Case Report Interdisciplinary Management of Maxillary ... · le deciduous canine and associated peg shaped permanent ... eruption anomalies a er third molars was considered as one

Case ReportInterdisciplinary Management of Maxillary Canine BuccalEctopia Associated with Peg Shaped Lateral Incisor

Karuna Singh Sawhny1 and Asheesh Sawhny2

1Department of Orthodontics and Dentofacial Orthopedics Rama Dental College Hospital and Research CentreKanpur Uttar Pradesh India2Department of Conservative and Endodontic Dentistry Rama Dental College Hospital and Research Centre KanpurUttar Pradesh India

Correspondence should be addressed to Karuna Singh Sawhny drkarunachibyahoocoin

Received 23 April 2016 Revised 13 August 2016 Accepted 22 August 2016

Academic Editor Husamettin Oktay

Copyright copy 2016 K Singh Sawhny and A Sawhny This is an open access article distributed under the Creative CommonsAttribution License which permits unrestricted use distribution and reproduction in any medium provided the original work isproperly cited

Aligning a displaced maxillary canine into the dental arch is one of the most complicated problems in orthodontics In casesof extremely high displacement the tooth is frequently removed surgically Because of the upper caninesrsquo significance to dentalesthetics and functional occlusion such a decision is a very serious oneThe purpose of this report is to illustrate an interdisciplinaryapproach involving both orthodonticmanagement and conservative tooth restorationThe case was treated through an orthodonticnonextraction fixed appliance mechanotherapy for successful alignment of buccally ectopic upper left canine followed by aconservative direct composite tooth buildup of peg lateral incisor associated with the upper left ectopic canine in a 16-year-oldadolescent North Indian female Posttreatment records demonstrated good alignment of the displaced tooth and restoration ofnormal anatomy of the peg shaped lateral incisor

1 Introduction

An ectopic tooth is defined as a tooth that is followingan abnormal eruption path whereas an impacted tooth isa tooth that is unable to erupt without assistance and isusually associated with an ectopic path of eruption Since thepermanent canines are the foundation of an esthetic smileand functional occlusion their proper alignment into thearch becomes a priority for the orthodontist The maxillarycanine is present superior to the deciduous canine angulatedmedially with its crown lying distal and buccal to the lateralincisor The canine follows a mesial path until the crownreaches the distal aspect of the lateral incisor root Theerupting canine is gradually uprighted to a more verticalposition and is guided by the lateral incisor root until it isfully erupted [1]

Maxillary canine ectopia occurs as the result of diver-gence from the normal path of eruption of the tooth Primaryetiological causes include disturbances in tooth eruptionsequence trauma retention of primary canine premature

root closure rotation of tooth buds localized pathologicallesions (cysts odontomas) [2] long developmental path [1]more difficult and tortuous path of eruption [3] and a geneticcomponent with recurring occurrence in some families[4] and in association with a crowded dentition [5] Butsometimes there is buccal displacement with no crowdingThe cause is genetic and the condition has been calledldquoprimary tooth germ displacementrdquo meaning developmentof the tooth bud in the aberrant position or orientationbecause of an abnormal genetic pattern [6] Such cases areusually associated with reduced mesiodistal width of thelateral incisor and increased prevalence of anomalous lateralincisor [7 8] The retention of the deciduous canine also aidsin the deflection of the maxillary canine buccally Rohrer [9]reported the incidence of permanent canine impaction to be20 times higher in the maxilla than in the mandible Hitchen[10] and Rayne [11] found that palatal impaction accounts for85 and labial impaction 15The prevalence rate of buccallydisplaced canine is 306 per cent with a male-to-female ratioof 1 1 [12] Shafer et al [13] enumerated the sequel for ectopic

Hindawi Publishing CorporationCase Reports in DentistryVolume 2016 Article ID 3045865 6 pageshttpdxdoiorg10115520163045865

2 Case Reports in Dentistry

eruption as labial or lingual malpositioning of the ectopicallyerupted tooth migration of the neighbouring teeth and lossof arch length internal resorption dentigerous cyst forma-tion infection particularly with partial eruption referredpain and external root resorption of the impacted tooth aswell as the neighbouring teeth [14] Following is a case of a 16-year-old female who presented with a buccally displaced leftmaxillary caninewhichwas successfully brought into the archby orthodontic fixed appliance mechanotherapy along withdirect composite buildup of the peg shaped lateral incisorassociated with it

2 Case History

A 16-year-old adolescent North Indian female presented withthe chief complaint of the irregular teeth in relation to upperand lower arches

3 Clinical Examination

Extraoral examination showed no gross asymmetry meso-prosopic facial form and straight profile competent lipsand complex and nonconsonant smile with 1mm of gin-gival display (Figures 1(a) and 1(b)) Intraoral examination(Figures 1(c) 1(d) 1(e) 1(f) and 1(g)) showed presence ofpermanent dentition till second molars ectopically erupted23 overretained deciduous canine (63) peg shaped lateralincisor (22) and mesiopalatally rotated 13 and mesiolabiallyrotated 22 Many teeth showed hypocalcification Occlusalrelationship showed Class I molar and canine relationship2mm overjet and 7mm (80) overbite Lower arch showedmild crowding Maxillary dental midline coincided with themandibular dental midline

4 Radiographic Examination

The panoramic radiograph (Figure 1(h)) showed no patholo-gies The maxillary and mandibular third molars were erupt-ing and overretained 63 The lateral cephalometric analysis(Figure 1(i) Table 1) revealed that the patient had a skeletalClass I relationshipwith a normal growth pattern retroclinedmaxillary and mandibular incisors and retrusive upper lip

The case was diagnosed with Class I skeletal bases AnglesClass I malocclusion with mild crowding in upper and loweranterior teeth buccally ectopic 23 peg shaped 22 retained63 mesiopalatally rotated 13 and mesiolabially rotated 22retroclined upper and lower anterior teeth decreased overjetand increased overbite and retrusive upper lip Clinicalfindings and radiographic examination indicated that theresulting buccal displacement was due to retained upperleft deciduous canine and associated peg shaped permanentlateral incisor

5 Treatment Objectives

The treatment objectives were to relieve the crowding in botharches to align the buccally displaced right maxillary canineinto the arch to direct cosmetic composite buildup of theleftmaxillary peg shaped lateral incisor restoring it to normal

anatomy to obtain a normal overjet and overbite and pleasingsmile and to improve incisor inclination and improve facialesthetics

6 Treatment Plan and Sequence

On the basis of clinical examination and diagnostic recordsa treatment plan to correct the malocclusion through nonex-traction fixed appliance mechanotherapy was selected Therationale was to gain space formild crowding by extraction ofretained deciduous canine (63) and proclination of upper andlower incisors to avoid compromising the patientrsquos profileand to shorten the treatment time

Overretained deciduous canine (63) was extracted Fullfixed 0022 inch MBT 00175 times 002510158401015840 TMA wire bracketswere bonded on both arches except 23 After initial lev-elling and alignment with 0014 0016 and 0018 nickel-titanium HANT archwires both the arches were stabilizedwith coordinated 001810158401015840 stainless steel wires 23 was bondedAn auxiliary segmented T-loop made from 0022 inch MBT00175 times 002510158401015840 TMAwire (Figure 2(a)) from 26was attachedto 23 and its mesial arm was activated in distal occlusaland palatal direction to bring the buccally displaced rightmaxillary canine in the arch Final alignment of the 23 wasdone using a piggy back 001410158401015840 NiTi archwire Slight spacewas opened between 21 and 22 with NiTi open coil spring(Figure 2(b)) After 10 months of the treatment the bracketin relation to 22 was deboned and referred to restorativedentist for direct composite build of peg shaped 22 A lightcure adhesive system (3M ESPE Scotch Bond UniversalAdhesive Neuss Germany) was applied The buildup wasdone by incremental placement of restorative composite (3MESPE Filtek Z 250 XT Nano Hybrid Universal RestorativeNeuss Germany A2 shade) followed by contouring and lightcuring Finally the restoration was finished and polished(Figure 2(c))

22 was rebonded levelled and aligned and slight spacemesial to 22 was closed (Figure 2(c)) Coordinated 0019times 002510158401015840 SS was placed with Class II elastic on left sideFinal finishing wires 01410158401015840 NiTi were placed Total treatmenttime was 15 months followed by bonding of a maxillary (tokeep the buccally displaced right maxillary canine in optimalposition) and mandibular fixed spiral wire retainer

7 Treatment Results

Posttreatment records revealed that treatment objectiveswereachieved Facial photographs showed an improved profileand smile (Figures 3(a) and 3(b)) Class I canine wasestablished with canine-protected occlusion Dental midlineswere aligned with the facial midline with ideal overbite andoverjet (Figures 3(c) 3(d) 3(e) 3(f) and 3(g)) Posttreatmentpanoramic radiograph showed acceptable root parallelismwith no signs of bone or root resorption (Figures 3(h) and3(i))

Posttreatment lateral cephalometric analysis (Table 1)and superimposition revealed a Class I skeletal patternimproved inclinations of maxillary and mandibular incisors

Case Reports in Dentistry 3

(b)(a) (c)

(d) (e)

(f) (g)

(h) (i)

Figure 1 (a) Pretreatment frontal photograph (b) Pretreatment profile photograph (c) Pretreatment intraoral frontal view (d) Pretreatmentintraoral right lateral view (e) Pretreatment intraoral left lateral view (f) Pretreatment intraoral occlusal view of maxillary arch (g)Pretreatment intraoral occlusal view of mandibular arch (h) Pretreatment lateral cephalogram radiograph (i) Pretreatment panoramicradiograph

ideal overbite and overjet and improvement in upper lipprotrusion

8 Discussion

The upper canine despite being the tooth of most frequenteruption anomalies after third molars was considered asone of the most important teeth of the dental arch For agood treatment prognosis the proper evaluation of canine

position must be done through clinical and radiographicevaluation and treatment alternatives analyzed according tothe particularities of each case after careful evaluation ofthe orthodontist and professionals of distinct areas Variousmethods have been suggested for the traction and alignmentof impacted canines among which are the orthodonticremovable or fixed appliances and the use of anchorage inthe same arch or opposite arch However a fixed orthodonticappliance provides greater control and effectiveness of the


(c) (d)

(b)(a)

Figure 2 (a) Auxiliary T-loop (00175 times 002510158401015840 TMAwire) (b) Alignment of canine in the arch (c) Direct composite build up of peg shapedlateral incisor (22) (d) Complete levelling and alignment of arches

Table 1 SNA sella nasion to point A SNB sella nasion to pointB ANB difference of SNA and SNB Wits perpendicular frompoint A and point B occlusal plane FMA FH plane to mandibularplane119910-axis FHplane to sella gnathion planeU1-NA upper incisorinclination to nasion-point A plane L1-NB lower incisor inclinationto nasion-point B plane

Cephalometric variables Pretreatmentvalues

Posttreatmentvalues

(1) SNA 81∘ 80∘

(2) SNB 79∘ 77∘

(3) ANB 2∘ 3∘

(4) Wits 0mm 0mm(5) FMA 25∘ 26∘

(6) 119910-axis 61∘ 59(7) U1-NA (∘) 19∘ 25∘

(8) U1-NA (mm) 3mm +5mm(9) L1-NB (∘) 17∘ 28∘

(10) L1-NB (mm) 1mm 6mm(11) Upper lipndashE-line (mm) minus45mm minus2mm(12) Lower lipndashE-line (mm) +1mm +2mm

force applied and in most of the cases there is a need tocorrect some other type of associated malocclusion and toopen and keep the space to apply traction on the toothusing specific accessories as loops With regard to the forcesystem for traction of impacted or ectopic canines one mustbe careful with the direction of the applied force becausethis should not direct traction to the roots of neighbouringteeth not to cause trauma and external root resorptionsIt is recommended initially to gain space in dental arches

before traction and also the use of force of low intensity(no more than 60 g) and the employment of sufficientlyrigid archwires to prevent deflection which may underminemovement control [15]

Direct composite bonding is a good treatment optionfor peg shaped laterals as it is conservative and can beplaced directly onto the tooth It also preserves sound toothstructure is long lasting can be repaired easily and is costeffective [16 17]

The present case uses cantilever system that providesthe proper control for canine movement associated witha smaller load on anchorage units It is constructed withtitanium-molybdenum wire (TMA) of 0017 times 0025 inchesThe advantage found in this method consists in the abilityto work with a defined force system [18] To avoid relapsein the future bonded retainers are the retainer of choiceBecker et al evaluated posttreatment alignment cases whosetreatment was completedThis would support fixed retentionin this case and in many cases where the relapse potential isincreased [19]

9 Conclusion

The successful treatment of a patient with an ectopic toothcan be a challenging task for an orthodontist This casereport has demonstrated careful planning in alignment of thebuccally displaced caninewithmild crowding and peg shapedlateral incisor by nonextraction fixed orthodontic mechanicsto deliver light controlled force with good results Thusthe planned orthodontic treatment resulted in correction ofocclusion harmony of smile periodontal health and stabilityafter treatment


(h) (i)

(g)(f)

(e)(d)

(c)(b)(a)

Figure 3 (a) Posttreatment frontal photograph (smiling) (b) Posttreatment profile photograph (c) Posttreatment intraoral frontalphotograph (d) Posttreatment intraoral right lateral photograph (e) Posttreatment intraoral left lateral photograph (f) Posttreatmentintraoral maxillary occlusal photograph (g) Posttreatment intraoral mandibular occlusal photograph (h) Posttreatment lateral cephalogram(i) Posttreatment panoramic radiograph

Disclosure

Dr Asheesh Sawhny is second author in the manuscript

Competing Interests

The authors declare that there are no competing interestsregarding the publication of this article

References

[1] P Ngan R Hornbrook and B Weaver ldquoEarly timely manage-ment of ectopically erupting maxillary caninesrdquo Seminars inOrthodontics vol 11 no 3 pp 152ndash163 2005

[2] S E Bishara ldquoImpacted maxillary canines a reviewrdquo AmericanJournal of Orthodontics and Dentofacial Orthopedics vol 101no 2 pp 159ndash171 1992


[3] R E Moyers F P Van der Linden M L Riolo and J AMcNamara Jr Standards of Human Occlusal DevelopmentMonograph 5 Craniofacial Growth Series Center for humanGrowth and Development The University of Michigan AnnArbor Mich USA 1976

[4] S Peck L Peck and M Kataja ldquoThe palatally displaced canineas a dental anomaly of genetic originrdquo Angle Orthodontist vol64 no 4 pp 249ndash256 1994

[5] H Jacoby ldquoThe etiology of maxillary canine impactionsrdquoAmerican Journal of Orthodontics vol 84 no 2 pp 125ndash1321983

[6] S Chaushu M Bongart A Aksoy Y Ben-Bassat and ABecker ldquoBuccal ectopia of maxillary canines with no crowdingrdquoAmerican Journal of Orthodontics and Dentofacial Orthopedicsvol 136 no 2 pp 218ndash223 2009

[7] A Becker P Smith and R Behar ldquoThe incidence of anomalousmaxillary lateral incisors in relation to palatally-displacedcuspidsrdquo Angle Orthodontist vol 51 no 1 pp 24ndash29 1981

[8] M Shalish S Peck A Wasserstein and L Peck ldquoIncreasedoccurrence of dental anomalies associated with infraocclusionof deciduousmolarsrdquoAngleOrthodontist vol 80 no 3 pp 440ndash445 2010

[9] A Rohrer ldquoDisplaced and impacted caninesrdquo InternationalJournal of Orthodontia and Dentistry for Children vol 15 no10 pp 1003ndash1020 1929

[10] A D Hitchen ldquoThe impacted maxillary caninerdquo British DentalJournal vol 100 pp 1ndash14 1956

[11] J Rayne ldquoThe unerupted maxillary caninerdquoThe Dental Practi-tioner and Dental Record vol 19 no 6 pp 194ndash204 1969

[12] MMucederoM R Ricchiuti P Cozza and T Baccetti ldquoPreva-lence rate and dentoskeletal features associated with buccallydisplaced maxillary caninesrdquo European Journal of Orthodonticsvol 35 no 3 pp 305ndash309 2013

[13] W G Shafer M K Hine and B M Levy Eds A Textbookof Oral Pathology WB Saunders Philadelphia Pa USA 2ndedition 1963

[14] S Ericson and J Kurol ldquoResorption of incisors after ectopiceruption of maxillary canines A CT studyrdquo Angle Orthodontistvol 70 no 6 pp 415ndash423 2000

[15] V G Kokich ldquoSurgical and orthodontic management ofimpacted maxillary caninesrdquo American Journal of Orthodonticsand Dentofacial Orthopedics vol 126 no 3 pp 278ndash283 2004

[16] A D Izgi and E Ayna ldquoDirect restorative treatment of peg-shapedmaxillary lateral incisors with resin composite a clinicalreportrdquo The Journal of Prosthetic Dentistry vol 93 no 6 pp526ndash529 2005

[17] A C Scarpelli A P S Reboucas T Compart J B Novaes Jr SM Paiva and I A Pordeus ldquoSeven-year follow-up of estheticalternative for the restoration of peg-shaped incisors a casestudy of identical twinsrdquo General Dentistry vol 56 no 1 pp74ndash77 2008

[18] S M Francisco and M Cappellette Jr ldquoAspects and clinicalprocedures of eruptive changes of permanent upper caninesrdquoDental Press Journal of Orthodontics vol 17 no 2 pp 132ndash1392012

[19] A Becker N Shpack and A Shteyer ldquoAttachment bondingto impacted teeth at the time of surgical exposurerdquo EuropeanJournal of Orthodontics vol 18 no 5 pp 457ndash463 1996

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eruption as labial or lingual malpositioning of the ectopicallyerupted tooth migration of the neighbouring teeth and lossof arch length internal resorption dentigerous cyst forma-tion infection particularly with partial eruption referredpain and external root resorption of the impacted tooth aswell as the neighbouring teeth [14] Following is a case of a 16-year-old female who presented with a buccally displaced leftmaxillary caninewhichwas successfully brought into the archby orthodontic fixed appliance mechanotherapy along withdirect composite buildup of the peg shaped lateral incisorassociated with it

2 Case History

A 16-year-old adolescent North Indian female presented withthe chief complaint of the irregular teeth in relation to upperand lower arches

3 Clinical Examination

Extraoral examination showed no gross asymmetry meso-prosopic facial form and straight profile competent lipsand complex and nonconsonant smile with 1mm of gin-gival display (Figures 1(a) and 1(b)) Intraoral examination(Figures 1(c) 1(d) 1(e) 1(f) and 1(g)) showed presence ofpermanent dentition till second molars ectopically erupted23 overretained deciduous canine (63) peg shaped lateralincisor (22) and mesiopalatally rotated 13 and mesiolabiallyrotated 22 Many teeth showed hypocalcification Occlusalrelationship showed Class I molar and canine relationship2mm overjet and 7mm (80) overbite Lower arch showedmild crowding Maxillary dental midline coincided with themandibular dental midline

4 Radiographic Examination

The panoramic radiograph (Figure 1(h)) showed no patholo-gies The maxillary and mandibular third molars were erupt-ing and overretained 63 The lateral cephalometric analysis(Figure 1(i) Table 1) revealed that the patient had a skeletalClass I relationshipwith a normal growth pattern retroclinedmaxillary and mandibular incisors and retrusive upper lip

The case was diagnosed with Class I skeletal bases AnglesClass I malocclusion with mild crowding in upper and loweranterior teeth buccally ectopic 23 peg shaped 22 retained63 mesiopalatally rotated 13 and mesiolabially rotated 22retroclined upper and lower anterior teeth decreased overjetand increased overbite and retrusive upper lip Clinicalfindings and radiographic examination indicated that theresulting buccal displacement was due to retained upperleft deciduous canine and associated peg shaped permanentlateral incisor

5 Treatment Objectives

The treatment objectives were to relieve the crowding in botharches to align the buccally displaced right maxillary canineinto the arch to direct cosmetic composite buildup of theleftmaxillary peg shaped lateral incisor restoring it to normal

anatomy to obtain a normal overjet and overbite and pleasingsmile and to improve incisor inclination and improve facialesthetics

6 Treatment Plan and Sequence

On the basis of clinical examination and diagnostic recordsa treatment plan to correct the malocclusion through nonex-traction fixed appliance mechanotherapy was selected Therationale was to gain space formild crowding by extraction ofretained deciduous canine (63) and proclination of upper andlower incisors to avoid compromising the patientrsquos profileand to shorten the treatment time

Overretained deciduous canine (63) was extracted Fullfixed 0022 inch MBT 00175 times 002510158401015840 TMA wire bracketswere bonded on both arches except 23 After initial lev-elling and alignment with 0014 0016 and 0018 nickel-titanium HANT archwires both the arches were stabilizedwith coordinated 001810158401015840 stainless steel wires 23 was bondedAn auxiliary segmented T-loop made from 0022 inch MBT00175 times 002510158401015840 TMAwire (Figure 2(a)) from 26was attachedto 23 and its mesial arm was activated in distal occlusaland palatal direction to bring the buccally displaced rightmaxillary canine in the arch Final alignment of the 23 wasdone using a piggy back 001410158401015840 NiTi archwire Slight spacewas opened between 21 and 22 with NiTi open coil spring(Figure 2(b)) After 10 months of the treatment the bracketin relation to 22 was deboned and referred to restorativedentist for direct composite build of peg shaped 22 A lightcure adhesive system (3M ESPE Scotch Bond UniversalAdhesive Neuss Germany) was applied The buildup wasdone by incremental placement of restorative composite (3MESPE Filtek Z 250 XT Nano Hybrid Universal RestorativeNeuss Germany A2 shade) followed by contouring and lightcuring Finally the restoration was finished and polished(Figure 2(c))

22 was rebonded levelled and aligned and slight spacemesial to 22 was closed (Figure 2(c)) Coordinated 0019times 002510158401015840 SS was placed with Class II elastic on left sideFinal finishing wires 01410158401015840 NiTi were placed Total treatmenttime was 15 months followed by bonding of a maxillary (tokeep the buccally displaced right maxillary canine in optimalposition) and mandibular fixed spiral wire retainer

7 Treatment Results

Posttreatment records revealed that treatment objectiveswereachieved Facial photographs showed an improved profileand smile (Figures 3(a) and 3(b)) Class I canine wasestablished with canine-protected occlusion Dental midlineswere aligned with the facial midline with ideal overbite andoverjet (Figures 3(c) 3(d) 3(e) 3(f) and 3(g)) Posttreatmentpanoramic radiograph showed acceptable root parallelismwith no signs of bone or root resorption (Figures 3(h) and3(i))

Posttreatment lateral cephalometric analysis (Table 1)and superimposition revealed a Class I skeletal patternimproved inclinations of maxillary and mandibular incisors


(b)(a) (c)

(d) (e)

(f) (g)

(h) (i)



8 Discussion




(c) (d)

(b)(a)




Posttreatmentvalues

(1) SNA 81∘ 80∘

(2) SNB 79∘ 77∘

(3) ANB 2∘ 3∘

(4) Wits 0mm 0mm(5) FMA 25∘ 26∘

(6) 119910-axis 61∘ 59(7) U1-NA (∘) 19∘ 25∘

(8) U1-NA (mm) 3mm +5mm(9) L1-NB (∘) 17∘ 28∘






9 Conclusion



(h) (i)

(g)(f)

(e)(d)

(c)(b)(a)


Disclosure


Competing Interests


References




























Biomaterials












Journal of




















(b)(a) (c)

(d) (e)

(f) (g)

(h) (i)



8 Discussion




(c) (d)

(b)(a)




Posttreatmentvalues

(1) SNA 81∘ 80∘

(2) SNB 79∘ 77∘

(3) ANB 2∘ 3∘

(4) Wits 0mm 0mm(5) FMA 25∘ 26∘

(6) 119910-axis 61∘ 59(7) U1-NA (∘) 19∘ 25∘

(8) U1-NA (mm) 3mm +5mm(9) L1-NB (∘) 17∘ 28∘






9 Conclusion



(h) (i)

(g)(f)

(e)(d)

(c)(b)(a)


Disclosure


Competing Interests


References




























Biomaterials












Journal of




















(c) (d)

(b)(a)




Posttreatmentvalues

(1) SNA 81∘ 80∘

(2) SNB 79∘ 77∘

(3) ANB 2∘ 3∘

(4) Wits 0mm 0mm(5) FMA 25∘ 26∘

(6) 119910-axis 61∘ 59(7) U1-NA (∘) 19∘ 25∘

(8) U1-NA (mm) 3mm +5mm(9) L1-NB (∘) 17∘ 28∘






9 Conclusion



(h) (i)

(g)(f)

(e)(d)

(c)(b)(a)


Disclosure


Competing Interests


References




























Biomaterials












Journal of




















(h) (i)

(g)(f)

(e)(d)

(c)(b)(a)


Disclosure


Competing Interests


References




























Biomaterials












Journal of












































Biomaterials












Journal of


























Biomaterials












Journal of



















Case Report Interdisciplinary Management of Maxillary ... · le deciduous canine and associated peg shaped permanent ... eruption anomalies a er third molars was considered as one

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