors (Eruption 8-9)
When would we take an OPG?
-Unerupted teeth
- Root morphology, position , shape , closure of the apex
- Developing dentition
- condyles
- Bone support levels
Pathology
- Cysts , supernumeraries, tumours , PA RLs
what are the advantages of an OPG?
Shows full teeth and jaw
Objects close or further away from the beam will be magnified or dimineshed helping localise position
What are the disadvantages of the OPG?
Poor quality at the midline
Narrow focal trough
Often require supplemental view to confirm details
What are the advantages of lateral cephologram?
Profile view - loclalise tooth positioj on horizontal plane
degree of impaction
What are the disadvantages of lateral ceph?
Exposes whole head and neck to radiation - even if low dose
When would we take an Lateral CEPH?
Skeletal AP relationship
Trace landmarks and compare to average
Position of unerupted canines in ap plane and vertical plane
What are the advantages of occlusal radiographs?
Good detail and low dosage
D: Needs complementary radiograohs to pinpoint tooth location
What is the aetiology of unerupted maxillary central incisors?
- Supernumerary
- Cleft lip and palate
- Cleidocranial dystosis
odontomas
Gingival fibromatosis
Trauma
Early xla
RR
CYSTS
endocrine abnormalities
bone disease
What is the management of unerupted Maxillary Central incisors?
Remove obstruction
- Primary and supernumerary
Make space
- URA
- sECTIONAL FIXED APPLIANCE
- Retainer
Exposure is indicated in failed erupt at 12 months
- erupt through attached ginigiva to minimise apical migration of the gingivae
When do the canines erupt?
UPPER 11-12
LOWER 9-10
3s should be palpable bucally by 8-10
What is the cause of impacted canines?
Long path of eruption - UR3 cLOSE TO ZYGOMATIC PROCESS
Develops earlier than 2s(8-9) in maxilla
Small or absent 2s
Guided erption by the 2s
Cs resistant ton resorption
Polygenic interfernace
what do have to warn the patient anout in impacted teeth?
Root resorption of the 2s
Cyst formation
What is interceptive Tx?
- XLA oF BOTH Cs to avoid centraline shift
- Creating or maintaning space
- Consider premolar xla
Distalation?
Orthodontic Traction
NICE - EXPOSE AND BOND IN FAVOUR OF EXPOSE AND PACK
When would you consider the surgical removal?
Consider if poorly positioned curved root or XLA needed as part of Orthodontic Tx
Uncrowded = Prostic replacement
Eliminated the ned for frequent radiographic monitoring
When do you use autotransplanation/ surgical repositioning?
- Poor posiotn
- Open apex at THE AGE OF 13-14TO AVOID THE LOSS OF VITALITY
- Risk of ankylosis and root resorption
May require endo - Long term prognosis is variable
- age dependant
can be removed autraumatically
older patient
Advantageous over RBB IMPLANT
what are the risks of alligning impacted canines?
Root resorption of adjacent teeth
Loss of vitality
Poor tissue contour
Increased Pocket depths
Canine root resorption
Ankylosis
Torque Problems
Causes and Tx of 5s?
- Likely due to premature loss of secondary primary molars
- accept
- Removal/ incorporate in orhto ext
- Expose and bond
Causes and Tx of 6s?
- Blubouse E
- CROWDING
- mesial path of eruption
- primary Fialure of erption
- after 8 yrs
- extract e and disimpact
