INTRODUCTION
· The most common impacted tooth after
mandibular third molars is maxillary canine.
· Since these impactions are asymptomatic, they
are incidentally found on radiographic examinations. however, impaction of
mandibular canines is less common.
· Unerupted canines occur 20 times more
frequently in the maxilla than in the mandible.
· They are almost always rotated from 60 to 90
degree on their longitudinal axis.
ETIOLOGY
· Hard palatal bone offers more
resistance to eruption than alveolar bone on the ridge
· Thick mucoperiosteal soft tissue
covering the anterior part of hard palate is dense and resistant than other
soft tissues of the oral cavity.
· Eruption of teeth depends to some extent on an
associated increase in apical development. this aid to eruption is minimised in
maxillary cuspid as root formation completes at the time of eruption.
· The canines are the last of permanent tooth to
erupt hence they are vulnerable for a long period of time to any unfavourable
environmental influences
POSITIONS
OF IMPACTED CANAINES
· In maxilla, the malposedcuspids are
found three times as frequently on the palatal side of the arch than on the
labial side.
· They are almost always rotated upon
the longitudinal axis and are usually in an oblique position
CLASSIFICATION
CLASSIFICATION
BASED ON POSITION IN THE DENTAL ARCH
•
Class i impacted cuspids in palate
1. Horizontal
2. Vertical
3. Semi vertical
•
Class
i impacted cuspids on buccal surface
1.
Horizontal
2. Vertical
3. Semi vertical
FIELD AND
ACKERMAN CLASSIFICATION (1935) Maxillary canines
A. Labial position
i. Crown in intimate relationship with
incisors.
ii. Crown well above apices of incisors.
b. Palatal position
i. Crown near surface in close relationship to
root of incisors.
ii. Crown deeply embedded in close
relationship to apices of incisors.
C.
Intermediate position
i. Crown between lateral incisors and first
premolar roots.
ii. Crown above these
teeth with crown labially placed and root palatally.
iii.
Or vice versa.
d. Unusual
position
i. In nasal or antral wall
ii. In
infraorbital region
RADIOGRAPHIC LOCALISATION
•
Localising
impacted maxillary cuspids
Clinical clues
1. Presence of distinct bulge in the palate or on the buccal
aspect of the maxilla.
2. If canine is labially impacted, there will be a heflection
of the lateral incisor (apical portion of root lingually and the crown
labially).
•
The
position of the upper canine is assessed from radiography which are taken in
two planes to give three dimensional impressions of the tooth and associated
structures. they are:
•
1.
Intraoral periapical films
•
2.
Vertex occlusal film
CLARK’S TUBE SHIFT METHOD
•
By
changing the angulation of the x-ray beam, an apparent displacement of the
object to be localised was seen, when the reference object is considered as the
tooth closest to the object to be localised,
•
The
image of the object that is farther (palatally or lingually placed object) from
the x-ray tube moves in the same direction as the tube, whereas the image of
the object closer to the x-ray tube (buccally placed object) moves in the
opposite direction.
•
This
technique was introduced by clark
MANAGEMENT
FACTORS DETERMINING TREATMENT
•
A. Age of the patient
•
B. Stage of tooth development
•
C. Position of impacted tooth d evidence of
root resorption of adjacent permanent teeth.
Surgical removal
Indications
1. Impacted canine is located very far from the oculus al
plane
2. No other methods are possible to retain the tooth
Contraindications
1. When the cuspid can be brought into normal position
surgically or orthodontically.
2. Medically compromised patients, presenting with impacted
cuspids.
Operative plan
a. Study radiographs
b. Classify
impaction
C. Plan the type of
soft tissue flap
d. Decide whether
sectioning of tooth is needed.
PROCEDURE
•
Soft tissue flap
•
1.
No. 12 bp blade is used to incise the tissues around the neck of the teeth
beginning on the lingual side of the maxillary central incisor and extending to
distal of 2nd bicuspid and the flap is raised as a mucoperiosteal flap from the
hard palate by means of periosteal elevator until the bone is exposed.
•
BONE REMOVAL
•
After reflecting the flap, it can be retracted
by help of a flat bladed instrument such as austin retractor or howarth
periosteal elevator.
•
Alternatively,
the flap can be retracted by the help of tie sutures, tied around the necks of
opposite side teeth.
•
Bone
is removed circumferentially 3 mm around the crown of the impacted tooth being
careful not to damage the roots of adjacent teeth.
•
Enlarge
the size of the opening with burs so that the complete crown may be seen.
•
Elevation
of tooth
•
An
appropriate elevator is placed on one side of crown and with the palatal bone
as the fulcrum impacted tooth is lifted from its crypt in the palate.
•
Extreme
care should be taken to prevent injury the adjacent teeth
•
If
this does not remove the impacted tooth, enlarge the opening and repeat the
procedure, using two elevators in the same way.
•
If
the tooth is still not luxated, the tooth requires crown root sectioning and extraction.
•
Wound
irrigation and closure
•
All
the debris, spicules are removed and bony mar gins trimmed.
•
Tooth
follicle is removed if present and the flap is sutured back into position.
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