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What is the advantage of the panoramic radiograph?

It offers a view of all the dentoalveolar region of both

maxillary and mandibular bones in one film.

What are the uses of a panoramic radiograph?

to see broad areas, to diagnose pathology, to treatment

plan, to evaluate anomalies, to follow up surgical and
traumatic cases.

What are advantages of panoramic radiographs?

shows a global vision of the dentoalveolar region and the

radiation dosage is low in general.

what are disadvantages of panoramic radiographs?

normalization, lack of detail and definition, distortion

What are clinical indications for use of a panoramic

radiograph in children?

1. after doing a very good anamnesis and intraoral exam,

2. what kind of information is desired, 3. is it necesary?
4. At 8-9 years old (end of the 1st transitional phase)

What are contraindications for taking a panoramic

radiograph?

1. young children (early stage). 2. in difficult patients when

you cannot take PA's or BW's.

What are the 5 regions included in the analysis of the

panoramic x-ray?

1.Nasomaxilary, 2. Mandibular, 3. temporomandibular

joint, 4. maxillary dentition, and 5. mandibular dentition

When looking at the maxillary and mandibular dentitions,

what things should be viewed?

1. UR, UL, LL, LR 2. Number, identity, position, formation

and stage of the tooth. 3. alveolar structures, dental
crypts, root resorption of the teeth.

What is the normal sequence of eruption for maxillary

teeth?

6-1-2-4-5-3-7: first molars, central incisors, lateral incisors,

first premolars, second premolars, canines, second molars

What is the normal sequence of eruption for permanent

teeth in the mandible?

6-1-2-3-4-5-7; first molars, central incisors, lateral incisors,

canines, first premolars, second premolars, second molars

What is the normal chronology of eruption for maxillary

teeth? (age at which teeth erupt)

6 year old - First molars; 7 years old - central incisors; 8

years old - lateral incisors;9 years old - First premolars; 10
years old - second premolars; 11 years old - canines; 12
years old - second molars

What is the normal chronology of eruption for mandibular

teeth? (age at which teeth erupt)

6 year old - First molars; 7 years old - central incisors; 8

years old - lateral incisors;9 years old - canines; 10 years
old - first premolars; 11 years old - second premolars; 12
years old - second molars

what are the patterns of eruption for the teeth of the

maxilla?

central and lateral inscisors erupt labially and distally;

canines erupt mesially and labially; first premolars erupt
mesially; second premolars erupt distally; molars erupt
mesially

what is the pattern of eruption for the teeth of the

mandible?

the central incisor erupts lingually, lateral incisors erupt

lingually and distally; the first premolar erupts mesially; the
second premolar erupts distally, and molars erupt mesially

What does malocclusion mean?

faulty position of the teeth such that they do not meet

properly.

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True or False? Malocclusion is a disease.

False - it is not a disease but itcan be a disability with

potential impact on physical and mental health, and
therefore, appropriate tx may be important for a person's
well-being.

When considering the craniofacial complex, what factors

should one lookat?

What are the (static/dynamic relationships of (1) the

teeth? and (2) the jaws? ... and how do they affect the
face (i.e., the smile, profile, etc.)? Lookat (in 3-D): (1)
Teeth - within the dental arches (MX, MN) and (2) Jaws with the dental arches together

What are the general rules used to describe dental

malalignment?

1. All assessments are made relative to "ideal" arch form.

2. Describethe deviation from "ideal" Consider: position,
angulation (tip), orientation (rotation) ... of the teeth in all
3-dimensions

What is considered ideal for "ideal arch form"?

Interdental contact areas and incisal edges wil be aligned

and teeth will be well-supported by the periodontium

Where is the dental midline?

line separating the maxillary and mandibular arch in half

between the central incisors.

How are anterior and posterior teeth divided in the

arches?

anterior teeth include the canines and incisors;

posteriorteeth include the premolars and molars

What region is referred to as vestibular?

the region betweenthe teeth andthe cheeks

what region is referred to as labial?

the region between the anterior teeth and the facial

components (lips)

What region is referred to as buccal?

the region betweenthe posterior teeth and the cheeks

What region is referred to as palatal

the back side of the maxillary teeth

What region is referred to as lingual

The region between the mandibular teeth and the tongue

What are some terms used to describe vertical dental

malalignments?

extruded: aka - incisal (anteriors) or occlusal (posteriors)

intruded: aka - gingival

What are some terms used to describe dental

malalignment referring to the angulation of the anterior
teeth?

proclination and retroclination

What does proclination mean?

incisal edge of the tooth is anterior compared to the root

What does retroclination mean?

the incisal edge is posterior when compared to the root

How is malocclusion classified inthe permanent dentition?

Angle system is the most common classification used

What are limitations of using the angle classification

system

focus is on horizontal (AP) malrelations; it is based on

MX6 postion, it relates MN to MX

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What is Angle Class I?

MB cusp of MX6 articulates with the MB groove of MN6.

Buccal segment corresponds (cusp-embrasure); MX3
cusp lines up with embrasure of MN 4-3.

What is Angles Class III?

MB cuspof MX6 is posterior to MB groove of MN6; buccal

segment not cusp-embrasure; MX3 cusp posterior to
embrasure of MN4-3; "Subdivision"= asymmetry (Class III,
I)

What is angles Class II?

The MB cusp of MX6 is anterior to the MB groove of MN6;

the buccal segment is not cusp-embrasure; the MX3 cusp
is anterior to the embrasure of MN 4-3; "Subdivision"=
asymmetry (Class II, I)

What is Class II Division 0?

Ui are normally inclined

What is Class II Division1?

The upper incisors are proclined and protruded

What is Class II Division 2?

MX1s are upright or retroclined and/or MX2s are proclined

(gang sign for this)

What terms are used to describe malocclusion in the

primary dentition?

malocclusion of the primary dentition is based on the

relationship of the distal surfaces of the primary 2nd
molars in lateral view: (1) flush terminal plane, (2) distal
step, (3) mesial step

What does a flush terminal plane in the primary dentition

mean?

the distal surfaces of the primary second molarsare

aligned in lateral view

What are the possible developmental consequences of a

flush terminal plane?

end-to-end (Class II) or Class I

What is a distal step when describing the primary

dentition?

The position of the mandibular distal surface as distal

relative to the maxillary distal surface.

What permanent classification does a distal step tend to

develop into?

Class II

What is a mesial step classification of the primary

dentition?

The position of the mandibular distal surface as mesial

relative to the maxillary distal surface.

What type of permanent dentition doesa mesial step tend

to develop into?

Class I or Class III

Whatis overjet?

the horizontal overlap of the incisors

What is the normal amount of overjet?

about 2 mm

What is it called if the lower incisors are in front of the

upper incisors?

anterior crossbite or reverse overjet

What does overbite refer to?

the vertical overlapof the incisors

What isthe ideal amount of overbite?

1-2 mm

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What is it called if there is no vertical overlap?

an open bite - measure the vertical separation in this case

What is an impinging bite?

when there is complete verticaloverlapand the lower

incisors are touching the palatal tissues.

What is a posterior crossbite?

a transverse discrepancy between teh MX and MN

posterior teeth, such that the MX tooth is palatal and/orthe
MN tooth is buccal

What is a buccal crossbite?

a transverse discrepancy where the MX (posterior) tooth is

completely buccal to the MN tooth

What landmarks are facial types based on?

AP position of the MN; reference lines: forehead-chin

(Glabella-Pognion),FH

What is a prognathic facial type?

MN is protruded relative to the MX, this is common in

Class III

What is a retrognathic facial type?

MN is retruded relative to the MX; this is common to Class

II-1

What is the desired facial type?

mesognathic - straigh profile

What are profile types based on?

based on AP position of subnasale (Sn) andreferenceline

GI-Pg

What is a straight profile type?

glabella-subnasale pognion are all in a line

What is a concave profile type?

the subnasale isposterior to the glabella pognion line

What is a convex profiletype

the subnasale is anteriortothe glabella pognion line

How do the facial type and profile types correspond?

mesognathic = straight;prognathic = concave; retrognathic

= convex

What are the vertical facial proportions?

Middle 1/3 of Face[MAFH]; lower 1/3 of Face [LAFH]

What area makes up the MAFH?

verticaldistance: eyebrows to subnasale

What area makes up the LAFH?

vertical distance: subnasale - menton

True or False? Ideally the MAFH= LAFH

True

What are ideal vertical facial portions for the lower 1/3 of
the face?

Sn-Stomion = 1/2 (Stomion-Menton)

When doing a clinical assessment, what should a dentist

be able to describe?

What would fall under preemergent eruption?

malalignment, malocclusion, and dentofacial features.

resorption

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What things would be under the category of postemergent

eruption?

juvenile equilibriumand adult occlusalequilibrium

what are some causes of early loss of primary teeth?

caries, severe crowding, and trauma

What should one consider when early loss of teeth

occurs?

space maintenance

What are some factors to consider when determining what

the outcome of early loss of primary teeth will be?

age, tooth extracted (or lost), type of crowding, degree of

crowding, dental arch, potential for crowding to be
concentrated at the extraction site

What can be done to minimizethe undesirable sequelae of

early loss of primary teeth?

balancing extractions, compensating extractions, and

space maintenance

What are some space maintenance guidelines?

primary 1st or 2nd molar is missing, early loss of C, fixed

space maintainer - unilateral or bilateral

When is space regaining possible?

when there is localized space loss of 3 mm or less.

Causes might be decay or ectopic eruption. In some
cases, may want to try this because the permanent 1st
molar moves mesially very quickly.

What are some options for space regaining in the

mandibular?

removable- jacscrew or wire; removable lower lingual arch

with loops for adjustments; a lip bumper: alters the
equilibrium of forces on anterior teeth, keeps lips off
mandibular incisors, incisors move forward and molars
move distally; can widen the arch; replace with lingual
arch once the space has been regained.

What is the goal of using space maintainers?

preserve space in premature loss of teeth, maintain

"leeway space" - maxillary arch -0.9 mm per side and
mandibular arch - 1.5 mm per side. Transpalatal arch
canrotate the first molars.

What is the desired leeway space for the maxillary arch?

0.9 mm per side

What is the desired leeway space for the mandibular

arch?

1.5 mm per side

What are some commonly used space maintainers

lower lingual arch, transpalatal arch, Hayes Nance

What are the categories for crowding?

none, mild-moderate,severe

What are good descriptors for generalized mildto

moderate crowding?

2-4 mm; no prematurely lost teeth; expect moderately

crowded incisors; treatmentplan - generalized expansion
of the arch to increase the arch perimeter

What is serial extraction?

planned sequence of tooth removal to reduce crowding

during transition. It allows teeth to erupt over the alveolus
and through keratinized tissue. Timed extraction of
primary and permanent teeth; severe crowding that is >10
mm

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True or False? If you start a patient on treatment with

serial extractions, you must complete it!

True

What is serial extraction?

Timed extraction of primary and then permanent teeth

When is the decision made to do serial extractions?

decision is made during the mixed dentition

What is the amount of crowding that makes serial

extractions necessary?

>10 mm per arch

What is the desired angles Class for serial extractions?

Class I

True or False? with serial extraction, only primary teeth

are extracted.

False - permanent teeth will also need tobe extracted.

What is the advantages of serial extraction?

It is a planned sequence of extractions that reduces

crowding and irregularities during the transition. It allows
teeth to erupt over the alveolus and through keratinized
tissue.

What is the order in which serial extractions should occur?

Want the first premolar to erupt before the canine remove the primary canines; wait 1-2 years, (premolar 1/2
- 2/3 root should be formed), remove the primary first
molar, when the first premolar erupts, extract it. If the
pano shows the canine erupting before the 1st premolar,
enucleate the 1st premolar at the time of extraction of the
primary first molar

What is Kjellgren 1948 definition of serial extraction as a

corrective procedure in dental orthopaedic therapy

Extraction of c's at age 8.5-9.5 years to encourage

alignment of permanent incisors; extraction of d's about 1
year later to encourage eruption of the 4's; extraction of
4's as 3's are erupting.

What is the primary goal of serial extraction?

facilitate unimpeded eruption of the permanent teeth

What are indications for serial extraction?

class I, about 9 years ofage, severe crowding, average

overbite, full complement of teeth, no doubt about
long-termprognosis of6's

What are some shortcomings ofserial extractions?

seldom removes the need for further appliance therapy;

three episodes of extraction may be required; cooperative
parents are a requirement due to the timing

What are some contemporary views to consider in

removal of upper c's?

When upper 2's are erupting in potential crossbite; to

create space for proclination of upper 2 or the eruption of
an incisor when a supernumerary has delayed its
appearance; to promote alignment of a palatally -displaced
upper 3

What are some contemporary viewsto consider removal of

lower c's?

to facilitate the lingual movement of a lower incisor with

reduced periodontal support; to allow lingualmovement of
the lower labial segment in some Class III cases

What are some periodontal considerations?

measurethe keratinized gingivaat the

mucogingivaljunction,mesure the sulcus probing depth.

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the attached gingiva is calculated how?

keratinized gingiva - sulcus probing depth

What is hyperdontia?

presence of extra (supernumerary) teeth

What is anodontia?

failure of teeth todevelope (agenesis of teeth) this is very

rare

What is oligodontia?

6 or more missing teeth- this is very rare

What is hypodontia?

less than 6 congenitally missing teeth

Congenital absenceof teeth results from disturbances

during the initial stages of tooth formation- these stages
are...

initiation and proliferation

True or False? Ifa primary tooth is missing there cannot

be a successor.

True - the primary tooth buds give rise to the permanent

tooth buds

True or False? If all primary teeth are present there will

be no missing permanent teeth.

False - can have missing permanentteeth even when the

primary teeth are all present.

What is hypodontia?

the absences of 1-5 teeth

What is the incidence of hypodontia, excluding 3rd

molars?

3.5-6.5% of the population (third molars aremissing in

20-25% of the population.

What is the incidence of congenitally missing primary

teeth?

0.1% to 0.4%

True or False? girls have a higher incidence of

hypodontia.

True girls have1.37 times as much hypodontia than boys

True or False? Hypodontia tends to run in families

True

What is the etiology of hypodontia?

Missing teeth can be inherited as part ofasyndrome or

isolatedin an autosomal-dominant or autosomal recessive
way. Genes- MSX,PAX9, AXIN2; cytotoxic drugs,
radiotherapy, syndromes - ectodermal dysplasia; and
other random things. etiology is unknownbut it is common
in families.

Hypodontia is associated with what systemic conditions

seen in patients?

random - no associateions; hypothyroidism: thyroid,

pituitary, hypothalamus abnormalities; Down Syndrome:
trisomy 21; ectodermal dysplasia: group of syndromes,
missing or peg shaped teeth. Thin sparse hair, absence
of sweat glands; cleftpalate: one in 600-800 births

What teeth are generally affectedby hypodontia?

usually affects the last tooth in a series- lateral incisors,

second premolars, and third molars. Most commonly
missing are 3rd molars, followed by maxillary lateral and
maxillary/mandibular second premolars

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What are possible treatment options for hypodontia?

maintainthe primary tooth - occlusal and size discrepancy

problems; replacement - prosthetically, transplant, implant
- retain primary until time of implant; extration of primary
w/drift of permanent; extractionofprimary followedby
orthodontic treatment.

What should be assessed for determining the best

treatment options for treatment of hypodontia?

facial profile,incisor position, spcae requirements, status of

primary teeth

What are some options in the case of missing second

premolars?

No crowding - retain and build-up; remove and implant;

For mild crowding- remove after 2's erupt to encourage
space closure; Severe crowding - leave and remove later

When replacing missing 2nd premolars with

animplant,what should be considered?

the implant will act like an ankylosed tooth if they are done
before growth has stopped- need to make sure to wait
until growth has stopped

What are treatment options for missing maxillary lateral

incisors?

maintain space, open space, or close the space

What thingsshould be considered when determining which

treatment option tousefor missing maxillary lateral
incisors?

patient's attitude and desire; color,size, shape, inclination

ofcanine; vertical skeletal relationship; occlusion of the
buccal segment; anteroposterior skeletal relationship;
whether arches are spaced or crowded

What two malocclusions permit canine substitution?

Class II with no mandibular crowding and Class I with

mandibular crowding requiring the extraction of two teeth.

Why is a diagnostic wax-up of canine substitution critical?

allows evaluation of final occlusion, amount of reduction

needed;acceptable esthetics - show the patient what it will
look like - the canines need to look like lateral incisors,
may need toreduce the canine to make it look like a
lateral.

When evaluating the profile to determine if canine

substitution isa goodplan what type is not a good
candidate?

convex profile with retrusivechin is a poor candidate; want

balanced, relatively straight profile, mildly convex profiles
might be acceptable as well. look at the facial profile
carefully

Compare the canine to the lateral incisor...

canine is wider with amore convex labialsurface. dentin

mightshow through with reduction required to reshape the
canine. color of the canine is usualy more saturated and
darker. mesioincisal and distoincisal edgemay need
restoration to look like a lateral

Why is evaluation of the crown width of the CEJ of the

canine important prior to treatment

The periapical radiograph helps one determine the

emergence profile for the tooth. a narrow mesiodistal CEJ
is more esthetic for an emergence profile; a wide
mesiodistal CEJ will have a poor emergence profile.

What are ideal situations for canine substitution?

canine is the same color as the central incisor; narrow at

the CEJ; relatively flat labial surface; narrow mid-crown
width (buccolingually)

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Why does the patients lip level need to be considered

when determining if canine substitution will work?

If the patient has an excessive gingiva to lip distance on

smiling,the gingivallevels will be more visible. The
gingivalmargin ofthe naturalcanine should be positioned
slightly incisal to the central incisors gingival margin.- may
need to do perio on the tooth to give it a more esthetic
look.

Microdontia is an expression of...

hypodontia

Abnormalities in tooth size and shape result from

disturbances during which stage of development.

the morphodifferentiation stage of development.

What is the most common abnormality in teeth?

variation in size- particularly maxillary lateral incisors and

second premolars

What percent of the population has a significant tooth size

discrepancy?

5%

What type of analysis is donewhen there is a tooth size

discrepancy?

Bolton Analysis: this is an important concept, unless the

teeth are matchedfor size, the normal occlusion is
impossible - a difference of 1.5 mm or less is usually not
of consequence.

What are the mostcommon teeth with hypodontia?

lateral incisors- essential to recognize this - there is not

enought tooth massto close the spaces. In treatment plan
- need to recognize this and plan for veneers or crowns on
these teeth.

What is the most common location for supernumerary

teeth?

a mesiodens at the maxillary midline

Where are 85% of supernumerary teeth found?

in anterior part of maxilla, laterals, premolars,and 4th

molars can also appear

Orthodontically why is it important to notice

supernumerary teeth early on?

the presence of extra teeth has a great potential to disrupt

normal occlusion- early intervention to remove them is
indicated.

According to Mosby's orthodontic reviewwhat is the

incidnce of hyperdontia?

much lower than hypodontia - 0.5% in primary dentition

and 1% in permanent dentition.

True or False? supernumerary teeth are typically tooth

shaped and difficult to notice

False - than can be typical or atypical in shape

What is the most common cause of an unerupted central

incisor inthe maxilla?

supernumerary tooth - mesiodens - they can exist

singularly or in combination and can deflect teeth

What is another name for a 4th molar?

the distodens

What is the mother of supernumerary teeth disorders?

cleidocranial dysplasia

What is the aim of treatment of supernumerary teeth?

treatment is aimed at extraction before problemsarise, or

on minimizing the effect on other teeth. As a generalrule:
more supernumeraries,moreabnormal,higher their position,
and increased difficulty in management.

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At what age are supernumerary teeth usually discovered?

age 6 or 7

When should extraction of supernumerary teeth be done?

as soon as possible without harming

developing/normalteeth - for surgery need to consider
access and root development of the permanent teeth.
consider the childs ability to tolerate surgery, the earlier
the extraction is done the morelikely the permanent tooth
will erupt without intervention. Later extractions are
morelikely to need surgical exposure of the permanent
tooth and ortho - usually the root has finished fomring and
the tooth will not erupt

When should one consider removing a conical

supernumerary tooth?

If it erupts, if it is inverted, if it is displacing adjacent teeth,

if it is producing a diastema, if it is delaying eruption of
permanent teeth

When should one leave a conicalsupernumerary tooth as

it is.

If it is wel above the apices of the permanent tooth - then

observe

What isa tubercle?

a weird shaped supernumerary tooth that is unlikely to

erupt - removesupernumerary and retaineddeciduous
tooth in the area and prepare for orthodontic eruption if
the permanent tooth doesn't erupt on itsown.

What are supplemental teeth and what should be done to

treat them?

supplemental teeth resemble a normal tooth in

morphology and commonly produce crowding or
displacement. Extract the tooth mostdissimilarto the
contralateraltooth, unless it is severely displaced

True or False? ankylosis only occurs in cases where

there is no successor present

False - it can ocdur in cases when there isa success and

in cases where there is no successor present

What is the definition of ankylosis?

an eruption anomaly defined as the union of the tooth root

tothe alveolar bone, with local elimination of the
periodontalligament,and cessation of eruption. continued
vertical alveolar growth anderuption of adjacent teeth

What things can aid one in making a clinical diagnosis of

ankylosis

infraocclusion is very diagnostic - marginal ridges will be

uneven;percussion - will make a different sound on
tapping (teeth have no PDLS and ankylosed tooth will
make a sharp solid sound with (>20% of the root fused);
mobility testing, lack of orthodontic movement, and
radiographs

What is the #1 ankylosed tooth in adults?

impacted canine

What are somedental implications of an ankylosed tooth?

ectopic eruption, tipping of adjacent teeth, loss of arch

perimeter,periodotnal compromise/problems,
supraeruption, complications with extraction of ankylosed
teeth

What is the prevalence of ankylosis?

1.3%-14%-most common in primary teeth with th eprimary

2nd molarand is 50% more common in the mandible.(no
accurate studies exist on ankylosis so there is a variance
in this number. more common in caucasians.

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True or False? primary anterior teeth usually do not

ankylose unless there is trauma

True

What are common causes of ankylosis?

trauma- especially in permanent teeth - unknonw for

primary teeth - theories: familial patterns, genetics,
metabolic disturbances

What are treatment options for ankylosed teeth?

observation, extraction, orthodontic treatment (done if

necessary to bring permanent teeth into place

What should one consider when determining best

treatment for an ankylosed tooth?

absence or presence of successor tooth, amount of

infraocclusion, dental age/root formation, complications

What are some problems associated with remaining

ankylosed teeth?

submerged tooth may not exfoliate, permanent premolar is

severely delayed, drift of the other permanentteeth into
the space of the delayed tooth can create a significant
malocclusion

What are some common problems associated with an

ankylosed tooth that has no successor?

long term periodontal problems, loss of alveolar bone,

difficult extraction

What are treatment options for an ankylosed tooth with no

successor?

Depends on the amount of crowsding have two options -->

Extract- moveteeth at leastpartially into edentulous spacecreate new bone - reposition later or Extract and close the
spaces orthodontically in cases of severe crowding

What are consequences of infraocclusion ofa deciduous

molar?

delayed exfoliation of primary tooth, progressive

submergence with failure of alveolar development, difficult
extraction often requiring surgery

What are consequences for the permanent successor ofa

ankylosed deciduous molar?

delayed and/or abnormaleruption, disturbed root

development, midline shift

What are consequences to the developing occlusion of a

infraocclusded ankylosed deciduous molar?

tipping of adjacentteeth, localized posterior open bite, loss

of bone if no successor is present

What is the prevalence of ankylosed primary molars?

8-14%

What isa definition of an ankylosed primary molar

Fusion of the root and bone, continued verticalgrowth and

eruption of the adjacent teeth causes infraocclusion

What is the total eruption path of the permanent first molar

- from the time it is first in occlusion until growth stops?

1.25 cm.- this means there can be a large vertical

discrepance depending on the time it becomes ankylosed

What is the management of a ankylosed primary molar

when a permanent successor is present?

keep under obseration, it may exfoliate, Extract if: delayed

past contralateral tooth, root formation of 2/3 complete,
permanent teeth are tipping into the site

What is the management plan for an ankylosed primary

molar if there is absence of a permanent successor?

Extract: 6 tipping mesially and riskofvertical defect

occurring, extract carefully so there will not be a worse
periodontal defect. move teeth into space tobring bone
along, plan forfuture implants or closure with orthodontics

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What is treatment options for ankylosis of permanent

tooth?

Implant planned,can't align ankylosed tooth;ifextractalveolar atrophy if growth isnotcomplete;"bank" alveolar

bone - remove crown,retain the rooth - fill with calcium
hydroxide, the root will resorb over a 3-5year period and
alveolar bone remains. The implant will be moresuccessful
without need for a graft. Pontic is placed on archwire
orremovableappliance. Implant is placed when
verticalgrowth is complete

How does one differentiate between over-retained and

delayed eruption?

over-retained means the successor root formation is>2/3

and the contralateral tooth is fully erupted. Delayed
eruption means the chonological age and denal age do
not match. Teh teeth on both sides of the arch are equally
delayed and affected

What should be done for managment of a retained primary

tooth when the successor tooth is absent?

assess crowding, remove- may need

toremovecontralateralpermanent tooth, retain

What should be done for managment of a retained primary

tooth when the successor tooth is unerupted and ectopic

consider removal of retained primary tooth to encourage

alignment if mildly ectopic, may need space maintainer or
orthodontic treatment.

What should be done for managment of a retained primary

tooth when the successor tooth is erupting?

removethe primary tooth if deflecting the eruption path,

space maintainer may be necessary,remove if root of
permanent tooth is >2/3 formed

What are some types of space maintainers that can be

used?

distal shoe, band loop, hayes nance, transpalatal bar,

lower lingual arch

What is the best space maintainer

the tooth itself

What are design factors that should be considered with

space maintenance?

anchorage, status of succedaneous teeth, eruption status

of other teeth, medical status, cleansability, patient
cooperation/abilities, need touse as active appliance

What are the clinical steps for a fixed space maintainer?

Spacers if needed 1st appointment - fit bands on the

teeth; take impression, remove bands, disinfect
impression and bands, place bands securely in
impression, pour in yellow stone, write prescription, send
to lab, extractteeth or refer for extractions 2nd
appointment - try appliance in mouth, adjust if necessary,
cement, clean excess cement, instructions for care,
maintenance appointments

What instructions should the patient be provided with

regarding the fixed space maintainer?

brush around the appliance a few times a day, do not eat

chewy or hard foods (caramels,gum, ice, etc), if it is loose,
call for recementation, keep 3 month appointment, if
permanent teeth erupt in space,call for an appointment.

What should be done at appointments fora removable

space maintainer?

1st appointment- take impression, disinfect impression,

pour in yellow stone, write laboratory prescription, send to
lab, extractions or refer for extractions 2nd appointment try appliance in mouth, adjust as necessary, instructions
for care, mainetance appointments

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What instructions should be given to patients with

removable appliances?

wear 24/7 except when eating, place appliance in case

when eating, brush with toothpaste or use denture
cleaner, if loose call for adjustment, keepregular
maintenance appointments (every 3 months)

What is the definition of impacted canine?

condition of being firmly lodged (impacted in alveolar

bone) or wedged by a physical barrier, usually other teeth
so it is prevented from erupting.

what is the definition of an ectopic eruption

eruption located away from the normalposition

What is the eruption process for a permanent tooth?

resoprtion ofoverlying bone, resorption of primary tooth

roots, eruption through the gingiva

What can cause interferences with eruption?

ectopic eruption of a permanent tooth - undermining

resorption of the primary tooth and non-resorption of the
primary roots; supernumberary teeth - remove these as
indicated, heavy fibrous gingiva - may need to expose the
tooth; sclerotic bone - may need to expose the tooth;
ankylosed tooth; lack of space - consider serial extracction
or orthodontics (age/crowding dependent)

What is considered the normal development pattern for

maxillary canines?

age 3 - located high in the maxillary bone - mesially and

lingually directed crowns; intrabony migration - lateral
roots - "ugly duckling stage";spontaneous closing
ofmidline diastema as caninessimultaneously upright and
erupt

what are some developmental landmarks for the canine?

4-6 months - development (calcification) begins high in the

maxilla; 6 years - crown completed; 10 years - palpable
high in the buccal vestibule; 11-13 years - eruption; 14-15
years - root completed;

What is the most frequently impacted tooth?

third molars - second is maxilary canine (50 times greater

occurrence in maxilla vs. mandible

Which type of impaction occurs more frequently for the

maxillary canine? buccal or palatal?

palatal 2:1-12:1 depending on study

What is the etiology of maxillary canine impaction?

availability of space in the arch, eruption path, horizontal

angulation of tooth, trauma to primary tooth bud,
disturbance in eruption sequence, rotation of tooth buds,
premature root closure.

Why is maxillary canine impaction such a diagnostic

problem?

it is usually the last tooth to replace a primary tooth, there

are fewer radiographs taken at recall - bitwings may not
show canines, need knowledge of crown development,
root development, and eruption

When is the most opportune time to observe the maxillary

canines beginning their eruption and detect the eventual
impaction?

8-9 years of age- thisis whenthemaxillary canines migrate

labially. EXTREMELY IMPORTANT to BE ABLE TO
OBSERVE THIS. Diagnositc pano should be taken
routinely at this age to makesure the canines are
evaluated

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Usually the canine erupts at 11-13 years of age, what are

causes of the primary canine not exfoliating?

overretention may be result of, not causeof ectopic

position of permanent canine - permanent canine has not
precipitated vertical resorption of the primary tooth's root;
canine crown inclined too far mesially, canine crown
having slipped over the root of the permanent lateral
incisor, isdeprived of the eruptive guidance of the lateral
incisor's distal surface

When should primary caninesbeextracted ifthe permanent

canine path is errant?

at age 10

After primary canines have been extracted, how long

doesit take to see improvement ifitwill happen

Teeth tend to take the path of least resistance, it generally

takes 6-18 months for improvement to be seen.

What factor is most important in determining if a

permanent canine will fill the space of an extracted
primary?

degree of horizontal angulation is important, 78% of

canines changed angulation within 18 months of primary
canine extraction,91%ifthe tip of the canine cusphad not
passed the midlineof th elateralroot. There must be space
for the canine to erupt - maintain or create the space after
primary extraction

What are clinical signs ofmaxillary canine impaction?

1. failure to palpate canine bulge in buccal vestibule by

10 years. 2. immobility of the deciduous canine,3.palatal
bulge indicating possible underlying canine,4. increased
mobility, non-vital central or lateral incisors,5. inadequate
space within the dental arch for canine eruption, 6. flared
lateral incisors - can also be normal, 7.asymmetry of
eruption,

True or False? impacted maxillary canines in individuals >

40 years of age are susceptible to ankylosis.

True

True or False? Failure to move impacted maxillary

canines in adolescents can indicate ankylosis

True

What are radiographic signs of probable canine

impcation?

long axis of the canine is angled more than 10degrees to

the verticalplane. The greater the angle, the more likely
there is a problem. 25 degree impaction, canine overlaps
the lateral or central incisor root, parallaxtechnique shows
the buccal/palatal position (SLOB rule or Clark'srule) the
greater the angle of impaction the more severe the
problem will be

What are treatment options for impacted canines?

extract deciduous canine, no treatment, orthodontic

alignment, surgical removal

What are considerations when making the decision to

extract a deciduous canine?

age 10, may help normalize the eruptive path in palatally

displaced canines, radiographic improvement is usually
seen in 6-18 months

What should be done when the no treatment option is

selected for maxillary canine impaction?

poorly motivated patient, inform of resorption risk and

cystic change within canine follicle, monitor
radiographically every 12 months

What should be done when the orthodontic alignment

option is selected for maxillary canine impaction?

following surgicalexposure,goldchain bonded to the tooth,

space is created, TPA in place

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What should be done when the surgical removal option is

selected for maxillary canine impaction?

This isvery unfavorable canine position, poorly motivated

patients, orthodontic treatment is contraindicated, severe
crowding (substitue 1st premolar)

What is ectopic eruption?

teeth erupting in a place out of normal position

What teeth aremost commonly ectopically erupted?

maxillary first molars, maxillary canines, mandibular

canines, maxillary premolars, mandibular premolars,
maxillary lateral incisors

What causes ectopic eruption?

malpositionedtooth bud can cause eruption in wrong place

(most commonly max 1st molar) can cause ectopic
eruption of other teeth and lead to transposition.

When lateral incisors erupt ectopically what are some

common concerns?

ectopic eruptoin cancause resorption of primary canine

-indicates lack of space. loss of only one primary canine
can cause midline shift - need to maintainlateral incisor
positon with appliance or extract the contralateralcanine.
loss of mandibualr primary canines cancause incisors to
tip lingually and there is loss of arch perimeter.Space
analysis is very important LLA (passive or active)

What is the prevalence for ectopic eruptoin of the

maxillary first molar?

2-6% (20-25% if cleft lip/palate)

What etiology can cause ectopic maxilary first molar

eruption?

crowding, large crowns, mesialeruption

What is common management for ectopic maxillary first

molar eruption?

observe - it may correct spontaneously - rarely after age 8

years or active treatment: brass wire or elastic separator mild cases, distalizing appliances more severe cases,
extract primary if pulpal involvement - space maintainer or
regainer

Early loss of primary teeth can cause what type of

problems?

2nd primary molar - mesial drift of first permanent molar greater if no occlusal forces are on it. early loss of primary
1st molar or canine - distal drift of incisors - force
fromactive contraction of transseptalfibers, pressure
fromthe lips and cheeks