Impacted mandibular canines

RE: Impacted mandibular canines

Evelyn Barbour-Hill — Thu, 06 Jul 2017 18:53:08 GMT

[quote user="Rob Davis"]Interesting... any significant evidence either way, or just personal observation?[/quote]

No significant evidence either way that I'm aware of.

Conventional wisdom holds, for instance, that retained deciduous lower canine teeth are the cause of lingual deviation of the permanent successors. Maybe they are, maybe they aren't. But conventional wisdom follows what eminent persons and their friends have asserted. Rather like the ridiculous recommendation to suture gingiva with 4/0, 3/0, or even heaven help us 2/0, material.

RE: Impacted mandibular canines

Rob Davis — Thu, 06 Jul 2017 18:18:56 GMT

[quote user="Beats"]n case i've got numbering wrong, the lower left canine had 1mm poking through just caudal to 3rd incisor, and had a deciduous one beside it which I extracted (rightly or wrongly) and then radiographed again after extraction.[/quote]

Ah... I understand - I hadn't realised that you had extracted the deciduous tooth (rightly!) and repeated the radiograph - that makes more sense now!

[quote user="Beats"]Is any further eruption likely at 1y6m?[/quote]

Probably not.

[quote user="Evelyn Barbour-Hill"]In my opinion – open to debate – and rather contrary to conventional wisdom – the effect which persistence of a deciduous tooth has upon the eruption (whether degree of eruption or angle of eruption) of its permanent successor is commonly much over-rated (like the films of Alfred Hitchcock).[/quote]

Interesting... any significant evidence either way, or just personal observation?

RE: Impacted mandibular canines

Beats — Thu, 06 Jul 2017 16:34:39 GMT

[quote user="Rob Davis"]I'm not clear from the pictures which is 304 and which is 404 (the top too appear to have conflicting R/L markers).[/quote]

I think the markers are correct, but wouldn't swear by it!

In case i've got numbering wrong, the lower left canine had 1mm poking through just caudal to 3rd incisor, and had a deciduous one beside it which I extracted (rightly or wrongly) and then radiographed again after extraction.

The lower right canine I thought was totally invisible, but when was showing to owner at discharge noted tiny white dot just caudal to third right incisor, which I'm pretty sure is the very tip of it just penetrating the gum.

[quote user="Rob Davis"]Checking visually will tell you if the tooth is erupting[/quote]

Is any further eruption likely at 1y6m?

[quote user="Rob Davis"] but periodic radiography would be necessary to check for early cyst formation. Ideally I would suggest x-raying 6 monthly initially.[/quote]

Happy to go with that plan :-)

RE: Impacted mandibular canines

Evelyn Barbour-Hill — Thu, 06 Jul 2017 12:34:02 GMT

[quote user="Rob Davis"] and extracting that tooth (if not already done) may encourage the adult to erupt further,[/quote]

In my opinion – open to debate – and rather contrary to conventional wisdom – the effect which persistence of a deciduous tooth has upon the eruption (whether degree of eruption or angle of eruption) of its permanent successor is commonly much over-rated (like the films of Alfred Hitchcock).

RE: Impacted mandibular canines

Rob Davis — Thu, 06 Jul 2017 10:39:58 GMT

I'm not clear from the pictures which is 304 and which is 404 (the top too appear to have conflicting R/L markers). I'm guessing that the side with the persistent deciduous tooth is the side which hasn't erupted, and extracting that tooth (if not already done) may encourage the adult to erupt further, though it may be too late for that (I'd be interested to hear what Evelyn or Pete think).

[quote user="Beats"]If wait and see, is checking orally every few months advisable initially, or annually, or taking xray to check periodically?[/quote]

Checking visually will tell you if the tooth is erupting (in which case I would be less concerned), but periodic radiography would be necessary to check for early cyst formation. Ideally I would suggest x-raying 6 monthly initially.

RE: Impacted mandibular canines

Beats — Wed, 05 Jul 2017 17:12:21 GMT

[quote user="Evelyn Barbour-Hill"]

I think it helps a good deal. Considerably less likely to cause trouble.

The 404 is likely to give trouble, in my opinion. But it would be OK to wait and see.

[/quote]

Great! Just what I was hoping for - really aprpeciate the advice.

If wait and see, is checking orally every few months advisable initially, or annually, or taking xray to check periodically?

I hate jsut ignoring something that could cause major problems, but equally I would hate being the cause of major problems earlier than would otherwise have happened...

RE: Impacted mandibular canines

Evelyn Barbour-Hill — Wed, 05 Jul 2017 16:43:56 GMT

[quote user="Beats"](not sure if little bit of 304 poking out helps any?)[/quote]

I think it helps a good deal. Considerably less likely to cause trouble.

The 404 is likely to give trouble, in my opinion. But it would be OK to wait and see.

[quote user="Beats"]If taking out now, ventral approach, certainly for 404, looks most straight forward to me - thoughts?[/quote]

Yes. Though no approach is going to be easy at this stage . But if a cyst forms, that might dictate a different approach as the easiest – dorsal, perhaps. And if it came to that, it would be perfectly acceptable to extract the 5 and the 6 if it made the approach easier.

Mr. Southerden may disagree.