CANINE IMPACTION 1.pptx

canine impaction

1. CANINE IMPACTION AND ITS MANAGEMENT BY MALA. M 2 ND MDS DEPT. OF OMFS GUIDED BY Dr. SANTOSH A NANDIMATH

2. CONTENTS Introduction Developmental considerations Aetiology Prevalence Sequelae Classification Diagnosis Management Maxillary canine Mandibular canine Conclusion

3. INTRODUCTION An impacted maxillary canine is usually diagnosed during a routine dental examination. Disturbance in the eruption of permanent maxillary canines can cause problems in the dental arch and adjacent teeth, which require special care and attention. Therefore, clinicians should be capable of dealing with this clinical situation to deliver optimal treatment. Canines are the most common impacted tooth, following the third molars.

4. Developmental considerations

5. Etiologic factors

6. Two major theories associated with palatally displaced maxillary canines The guidance theory Genetic theory

7. Maxillary canines are the most commonly impacted teeth, second only to third molars. Maxillary canine impaction occurs in approximately 2% of the population More common in women (1.17%) than in men (0.51%) as a ratio about 2:1 . maxilla > mandible. Of all patients who have impacted maxillary canines, 8% have bilateral impactions. Approximately one-third of impacted maxillary canines are located labially and two-thirds are located palatally. PREVALENCE

8. > > EPIDEMIOLOGY

9. Sequelae of Canine Impaction Shafer et al. suggested the following sequelae for canine impaction:

10. Classifcation of Impacted Maxillary Canines Classifcation Suggested by Archer (1975) Class I : Impacted canines in the palate. 1. Horizontal 2. Vertical 3. Semivertical Class II : Impacted canines located on the labial surface. 1. Horizontal 2. Vertical 3. Semivertical Class III : Impacted canine located labially and palatally—crown on one side and the root on the other side. Class IV : Impacted canine located within the alveolar process—usually vertically between the incisor and first premolar. Class V : Impacted canine in edentulous maxilla— Impacted canine can be in unusual positions like inverted position.

11. Ericson and Kurol in 1988. •  Sector 1 : If the cusp tip of the canine is between the inter incisor median line and the long axis of the central incisor •  Sector 2 : If the cusp tip of the cuspid is between the major axis of the lateral and central •  Sector 3 : If the cusp tip of the cuspid is between the major axis of the lateral and the first premolar .

12. Modification of Ericson and Kurol’s classification by Lindauer •  Sector I: Located distal to a tangent to the distal crown and root of the lateral incisor •  Sector II: The area from the tangent on the distal surface to a midline bisector of the lateral incisor tooth •  Sector III: The area from the midline bisector to a tangent to the mesial surface of the lateral incisor crown and root • Sector IV: All areas mesial to sector III

13. The Yamamoto et al. [ 9 ] seven subtypes classification

14. Field and Ackerman (1935) Classifcation Maxillary Canines 1. Labial position • Crown in intimate relation with incisors. • Crown well above apices of incisors. 2. Palatal position • Crown near surface. • Crown deeply embedded in close relation to apices of incisors. 3. Intermediate position • Crown between lateral incisor and first premolar roots. • Crown above these teeth with crown labially placed and root palatally placed or vice versa. 4. Unusual position • In nasal or antral wall. • In infraorbital region.

15. MANDIBULAR CANINE a. Labial position: Vertical, oblique, and horizontal b. Unusual position: At inferior border, • In mental protuberance, • Migrated to the opposite side along with the original nerve supply.

16. DIAGNOSIS i . Clinical assessments ii. Radiographic assessments.

17. Clinical assessments Impacted canine teeth can be detected as early as the age of 8 years. It is done with two methods: Clinical inspection and palpation [Figure 2].[2,3] Inspection Clinical examination includes overall arch inspection. Mobility or the absence of primary canines past its eruption age. Persistent median diastema, abnormality or missing lateral incisor, ectopic deviation of lateral incisor from its position may all be signs of canine impaction. Clinical examination for the presence of bulge in the canine region deep in the vestibule should be done buccally as well as palatally

18. Palpation In the absence of canine, palpation by finger deep in the vestibule above the deciduous canine should be done palatally/buccally above the deciduous canine 2–3 years before its eruption. It should be palpated deep above attached gingiva in the sulcus where mucosa reflects. Deciduous canine should be checked for mobility. The presence of bulge provides a positive sign of impacted canine. However, it should be noted that the absence of bulge does not prove the absence of impacted canine. When there is a clinical presence of any of these signs, radiographic examination should be performed to confirm the diagnosis

19. Radiographic Localization of Impacted Canine Radiographic examinations may include periapical X-ray, occlusal radiography, anteroposterior and lateral radiographic views of maxilla, OPG, CBCT, CT scan.

20. Periapical films A single periapical film provides the clinician with a twodimensional representation of the dentition. In other words, it would relate the canine to the neighboring teeth both mesiodistally and superoinferiorly . To evaluate the position of the canine buccolingually, a second periapical film should be obtained by one of the following methods. Tube-shift technique or Clark’s rule or (SLOB) rule Buccal-object rule

21. Occlusal Films Also help to determine the buccolingual position of the impacted canine in conjunction with the periapical films, provided that the image of the impacted canine is not superimposed on the other teeth.

22. Extraoral films Frontal and lateral cephalograms These can sometimes aid in the determination of the position of the impacted canine, particularly its relationship to other facial structures (e.g., the maxillary sinus and the floor of the nose).

23. Panoramic films These are also used to localize impacted teeth in all three planes of space, as much the same as with two periapical films in the tube-shift method, with the understanding that the source of radiation comes from behind the patient; thus, the movements are reversed for position.

24. CT/CBCT Clinicians can localize canines by using advanced threedimensional imaging techniques. Cone beam computed tomography (CBCT) can identify and locate the position of impacted canines accurately. By using this imaging technique, dentists also can assess any damage to the roots of adjacent teeth and the amount of bone surrounding each tooth. However, increased cost, time, radiation exposure, and medicolegal issues associated with using CBCT limit its routine use. The proper localization of the impacted tooth plays a crucial role in determining the feasibility of as well as the proper access for the surgical approach and the proper direction for the application of orthodontic forces.

25. Treatment options No treatment Interceptive treatment Extraction of the impacted canine Auto transplantation of the canine Surgical exposure and orthodontic alignment