85 of ectopic maxillary canines are palatally located

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85% of ectopic maxillary canines are palatally located Risk of resorption of lateral incisor root Risk of resorption of lateral incisor root is greater if ectopic canine is palatal (approx 12% affected) Extraction of 1 o canine may improve path of eruption of 2 o canine Carter NE. in: Paediatric Dentistry (3 rd ed). Welbury RR, et al. Oxford University Press (2005).
Vertical parallax to locate impacted canines X-ray tube at 0-5 o X-ray tube at +60 o Mnemonics: Mnemonics: Your Your pal pal moves with you” moves with you” (Object located pal atally will appear to “move” in the same direction as the X ray tube) SLOB rule: Same = Lingual, Opposite = Buccal” SLOB rule: Same = Lingual, Opposite = Buccal” (Object located lingually / palatally will appear to “move” in the same direction as the X- ray tube; object located buccally will appear to “move” in the direction opposite to that of the X-ray tube)
SPACE LOSS SPACE LOSS resulting from caries resulting from caries and and early loss of primary teeth early loss of primary teeth
Early loss of primary teeth Early loss of primary teeth Early loss generally worsens crowding Usually the distal tooth drifts forward Incisors : Space loss unlikely once Cs erupted Canines : Balance extractions First molars : Space maintain/balance if 6’s not fully erupted and in Class I occlusion Second Molars : Space maintain
Ortho considerations prior to extractions Ortho considerations prior to extractions Age (dental development) of patient Age (dental development) of patient Degree of crowding Degree of crowding Conserve lower arch in Cl. II div 2 Conserve lower arch in Cl. II div 2 Conserve upper arch in Cl. III Conserve upper arch in Cl. III Caries status Caries status Presence/absence of other teeth (e.g. 8s) Presence/absence of other teeth (e.g. 8s) Type of malocclusion Type of malocclusion
Space loss Space loss: Maxilla > mandible Worse prior to eruption of 6s Loss of E > loss of D Crowded arches No opposing tooth ? Use of space maintainers Laing E, Laing E, et al. et al. Space maintenance Space maintenance Int J Paediatr Dent 2009; 19: 155-162 2009; 19: 155-162
Early loss of primary molars may lead to problems: Crowding Midline shift Ectopic eruption Dental impaction Crossbite formation Laing E, et al. et al. Int J Paediatr Dent Int J Paediatr Dent 2009; 19: 155-162 2009; 19: 155-162 Crowding and impaction of 35 Resulting from early loss of 75
Space maintainers Space maintainers Advantages Advantages Retain space, so overcoming problems of loss of arch length May lessen need for later complex ortho treatment Disadvantages Disadvantages Plaque retentive May contribute to gingivitis May predispose to caries May impinge on soft tissues May interfere with eruption of adjacent teeth May fracture/become dislodged Compliance problems/loss of appliance (removable SM) Regular review required The best space maintainer is a well- maintained primary tooth Laing E, Laing E, et al. Int J Paediatr Dent 2009; 19: 155-162 2009; 19: 155-162
Recommendations for use of space maintainers

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