Radio Graphic Assessment by Bhawna (2)

RADIOGRAPHIC ASSESSMENT RADIOGRAPHIC ASSESSMENT OF DENTAL ANOMALIES IN OF DENTAL ANOMALIES IN PATIENTS WITH ECTOPIC PATIENTS WITH ECTOPIC MAXILLARY CANINEMAXILLARY CANINE

HELLE BUDTZ SORENSEN, LON ARTMANN, HELLE JUUL LARSEN &INGER KJER HELLE BUDTZ SORENSEN, LON ARTMANN, HELLE JUUL LARSEN &INGER KJER

Presented by: Dr. Bhawna Arora.

Mentored by: Dr. Vineet.I.S. KhindaDr. Manjeet kaur.Dr. Nitika.

Source: International journal of pediatric dentistry 2009 Vol-19, No.2, March Issue

1

ContentsContents Introduction Materials and methods Results Conclusion Related journals

2Radiographic assesment of ectopic canines

IntroductionIntroduction Ectopically erupted maxillary canines pose problem in

early prediction, diagnosis as well as treatment CT gives a more accurate result that whether they are

palatally or bucally erupted Altogether 8% of 505 longitudinally studied children (8-12

years) show signs of ectopic canine eruption. It is difficult to determine path of eruption before 10

years of age Variation in tooth germ position. changes in path during eruption.

After the age of 11 years, 1.7% of children show eruption disturbances.


Etiology Etiology

Longest path of eruption Crowding Supplementary tooth. Supernumerary tooth. Abnormal dentoskeletal features. Other dental anomalies Insufficient Arch length.

Buccal Eruption

4Radiographic assesment of ectopic canines 4

Radiographic assesment of ectopic canines

Palatal eruptionPalatal eruptionGenetic Theory, polygenic multifactorial inheritanceGuidance Theory, Missing lateral incisors Peg shaped lateral incisors Transposition of teeth Retained deciduous and retarded eruption

of permanent teeth Other pathological lesions like odontomes Ankylosis Trauma to maxillary region

Radiographic assesment of ectopic canines 5

Secondary CausesSecondary Causes

1. Endocrinal disturbances2. Vitamin D deficiency3. Febrile diseases



Bucally erupted canine

Palatally Erupted canine

Canine transpositionCanine transposition


* Canine–first premolar 71%; * Canine–lateral incisor 20%; * Canine to first molar site 4%; * Lateral incisor–central incisor 3%; * Canine to central incisor site 2%.

Sequelae of canine Sequelae of canine impaction, Ectopic eruption impaction, Ectopic eruption and Transpositionand Transposition Root resorption of impinging teeth Infection Referred pain Dentigerous cysts Self resorption.


Maxillary canine puts Maxillary canine puts excessive pressure on lateral excessive pressure on lateral incisor resorbing the rootsincisor resorbing the roots


The pressure from the erupting canine might result is resorption of incisors.

The purpose of this study was to analyze radiographic evidence of dental deviations in the maxillary incisor region and the dentition in general in cases with palatally or labially located ectopic canines.


The maxillary incisor region develops from The maxillary incisor region develops from frontonasal process of embryo has a different frontonasal process of embryo has a different origin at the neural crest rather than canine origin at the neural crest rather than canine premolar areapremolar area


DiagnosisDiagnosisVisual methodBidigital palpationRadiographic Localization


MATERIALS AND METHODSMATERIALS AND METHODS

Panoramic and intra-oral radiographs from 69 patients with ectopic maxillary canines were analyzed. The patient group constituted all patients with palatally or labially located ectopic canines, referred to as specialized surgery unit in the Arhus Community Dental Service within a 2-year period.

The radiographs were divided into three groups according to dental deviations in the maxillary incisor field and the dentition in general. Due to late maturation, the third molars were not analyzed.


Group I: No deviations in the dentition,

Group IIa: Deviations in the dentition within the maxillary incisor field only,

Group IIb: Deviations in the dentition in general

Each of these three groups was divided according to occurrence of palatally and labially located ectopic canines.


Group I : No dental deviations



Group IIa : dental deviations in the incisor region


Group IIb : With dental deviations in in general including upper incisor region


How to assess radiographically the ectopically erupted canine in relation to other teeth?


Panoramic radiographs give valuable information that should not be underestimated. Since they are taken routinely for orthodontic records, they are an excellent screening tool for detecting ectopically erupting canines. Sector location and angulation of the unerupted canine can be analyzed from the panoramic X-ray.

1. Angular Measurement:A horizontal reference line is chosen, Warford et al used a bicondylar line passing through the most superior point of the condyles. The mesial angle formed by using the constructed horizontal line and the long axis of the unerupted canine is measured. The higher the angle the less tendency to ectopic eruption and therefore the less tendency to impaction. Warford et al, showed in their study angulation was higher for non-impacted teeth, with a mean of 75.12° compared with 63.20° for impacted teeth.



2. Sector Measurement:

Three lines are drawn; one that coincide with the mesial surface of the lateral incisor, the other line with the distal surface of the lateral incisors, and the last one bisect the lateral incisor into two halves. These lines divide the area into four sectors; sector I, II, III, IV . If canines are in sector I, they are not ectopically erupting. Therefore, there is no risk of impaction. The risk of impaction becomes higher in sector II, III, and IV.

The dentitions in 69 cases with palatally and labially erupted canines

Group I No dental deviations

Group IIa Maxillary incisor deviations*

Group IIb General dental deviations**

N % N % N %

Palatal Female n=38 9 24 8 21 21 55

Male n=12 6 50 3 25 3 25

Labial Female n = 11 3 27 3 27 5 46

Male n = 8 3 38 4 50 1 12

Deviations in the dentition Deviations in the dentition that was noted:that was noted:

1) Morphological: invaginations, screw shaped crowns, taurodontic molars, short premolars and slender roots.

2) Agenesis 3) Eruptional deviations such as

retarded eruption4) Ectopic eruption


,

Results Results 50 patients had palatally located canines 19 patients had labially located canines. The prevalence of ectopia is higher in females than in males. Furthermore, it is documented that palatally as well as labially located ectopic canines can occur in dentitions without other dental deviations. Dental deviations occurred in approximately two-thirds of all cases, more often in females and in cases with palatally located canines. The deviations in the incisor region were: invaginations (16 patients), narrow crowns (14 patients), and malformed roots (19 patients). In the premolar /molar regions, taurodontic roots shapes were registered in 16 patients and eruptional deviation and short premolar roots in six patients.

Some other methods to Some other methods to examine ectopic eruption of examine ectopic eruption of caninecanine Modified occipito-mental view



Occlusal view of ectopically erupted canine


Intra oral periapical radiograph



Recent Advances in Imaging

1. Three dimensional C T2. Computed tomography3. Cone beam radiography4. Scanography5. Dentascan Imaging

Computed Computed TomographyTomography

• Can also be used to visualize an impaction.

• Technique which uses a series of radiographic axial sections to produce a computer generated three dimensional image.

• Most precise method of radiographic localization.



Computed tomographic technique

3D Computed 3D Computed TomographyTomography

Dentascan imagingDentascan imaging It is nothing but a modification of panoramic imaging.

Radiologist has to indicate the curvature of mandible and maxilla.

Computer generates reinforced cross sectional and tangential images.


Limitation Image requires compensation for magnification

Use It is used in implant imaging


Treatment plan

Leave and observeInterceptive treatment with the extraction of primary canine Extraction of canines Orthodontic positioning of permanent canines Surgical realignment, repositioning /alignment and transplantation


How to manage such cases? We have a few case reports to see the management of such cases.

Palatally displaced 22 and totally bucally blocked out 23


Upper arch: 0.017 inch × 0.025 inch stainless steel arch wire, open coil to create space for 22, 23 and to correct midline. Lower arch: 0.014 inch NiTi arch wire


Upper arch: Extraction of 24. 23 allowed to drift down Lower arch: 0.017 inch × 0.025 inch stainless steelarch wire. Open coil to create space for 32, 33 and to correctlower midline.


Upper arch: 0.018 inch stainless steel mainarch wire. 0.017 inch × 0.025 inch TMA sectional wire withclosing loop for distalisation, palatal root torquing and then extrusion of 23


Upper arch: 0.014 inch thermal NiTi arch wire toalign 23. 22 not bonded. Lower arch: 0.019 inch × 0.025 inchstainless steel arch wire. Open coil to create space for 32, 33and to correct lower midline. Power chain to retract 43.


Extraction of 34. 0.014 inch NiTi arch wire to align 32, 33


0.019 inch × 0.025 inch stainless steel arch wire forarch coordination and space closure.


Finished occlusion


Similarly for palatally impacted canines


Summary

Disturbances in the eruption of permanent maxillary canines are common.

Careful supervision of the developing dentition and early diagnosis of ectopic eruption may prevent impaction of these teeth and resorption of the neighbouring incisors.

Protocol is; clinical and radiographic evaluation combined with primary canine removal followed by maintaining the space.

This protocol is effective when the condition is detected early , it is important to evaluate the canine position no later than 10 years of age.

Radiographic assessment of Radiographic assessment of maxillary canine eruption in maxillary canine eruption in children with clinical signs of children with clinical signs of

eruption disturbance eruption disturbance

Sune Ericson and Jüri Kurol,

Dr Jüri Kurol, Department of Orthodontics, The Institute for Postgraduate Dental Education, J rnvägsgatan 9, S-552 55 JÖNKÖPING, Sweden

The positions of maxillary canines were radiographically investigated in children .

Altogether 8 % of 505 longitudinally studied children, aged 8–12 years at the start of the project showed clinical signs of canine eruption disturbances.


In children aged 10 years and younger, it was found that attempting to determine the path of eruption

This may be due to the large variation in tooth germ positions and because of changes in the path during eruption.

In children aged 11 years and older, altogether 1.7 % of the canines showed eruption disturbances, mostly with a palatal path of eruption.

The radiographs showed that when the lateral incisor root was in close contact with an erupting canine, 35 per cent showed an absence of the lamina dura.

Early Timely Management of Early Timely Management of Ectopically Erupting Maxillary Ectopically Erupting Maxillary

CaninesCanines Peter Ngan , Robert Hornbrook†, Bryan Weaver‡

The European Journal of Orthodontics 1988 10(1):115-120; doi:10.1093/ejo/10.1.115 © 1988 by European Orthodontic Society

Diagnosis and treatment of ectopically erupting permanent maxillary canines require timely management by the orthodontist. Potentially impacted maxillary canines may be inadvertently overlooked in the mixed dentition due to the variations in eruption patterns and timing. Periodic examination starting at age 8, including clinical intraoral palpation and selective radiographs, may aid in the early diagnosis of unerupting and potentially impacted permanent canines. When such a diagnosis is apparent, timely interceptive therapy may then be instituted. This article reviewed the incidence, etiology, and development of the maxillary canine. The rationale for early management of potentially impacted maxillary canine is discussed together with the treatment for labially and palatally impacted canines. Radiographic assesment of ectopic

canines 51

Peter Ngan , Robert Hornbrook†, Bryan Weaver‡

The European Journal of Orthodontics 1988 10(1):115-120doi:10.1093/ejo/10.1.115 © 1988 by European Orthodontic Society

Diagnosis and treatment of ectopically erupting permanent maxillary canines require timely management by the orthodontist..

Periodic examination starting at age 8, including clinical intraoral palpation and selective radiographs, may aid in the early diagnosis of unerupting and potentially impacted permanent canines

. When such a diagnosis is apparent, timely interceptive therapy may then be instituted.

This article reviewed the incidence, etiology, and development of the maxillary canine. The rationale for early management of potentially impacted maxillary canine is discussed..

CT diagnosis of ectopically CT diagnosis of ectopically erupting maxillary canines—aerupting maxillary canines—a case report case report

Sune Ericson and Jüri Kurol 1Dr Jüri Kurol Department of Orthodontics The Institute for Postgraduate Dental education Järnvägsgatan 9 S-552 55 Jönk ping Sweden

This case report describes the use of high-resolution computed

tomography (CT) in the diagnosis of both the location and extent

of root resorption of permanent incisors

. The CT image proved to be superior and more information was obtained than when conventional radiographic methods, including polytomography, are used.

As the skin entrance dose is also low and the exposure of radio-sensitive organs can be avoided

we consider that the advantages of CT clearly warrant its use in this type of patient with a potential resorptive canine/lateral situation due to ectopic eruption of the maxillary canines.


Reference1 .Helle budtz sorensen, lone artmann, helle juul larsen & Inger kjaer: radiographic assessment of dental anomalies in patients with ectopic canines. International journal of paediatric dentistry 2009;19:108-114

2.Patric .f.mcsherry,:the ectopic maxillary canine: a review. British journal of orthodontics Vol 25/1998/209-216

3.Grace Richardson, kathy A. Russel:A Review of impacted permanent maxillary cuspids- diagnosis and prevention. J Can Dent Assoc 2000;66:497-50

4. Sune Ericson, Juri Kurol: Incisor Resorption caused by Maxillary Cuspids A Radiographic Study. Angle Orthodontist, 1987 No. 4, 332 – 346.

5.John H Warford, Ram K Grandhi and Daniel E Tira: Prediction of maxillary canine impaction using sectors and angular measurement. Am J Orthod Dentofacial Orthop. Volume 124, pages 651-655, Dec 2003.6. Hessa M Alkhal, Bakr Rabie and Ricky W K Wong: Orthodontic tooth movement of total buccally blocked-out canine Cases Journal 2009, 2:7245 doi: 10.4076/1757-1626-2-7245


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Radio Graphic Assessment by Bhawna (2)

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