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Presented by:
Dr. I. ROHINI
Post graduate student
NARAYANA DENTAL COLLEGE
www.indiandentalacademy.com
Why cuspids are so essential?
Esthetic smile
Functional occlusion.
Functionally, the lack of canine guidance has
negativ...
Impaction
 Impaction is defined as the total or partial lack of
eruption of a tooth well after the normal age for
eruptio...
DEVELOPMENT OF CANINE
First evidence of canine development: 30 weeks
Calcification: 4-5 months
Normal eruption : 11-12 yea...
Class I - Palatally impacted maxillary canine
-Horizontal, vertical, Angulated.
Class II - Labially impacted canine
-Horiz...
Classification of palatal canine impaction - Olive Aus ortho02
Sector I - Distal to the outline of the root of the lateral...
I. Primary causes:
1. Rate of root resorption of deciduous teeth.
2. Trauma of the deciduous tooth bud.
3. Disturbances in...
SEQUELAE OF IMPACTION
• Migration of the neighboring teeth and loss of arch length.
• Labial or lingual malpositions of th...
CLINICAL METHOD FOR DIAGNOSIS
 Delayed eruption of permanent canine.
 Prolonged retention of deciduous canine.
 Absence...
RADIOGRAPHIC METHOD FOR DIAGNOSIS
I. Qualitative radiographs
Periapical Occlusal Extraoral
Maxillary arch
Lateral ceph
Max...
Parallax method
II. 3-D diagnosis of the position
C T scanning
Radiographic views at right angles
www.indiandentalacademy....
Various treatment options:
No treatment, but with periodic evaluation for
pathologic changes.
Interceptive removal of the ...
I. Surgical techniques for exposing impacted
canines
1. Window approach (gingivectomy).
2. Apically repositioned flap (ARF...
Window approach
excision of a full thickness flap to expose the
incisal 1/2 to 2/3 of the crown.
Apically repositioned fla...
Full Flap Closure: (Closed eruption technique)
This procedure was proposed by MC Bride (1979) ,
A buccal surgical flap was...
 Full thickness flap raised ( Impacted tooth exposed)Full thickness flap raised ( Impacted tooth exposed)
↓↓
 Deciduous ...
Bonding
Composites - Hydrophobic functional monomers
Glass ionomer cements - Hydrophilic functional
monomers.
A hybrid com...
III. Attachments used for the exposed canine
{a} Lasso wires: (b) Threaded Pins:
{c} Orthodontic bands {d} Standard orthod...
{e} A simple eyelet:
-.
f) Elastic ties and modules
{f} Magnets:
www.indiandentalacademy.com
IV. Methods of applying traction
considerations
 The use of light forces (60 grams of force)
 creation of sufficient spa...
BALLISTA SPRING
• Harry Jacobay (1979)
A J O 1979
www.indiandentalacademy.com
22
2) Active palatal arch (Becker1978)
It consist of fine 0.020 inch removable palatal arch wire carrying an
omega loop on...
23
3) Light Auxiliary Labial Arch (Kornhauser1996)
It is made up of 0.014 inch round SS wire with vertical
loops in the ar...
Mandibular removable appliance (Orton1996)
It consist of clasps through which elastic is applied
from clasp to the pigtail...
Canine Extrusion Auxiliary
SEONG-SENG TAN, have devised a Begg
auxiliary to extrude palatally impacted canines,
resembles ...
Cantilever System jco 2000 nov
A typical cantilever design is a wire fully engaged in the
bracket of one tooth and tied in...
TMA BOX LOOP
• TMA .017 X .025 wire used.
• Produce sagittal and horizontal
corrections while continuing
vertical eruption...
NICKEL TITANIUM CLOSED-COIL SPRING
Loring L.Ross (1999)
• 0.009”X 0.041” spring
• Provides 80 gm of force when stretched t...
THE MONKEY HOOK
S. Jay Bowman (2002)
• It is a simple auxiliary with an open loop on each end for the
attachment of intra ...
THE K- 9 SPRING
•Varun Kalra (2000)
• Made in 0.017”X 0.025”TMA wire
Adv:
• Simple in design
• Low cost
• No patient compl...
AUSTRALIAN HELICAL ARCHWIRE
• Christine Hauser (2000)
• Made in special plus .016” arch
wire
• Force should not exceed 200...
Implant supported deimpactor system (ISDS)
- Aldo Giancotti
Type I -. .032 ” TMA springs
inserted in each lingual sheath f...
WHEN TO EXTRACT AN IMPACTED CANINE
 If it is ankylosed & cannot be transplanted.
 If it is undergoing external or intern...
RETENTION CONSIDERATIONS
Evaluation of post treatment alignment by Becker et al
• Incidence of rotations and spacings
1. I...
complicationscomplications
www.indiandentalacademy.com
Orthodontic management of impacted canines can
be very complex and requires a carefully planned inter-
disciplinary approa...
www.indiandentalacademy.com
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Canine impaction1

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Canine impaction1

  1. 1. Presented by: Dr. I. ROHINI Post graduate student NARAYANA DENTAL COLLEGE www.indiandentalacademy.com
  2. 2. Why cuspids are so essential? Esthetic smile Functional occlusion. Functionally, the lack of canine guidance has negative consequences on joint dynamics. www.indiandentalacademy.com
  3. 3. Impaction  Impaction is defined as the total or partial lack of eruption of a tooth well after the normal age for eruption  Maxillary canine impaction is suspected when it doesn’t erupt even after 14 yrs of age.  Palatal : Buccal is 3:1  Female: Male is 3: 1 -Oliver et al-(JO 89) 2.5: 1 Becker et al- Angle 81 www.indiandentalacademy.com
  4. 4. DEVELOPMENT OF CANINE First evidence of canine development: 30 weeks Calcification: 4-5 months Normal eruption : 11-12 years » Longest period of development Location: High in the infant maxilla at the lateral margin of the piriform aperture & travels 22mm. » Longest path of eruption www.indiandentalacademy.com
  5. 5. Class I - Palatally impacted maxillary canine -Horizontal, vertical, Angulated. Class II - Labially impacted canine -Horizontal, vertical, Angulated. Class III - Impacted canine with crown on the palatal side and root on the buccal side or vice versa. Class IV - Vertically impacted canine between lateral incisor and 1st premolar. Class V - Canine impacted in the edentulous maxilla. Class VI - Maxillary canines in unusual position. CLASSIFICATION OF IMPACTED CANINE www.indiandentalacademy.com
  6. 6. Classification of palatal canine impaction - Olive Aus ortho02 Sector I - Distal to the outline of the root of the lateral incisor Sector II - Mesial to sector I, but distal to the midline of the root of the lateral incisor. Sector III - Mesial to sector II ,but distal to the mesial outline of the root of the lateral incisor. Sector IV - Mesial to sector III. www.indiandentalacademy.com
  7. 7. I. Primary causes: 1. Rate of root resorption of deciduous teeth. 2. Trauma of the deciduous tooth bud. 3. Disturbances in tooth eruption sequence 4. Discrepancy of space in the arch. 5. Rotation of tooth buds. 6. Premature root closure. 7. Canine eruption into the cleft area II. Secondary causes:  Abnormal muscle pressure.  Febrile diseases.  Endocrine disturbances.  Vitamin D deficiency - Bishara et al (AJO-1992) Etiology www.indiandentalacademy.com
  8. 8. SEQUELAE OF IMPACTION • Migration of the neighboring teeth and loss of arch length. • Labial or lingual malpositions of the impacted tooth. • Internal & external root resorption. • Dentigerous cyst formation. • Referred pain. SHAFER et al 1963 www.indiandentalacademy.com
  9. 9. CLINICAL METHOD FOR DIAGNOSIS  Delayed eruption of permanent canine.  Prolonged retention of deciduous canine.  Absence of normal labial canine bulge.  Presence of palatal bulge (Abnormal).  Delayed eruption, distal tipping or migration of lateral incisor. www.indiandentalacademy.com
  10. 10. RADIOGRAPHIC METHOD FOR DIAGNOSIS I. Qualitative radiographs Periapical Occlusal Extraoral Maxillary arch Lateral ceph Max. anterior occlusal O.P.G P.A view True (vertex) occlusal www.indiandentalacademy.com
  11. 11. Parallax method II. 3-D diagnosis of the position C T scanning Radiographic views at right angles www.indiandentalacademy.com
  12. 12. Various treatment options: No treatment, but with periodic evaluation for pathologic changes. Interceptive removal of the deciduous canine (Ericson and Kurol, 1988). Surgical exposure of the canine and orthodontic alignment (Bishara, 1992) Auto transplantation of the canine (Shaw et al., 1981, Sagne et al., 1986 Prosthetic replacement www.indiandentalacademy.com
  13. 13. I. Surgical techniques for exposing impacted canines 1. Window approach (gingivectomy). 2. Apically repositioned flap (ARF). 3. Flap closed eruption technique (FCET). 4. Tunnel traction (TT). www.indiandentalacademy.com
  14. 14. Window approach excision of a full thickness flap to expose the incisal 1/2 to 2/3 of the crown. Apically repositioned flap A pedicle flap with adequate attached gingiva overlying the impacted tooth is reflected and repositioned apically & sutured so as to expose 1/2 to 2/3 of the crown. www.indiandentalacademy.com
  15. 15. Full Flap Closure: (Closed eruption technique) This procedure was proposed by MC Bride (1979) , A buccal surgical flap was raised as high as necessary to expose the unerupted canine. An attachment was then bonded to the tooth, and the flap was fully sutured back to its for original place. www.indiandentalacademy.com
  16. 16.  Full thickness flap raised ( Impacted tooth exposed)Full thickness flap raised ( Impacted tooth exposed) ↓↓  Deciduous canine extractedDeciduous canine extracted ↓↓  Socket is extended and widened sufficiently to allow passage ofSocket is extended and widened sufficiently to allow passage of fine wire through itfine wire through it ↓↓  An eyelet attachment on steel mesh is threaded withAn eyelet attachment on steel mesh is threaded with 0.011’’ligature wire bonded on impacted canine0.011’’ligature wire bonded on impacted canine ↓↓  Surgical flap resutured to its former positionSurgical flap resutured to its former position ↓↓  Formed tunnel is used for tractionFormed tunnel is used for traction ↓↓  Traction phase started after one week and directed to the centerTraction phase started after one week and directed to the center of the alveolar ridge.of the alveolar ridge. Tunnel traction of infraosseous impacted canines A. Crescini et al(1994) www.indiandentalacademy.com
  17. 17. Bonding Composites - Hydrophobic functional monomers Glass ionomer cements - Hydrophilic functional monomers. A hybrid compomer (Dyract) - Robert . Miller JCO 1996 J.M. Cobo&. Moro. used a third-generation hydrophilic adhesive, Multiadhesion Scotchbond, in blood contamination situation. II. Bonding an attachment after surgical exposure www.indiandentalacademy.com
  18. 18. III. Attachments used for the exposed canine {a} Lasso wires: (b) Threaded Pins: {c} Orthodontic bands {d} Standard orthodontic brackets: www.indiandentalacademy.com
  19. 19. {e} A simple eyelet: -. f) Elastic ties and modules {f} Magnets: www.indiandentalacademy.com
  20. 20. IV. Methods of applying traction considerations  The use of light forces (60 grams of force)  creation of sufficient space in the arch  Maintenance of the space by either continuous tying of the teeth mesial and distal to the canine  Provision by the arch wire of sufficient stiffness (e.g., 0.018 × 0.022 inch) to resist deformation by the forces applied to it as the canine is extruded . www.indiandentalacademy.com
  21. 21. BALLISTA SPRING • Harry Jacobay (1979) A J O 1979 www.indiandentalacademy.com
  22. 22. 22 2) Active palatal arch (Becker1978) It consist of fine 0.020 inch removable palatal arch wire carrying an omega loop on each side. End of the wire is doubled for Friction fit in lingual sheath. It is activated by elevating downward and hooking the pigtail ligature around it www.indiandentalacademy.com
  23. 23. 23 3) Light Auxiliary Labial Arch (Kornhauser1996) It is made up of 0.014 inch round SS wire with vertical loops in the area of impacted canine on both sides. This loop has a small helix. This wire is tied with the basal arch wire in piggyback fashion. If basal arch wire is not used it will lead to extrusion of adjacent tooth and cause alteration of occlusal plane . www.indiandentalacademy.com
  24. 24. Mandibular removable appliance (Orton1996) It consist of clasps through which elastic is applied from clasp to the pigtail ligature wire. This provide the necessary extrusive force for the eruption of canine www.indiandentalacademy.com
  25. 25. Canine Extrusion Auxiliary SEONG-SENG TAN, have devised a Begg auxiliary to extrude palatally impacted canines, resembles a reverse torquing auxiliary with power arms to the impacted cuspids .It is tied with steel ligatures to the centrals and pinned with the main archwire to the laterals. www.indiandentalacademy.com
  26. 26. Cantilever System jco 2000 nov A typical cantilever design is a wire fully engaged in the bracket of one tooth and tied in a point contact to another tooth . A moment and a force are created at the tooth in which the wire is fully engaged, whereas only a single force is developed at the other end of the cantilever—the single-point contact www.indiandentalacademy.com
  27. 27. TMA BOX LOOP • TMA .017 X .025 wire used. • Produce sagittal and horizontal corrections while continuing vertical eruption. Surendra Patel J C O 1999 www.indiandentalacademy.com
  28. 28. NICKEL TITANIUM CLOSED-COIL SPRING Loring L.Ross (1999) • 0.009”X 0.041” spring • Provides 80 gm of force when stretched to twice its resting length JCO Feb 1999www.indiandentalacademy.com
  29. 29. THE MONKEY HOOK S. Jay Bowman (2002) • 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. JCO July 2002www.indiandentalacademy.com
  30. 30. THE K- 9 SPRING •Varun Kalra (2000) • Made in 0.017”X 0.025”TMA wire Adv: • Simple in design • Low cost • No patient compliance • Light continuous eruptive and distalizing forces JCO Oct 2000 www.indiandentalacademy.com
  31. 31. AUSTRALIAN HELICAL ARCHWIRE • Christine Hauser (2000) • Made in special plus .016” arch wire • Force should not exceed 200 gm • Activation by twisting the steel ligature wire every two weeks JCO Sep 2000www.indiandentalacademy.com
  32. 32. Implant supported deimpactor system (ISDS) - Aldo Giancotti Type I -. .032 ” TMA springs inserted in each lingual sheath for maxillary molar distalization. Two .040” stainless steel arms are soldered to the mesial portion of the steel cap for initial extrusion. Type II - .032” TMA springs are inserted in the lingual sheaths as cantilever arms to produce extrusion of impacted canine in the vertical plane. An orthosystem palatal implant is used for anchorage in the treatment of impacted maxillary canines www.indiandentalacademy.com
  33. 33. WHEN TO EXTRACT AN IMPACTED CANINE  If it is ankylosed & cannot be transplanted.  If it is undergoing external or internal root resorption.  If the root is severely dilacerated.  If there are pathologic changes {cystic formation, infection} Which patients are good candidates for autogenous transplantation procedure? Adults have finished vertical growth of their alveolus and therefore if the tooth is transplanted, there should be no subsequent changes in vertical level of the dentition following the transplantationwww.indiandentalacademy.com
  34. 34. RETENTION CONSIDERATIONS Evaluation of post treatment alignment by Becker et al • Incidence of rotations and spacings 1. Impacted side- 17.4% 2. Control side 8.7% To minimize rotational relapse, options available are 1. Fiberotomy 2. Bonded fixed retainer www.indiandentalacademy.com
  35. 35. complicationscomplications www.indiandentalacademy.com
  36. 36. Orthodontic management of impacted canines can be very complex and requires a carefully planned inter- disciplinary approach www.indiandentalacademy.com
  37. 37. www.indiandentalacademy.com

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