Unusual impacted canine

Sent: Friday, December 11, 2009 9:56 AM
Subject: unusual impacted canine
has anyone had experience, pro or con, with a similarly impacted maxillary canine?
  
thanks for the input, and Happy Channukah.
 
Josh Wachspress
Modi’in, Israel

5 responses to “Unusual impacted canine

  1. In my practice, I would have that canine removed and plan for an implant.

    A side note, I’ve not had the chance to look at lots of CBCT’s. Is there actually no bone where that canine is supposed to be, or is it just burnout? If it is burnout, how can we use CBCTs to judge how much bone is present anywhere? If there actually is no bone there, how do you explain that? Traumatic baby tooth extraction?

    Diane Johnson

  2. Yep – I have
    Adrian Becker

    See before, during and after pictures attached.
    Before

    During

    After

    • An excellent result. I have done many of these, but am retired now and don’t haqve access to my old QuickCeph photos. I would add several comments.

      1. Adrian Becker is an expert, so believe what you see. So is Bjørn Zachrisson who has also treated many of these
      2. The first and still one of the best analyses and treatment protocols for such teeth was published by Percy Begg over 50 years ago.
      Usually, the root tip is in the alveolar trogh or reasonably so. The physics of proper positioning require application of a moment at the tip. Beg showed how to twist a loop in a simple piece of .010 ligature wire, nend it 90 degrees and “bond” it to the extreme tip of the crown using black copper cement (this was before composite or ionomer cements or even superglue)
      3. as Becker shows, traction is applied to a heavy arch bar, could even be an auxiliary arch slipped into headgear tubes.
      4. Gentle traction is easy using light elastic thread or elastomeric thread but running it through a loop or hook in the direction of desired crown movement, and then all the way back to a molar so that the force applied will be almost constant as the tooth moves.
      5. As we have gained experience and enlisted periodontist as well as OMFS exposure help, the “closed eruption” method has produced better gingival health. Adrian did not show the covering or the traction in this case, but bonding exactly at the tip and covering the tooth with a flap, having just the thread emerging from the tissue, might possibly have left more attached buccal tissue.
      6. Very important and beautifully displayed, the wire, or thread, does not touch the other tissue, which could cause a severe dehiscence.
      7. An implant is a last chance, not a first choice, IMHO

      Dick Carter
      drdcarter@mac.com
      Santa Fe NM

      • There is only 1 point in Dick Carter’s posting that I would like to reply to and this is regarding the attached buccal tissue:-
        The case I indicated is 1 of 3 in an article to be published in an upcoming issue devoted to tooth impaction in Seminars in Orthodontics and in it I show pictures of the replaced flap and the means of traction – I cannot upstage the article by publishing them here….. so you will be able to see these when your copy of Seminars arrives or when you browse for it online or perhaps you will need to renew your subscription for Seminars!
        Perhaps the most important item in that article is that I also relate how, close to the end of the traction of the tooth, the patient was kicked in the mouth by her horse. Both the canine and adjacent lateral incisor were partially avulsed, with mucosal lacerations. The avulsions were reduced, the mucosa sutured and the article in Seminars carries a picture of the splinted teeth and sutured lacerations at 3 days post-trauma. Having nursed this case along successfully for many months, imagine my disappointment when this happened. The result was what you saw in the “after” photograph. In the normal run of things I would have expected the better attached buccal tissue that Dick refers to.

        Adrian Becker

  3. What about the severe root resorption at the end of treatment? Could it be related to high orthodontic forces?

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