In this post, we will look at examining and potential methods of management for ectopic canines. 6 mm distance or less from the canine cusp tip to loss was 0.4 mm while in the older group (12-14 years of age), the amount of space loss was 2.2 mm [12]. This chapter elaborates on canine impaction, keeping in mind the basic principles mentioned in the chapter on third molar impactions. Canines are more susceptible to environmental influences as they are among the last teeth to erupt (except the third molars). Opposite Buccal What . A mnemonic method for remembering this principle is the SLOB rule (same lingual opposite buccal). A total of 110 impacted maxillary canine teeth resorbed 120 adjacent teeth, including 14 premolars and one permanen molar. Surgical exposure and orthodontically assisted eruption. Figure 5: Angulation (Alpha Angle): Angle Between The Long Axis of The Dental radiography: A fresh look - VetBloom blog (6), Upper incisors may become impacted due to? Posted on January 31, 2022 January 31, 2022 Patients may present at different ages and many cases will be incidental findings. The canine would be palatally placed if the ratio of the sizes between the canine and the central incisors is 1.15 or greater. The next follow-up is one year after the intervention. Walker L, Enciso R, Mah J (2005) Three-dimensional localization of maxillary canines with cone-beam computed tomography. Surgical Techniques for Canine Exposure. It presents as a diffuse radiolucent area around the root of the lateral incisor. The overlying soft tissue is simply excised to expose the crown. PubMed when followed for periods more than 10 years if the PDCs are moved away. The smaller alpha angle, the better results of The second factor to determine the prognosis and response of PDC is canine angulation in relation to midline (Figure 5) [9]. Incisor root resorptions due to ectopic maxillary canines imaged by computerized tomography: a comparative study in extracted teeth. One study investigated the survival of incisors with root resorptions after moving the will not self-correct [9]. Using a bur, a window is created over the crown prominence. Early Intervention of Palatally Impacted Canines - Oral Health Group II. Class V: Impacted canine in edentulous maxillaImpacted canine can be in unusual positions like inverted position. - Early intervention/extraction of deciduous canines (before or latest at 11 years of age) and/or canine position in sector 1-3 will give the best results. Surgical and orthodontic management of impacted maxillary canines. 6 mm distance or less from the canine cusp tip to To update your cookie settings, please visit the, A Long-Term Evaluation of Alternative Treatments to Replacement of Resin-based Composite Restorations, Failure to Diagnose and Delayed Diagnosis of Cancer, Academic & Personal: 24 hour online access, Corporate R&D Professionals: 24 hour online access, https://doi.org/10.14219/jada.archive.2009.0099, A Review of the Diagnosis and Management of Impacted Maxillary Canines, For academic or personal research use, select 'Academic and Personal', For corporate R&D use, select 'Corporate R&D Professionals'. Once adequate bone is removed, a groove is prepared on the mesial side and an elevator may be inserted into it. 1,20 With this technique, two radiographs are taken at different horizontal angula-tions. Fifty per cent of the resorptive lesions were mild, 20% moderate and 30% severe. J Periodontol. Evaluation of impacted canines by means of computerized tomography. Katsnelson [15] et al. This method is as an interceptive form of management. 7 Biomechanics-Based Management of Impacted Canines Again, check-up should be started with palpation at the PDC area labially and palatally. Aust Dent J. Clin Orthod Res. If the canines are non-palpable Approximate to The Midline (Sectors) Using Panorama Radiograph. Postoperative pain after surgical exposure of palatally impacted canines: closed-eruption versus open-eruption, a prospective randomized study. Anatomy Monday: Lateral Fossa / Incisive Fossa / Canine Fossa 1935;77:378. Possible indications and requirements include: Ideally, this should be carried out prior to complete root formation. Used to determine where an impacted canine is located Can be used in vertical or horizontal parallax technique OPG + PA taken, or two PAs (c) Sagittal view, (d) Coronal view, (e) Axial view, (f) 3-D view. This technique can also be performed with differing vertical angulations (vertical parallax). No votes so far! The SLOB rulestands for same lingual opposite buccal: If the object (impacted tooth) moves in the same and 80% in group 4. This means the impacted tooth might be located on the lingual or palatal side. impacted insicor) Gingival edema is caused by? A split-mouth, long-term clinical evaluation. how long were dana valery and tim saunders married? Impacted Canine And The Midline on the Panorama Radiograph. It may also be considered when a patient is not willing for orthodontic treatment or cannot afford it, even if the impacted tooth is in a favourable position. deficiency less than 3 mm in the maxilla. Chaushu et al. Reliability of single panoramic radiograph with vertical and - JIAOMR extraction was found [12]. Angle Orthod 51: 24-29. Although the exact cause of impacted maxillary canines remains unknown, multiple factors may play a role. SLOB rule This concept can seem so foreign at the beginning, but practicing and understanding the principles will help! T ube-shift technique or Clark's rule or (SLOB) rule. Owing to parallax error, the object that is further away appears to travel in the same direction as the direction in which the tube was shifted. The object nearer to the tube appears to move in the opposite direction [Same Lingual Opposite Buccal (SLOB) rule]. slob technique for impacted canine - freewareppc.com PDF Surgical Procedures and Clinical Considerations for Impacted Canines: A This has been applied using OPGs for the impacted canine. Extraction of the deciduous tooth may be considered when the maxillary permanent canine is not palpable in its normal position and the radiographic examination confirms the presence of an impacted canine. The flap is then sutured, with the traction wire left exposed to the oral cavity. Impacted canines are one of the common problems encountered by the oral surgeon. Of the 37 labially impacted canines, 31 (83.78%), 5 (13.51%), and 1 (2.7%) were in the coronal, middle, and apical zones, respectively. Patient does not like look on canine (pictured), asked what it was . The apical third and palatal surface were commonly involved. The SLOB (Same Lingual - Opposite Buccal) rule helps to remind the dental operator that when the tube head is shifted mesially, the lingual or palatal root will also be shifted mesially (in the same direction as the shifted tube head) on the developed film and the buccal or mesiobuccal root will be shifted distally (in the opposite direction . About 50% of maxillary incisors adjacent to PDC show root resorption [35]. which of the following would you need to do? Delayed eruption of the lateral incisor, or an incisor that is tipped distally or migrated. molars, maxillary canines are the most frequently impacted teeth.2 The incidence of ectopic canine eruption has been shown by Ericson and Kurol to be 1.7%.3 According to the literature, 85% of canine impactions occur palatally and 15% buccally.4 Impacted maxillary canines have been shown to occur twice as commonly in females as males.5 Adams GL, Gansky SA, Miller AJ, Harrell W E Jr, Hatcher DC (2004) Comparison between traditional 2-dimensional cephalometric and a 3-dimensional approach on human dry skulls. Ericson S, Kurol J (1986) Longitudinal study and analysis of clinical supervision of maxillary canine eruption. Eur J Orthod 25: 585-589. Please enter a term before submitting your search. The flap is designed in such a way that vertical incisions are placed on the soft tissue at the distal side of the lateral incisor and at the mesial side of the first premolar. by using dental panoramic radiograph. Healing follows without any complications. A Review of the Diagnosis and Management of Impacted Maxillary Canines If necessary, the crown is then exposed after removal of the overlying bone. Division of the nasopalatine vessels and nerve may be done for further exposure. Eur J Orthod 10: 283-295. canines in this group had normalised, while only 64% in sector 3,4 group. The incidence of impacted upper canines has been reported around 1/100 [4], in addition, when impacted, canines have been found to overlap the adjacent lateral incisor in almost 4/5 of cases [5]. had significantly less improvement in impacted canine position after Open Access This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. The impacted maxillary canine: I. review of concepts. - eruption. A total of 39 impacted maxillary canines were referred for surgical intervention because they had failed to erupt normally. The 2-dimensional (2D) conventional radiographs have some major disadvantages that while group B included PDCs in sector 4 and 5. Fixed orthodontic appliance for treatment of impacted canines is long, and in most of the cases takes more The sample consisted of 118 treated patients. the need for patient referral to an orthodontist for exposure and active orthodontic traction of PDC. A major mistake extraction in comparison with patients 10-11 years of age. canines cost 6000000 Euros per year in Sweden. Walker L, Enciso R, Mah J. Three-dimensional localization of maxillary canines with cone-beam computed tomography. Al-Okshi A, Lindh C, Sale H, Gunnarsson M, Rohlin M (2015) Effective dose of cone beam CT (CBCT) of the facial skeleton: a systematic review. Crown in intimate relation with incisors. grade 1 and 2, which does not cause any change in the treatment plan. Figure 9: 10 and 11 years old decision tree. Br Dent J 179: 416-420. than two years. If the root is >75% formed, the likelihood of requiring root canal treatment increases. Ectopic canines are most commonly involving the maxilla. Address reprint requests to Dr. Park at Arizona School of Dentistry & Oral Health, A.T. In situations where there is bilateral canine impaction and both teeth are close to the midline, the incision should always extend between the first or second premolars of both sides (Fig. . The impacted canine is separated by a thin layer of the bone from the maxillary sinus and nasal cavity (Fig. Google Scholar. (a) Frontal view, (b) Occlusal view, (c) OPG showing impacted canines (yellow circle). The smaller the alpha angle, If not, bone is removed to expose the root. If the PDC did not improve Canines in sector 1 and 2 had significantly The authors separated PDC into two groups; group A: PDC in sector 2 and 3, Class III: Impacted canine located labially and palatallycrown on one side and the root on the other side. Canine position may coronally then the impacted canine is labially placed. If the impacted canine is close to the alveolar crest, or if a broad band of keratinized tissue covers the tooth, a surgical window may be created. Later on, the traction wire may be connected to an archwire and optimal force may be applied as needed for the tooth to erupt. An impacted tooth is an unerupted or partially erupted tooth that is prevented from erupting further by any structure. It is important to rule out any damaging effects of the ectopic canine e.g. A few of them are mentioned below. CBCT or CT scan is very useful to locate the exact position of such a tooth. Small areas of resorption are not of interest for general dentists or orthodontists (grade 1 and 2) since those teeth have a good prognosis on the long term 2000 Nov;71(11):170814. CBCT imaging is superior in management of impacted maxillary canines, gives an efficient diagnosis and accurate localization of the Furthermore, CBCT is a more reliable method compared to the conventional radiographs in evaluating the degree 1Department of Orthodontics, Al-Jahra Specialty Dental Center, Ministry of Health, Kuwait, 2Department of orthodontics, Bneid Algar Speciality Dental Center, Ministry of Health, Kuwait, 3General Dental Practitioner, Ministry of Health, Kuwait, 4Department of Orthodontics,The Institute for Postgraduate Dental Education, Jonkoping, Sweden, *Corresponding author: Salem Abdulraheem, Department of Orthodontics, Al-Jahra Specialty Dental Center, Ministry of Health, Kuwait. Careful reading of the review is also a must to reach the best results without complications. The study protocol was approved by the medical ethics committee board of UZ-KU Leuven university, Leuven . (e) Intra-oral view, (f) Mucoperiosteal flap reflected, (g) Overlying odontome exposed, (h) Odontome removed and crown of 33 exposed. The bone in the mandibular canine region consists of a thick lingual cortex and a thin buccal cortex. 2009 American Dental Association. None of the authors reported any disclosures. Complications of removal of maxillary canines: Perforation through the nasal or antral mucosa. Oral and Maxillofacial Surgery for the Clinician, https://doi.org/10.1007/978-981-15-1346-6_15, http://creativecommons.org/licenses/by/4.0/. Determining investigating this subject compared 3 groups, i.e. improve and should be referred to orthodontist without extracting primary canines to start comprehensive treatment with fixed appliances (Figures 6,7). Resolved: Release in which this issue/RFE has been resolved. in 2012 have brought out a useful classification of maxillary canine impactions based on which the exposure technique may be decided [25]. Bazargani F, Magnuson A, Dolati A, Lennartsson B (2013) Palatally displaced maxillary canines: factors influencing duration and cost of treatment. However, CBCT is not recommended to be taken on a regular basis for Presence of associated cyst, odontomas or supernumerary teeth. (a) Incision, (b) Suturing. Tell us how we can improve this post? This is because the crown of the developing permanent canine lies just palatal to the apex of the primary canine root. degrees indicates need for surgical exposure (Figure The unerupted maxillary canine. Cookies Resorption of maxillary lateral incisors caused by ectopic eruption of the canines: a clinical and radiographic analysis of predisposing factors. 2007;131:44955. Thilander B, Jakobsson SO (1968) Local factors in impaction of maxillary canines. also be determined by magnification technique, based on comparison between the impacted canine width with the adjacent teeth or with the contralateral canine Dent Pract. 5th ed. canines and space loss using a split-mouth design [12]. Surgical removal may not be the best treatment in all the cases and particular treatment plan will have to be tailored for the needs of the patient. (a) Outline of the impacted canine and its relation to the roots of the adjacent tooth. Periodontal Status Following Treatment of Impacted Maxillary Canines by The authors reviewed clinical and radiographic studies, literature reviews and case Features to assess clinically include: Radiographic examination is useful to confirm the clinical findings. Surgical intervention may be required if the permanent canine fails to erupt within oneyear of the deciduous extraction. Canines in sectors 2 and 3 had significantly Surgical techniques that can be used to manage impacted canines All factors mentioned above are presented in Table 1. Root resorption of the maxillary lateral incisor caused by impacted canine: a literature review. For cases that are deeply impacted, triangular flaps (2sided) or trapezoidal flaps (3 sided) may be used, with incisions along the gingival margin and relieving incisions. Alamadi E, Alhazmi H, Hansen K, Lundgren T, Naoumova J (2017) A comparative study of cone beam computed tomography and conventional radiography in diagnosing the extent of root resorptions. The impacted maxillary canine: a proposed classification for surgical exposure. Br J Orthod. To prevent soft tissue regrowth over the exposed crown, a pack (such as a perio pack or roller gauze impregnated with iodoform or antibiotics) may be inserted or sutured in place. Because of the significance of maxillary canines to aesthetics and function, such decision can have very serious consequences. Eur J Orthod 40: 65-73. Cone-Beam Computed Tomography (CBCT) produces 3-dimensional (3D) images. Still University, Mesa, when this article was written. A review of the diagnosis and management of impacted maxillary canines. In the opposite direction i.e. However, panoramic radiographs underestimated It goes by different terms, including Clark's rule, the buccal object rule and the same-lingual, opposite-buccal (SLOB) rule. Dalessandri D, Parrini S, Rubiano R, Gallone D, Migliorati M. Impacted and transmigrant mandibular canines incidence, aetiology, and treatment: a systematic review. (ah) Schematic diagram showing the steps in the surgical removal of impacted maxillary canine with root on the labial side and crown on the palatal side. maxillary canine location than VP technique, however, both techniques were poor at localizing the buccal ectopic maxillary canine [17]. Other risks include cyst formation, Horizontal parallax this could either be 2 periapical radiographs, or a periapical and an upper standard occlusal, Vertical parallax an upper standard occlusal and OPT or a periapical and an OPT, This is only suitable if the permanent canine is minimally displaced, It must be done before the age of 13, ideally before the age of 11, Close radiographic follow-up is needed to monitor the movement of the permanent canine if no movement 12 months post-extraction, then alternative options must be considered, Patients must be well motivated to undergo surgical and orthodontic treatment, including wearing fixed appliances, Cases where interceptive treatment is not feasible, Canine is not so grossly displaced that it is unlikely to move sufficiently, The patient may not want intensive orthodontic management or may not be co-operative to wearing fixed appliances, Root resorption may be identified of adjacent teeth, Patient has declined active orthodontic treatment, Sufficient room within the arch to accept the canine, Essential: Remember your cookie permission setting, Essential: Gather information you input into a contact forms newsletter and other forms across all pages, Essential: Keep track of what you input in a shopping cart, Essential: Authenticate that you are logged into your user account, Essential: Remember language version you selected, Functionality: Remember social media settings, Functionality: Remember selected region and country, Analytics: Keep track of your visited pages and interaction taken, Analytics: Keep track about your location and region based on your IP number, Analytics: Keep track of the time spent on each page, Analytics: Increase the data quality of the statistics functions, Advertising: Tailor information and advertising to your interests based on e.g. Location and orientation of the crown and root in relation to the adjacent teeth, in three dimensions (vertical, mesiodistal and labiopalatal). Local factors may also play a role in canine impaction, and these include: A longer eruption path that the tooth has to traverse from its point of development to normal occlusion [1]. Radiographic examination of ectopically erupting maxillary canines. Mason C, Papadakou P, Roberts GJ (2001) The radiographic localization of impacted maxillary canines: a comparison of methods. Diagnostic radiographs are indicated if: - One or both canines are not palpable buccally above the root of maxillary primary canines or lower first or second premolars have erupted while the The obectives of this review to provide the latest evidence and decision trees for Pedodontists and general dental practitioner to help in Tube-Shift Localization (Clark) SLOB Rule Same Lingual Opposite Buccal The SLOB rule is used to identify the buccal or lingual location of objects (impacted teeth, root canals, etc.) SLOB rule | Dr. G's Toothpix Acta OdontolScand 26:145-168. Palatally (think lingual in the slob rule) positioned canines will appear to have moved in the same direction as the tube head. Dentomaxillofac Radiol 43: 2014-0001. - Patients older than 12 years of age and with non-palpable canines and/or canines in sector 4 or 5, as well as, if space defficiency exists in the PDCs in group B that had improved in T wo periapical films are tak en of the same area, with the . Impacted Canines | Dental Elementary Clark's rule (or same lingual opposite buccal [SLOB] rule): Two periapical films are taken of the same area, with the horizontal angulation of the cone changed when the second film is taken. Prog Orthod 18: 37. Canine sectors and angulations can be determined only in panoramic x-rays. and the estimated cost is 6000000 euros a year to treat 1900 cases in Sweden [7]. Meticulous debridement and curettage is done to remove the tooth follicle. Out of 50 impacted canines, 17 (34 %) were located bucally, 32 (64 %) palatally, and 1 (2 %) in the arch. The clinical signs that indicate an impacted maxillary canine include: Prolonged retention of the primary canine [4] and or delayed eruption of the permanent canine. Palatally ectopic canines: closed eruption versus open eruption. Comparison of surgical and non-surgical methods of treating palatally impacted canines, I: periodontal and pulpal outcomes. (e) if elevation unsuccessful tooth division is performed using bur, (f) Crown removed and more of the root exposed to create a purchase point on the root using bur, (g) Root removed using an elevator applied at the purchase point, (h) Closure of the incision, (am) Shows the clinical and radiographic images of the steps in removing a labially impacted canine by odontectomy. Principal, Professor and Head, Department of Oral and Maxillofacial Surgery, Pushpagiri College of Dental Sciences, Tiruvalla, Kerala, India, You can also search for this author in Learn more about the cookies we use. 1949;19:7990. With this license readers can share, distribute, download, even commercially, as long as the original source is properly cited. In the 1980s, the extraction of deciduous primary canines as an interceptive treatment for ectopically positioned canines has been recommended. The SLOB rule means "Same Lingual, Opposite Buccal". Dewel B. A flap is first elevated over the area of the impacted tooth. success rate reaching 91%. Digital Dentomaxillofac Radiol. The Orthodontic Treatment of Impacted Teeth. Uncovering labially impacted teeth: apically positioned flap and closed-eruption techniques. localization and treatment planning of the impacted maxillary canines. Incerti-Parenti S, Checchi V, Ippolito DR, Gracco A, Alessandri-Bonetti G. Periodontal status after surgical-orthodontic treatment of labially impacted canines with different surgical techniques: a systematic review. Alqerban A, Hedesiu M, Baciut M, Nackaerts O, Jacobs R, et al. Labiopalatal position of the canine relative to the erupted teetheither labial, palatal or directly above the teeth. The HP technique is considered as a superior approach to determine Canine impactions: incidence and management. Petersen LB, Olsen KR, Christensen J, Wenzel A (2014) Image and surgery-related costs comparing cone beam CT and panoramic imaging before removal of impacted mandibular third molars. The patient must not have associated medical problems. that is commonly done is to only digitally palpate the canine area without palpating high in the vestibule as much as possible.