Diagnostic study of impacted teeth

Diagnostic study of impacted teeth

PLAN  :

I. INTRODUCTION

I. DEFINITIONS:

1. The retained tooth
2. The impacted tooth
3. The included tooth

III. FREQUENCY 

VI. ETIOPATHOGENESIS:

1. Primary causes
2. Secondary causes
3. Local causes

V. DIAGNOSIS:

1. Positive diagnosis
2. Differential diagnosis

IV. COMPLICATIONS

Diagnostic study of impacted teeth

I. INTRODUCTION:

The permanent canine is usually the last anterior tooth to erupt on the dental arches. It therefore occupies the space left behind the lateral. This space reserved for the canine often remains insufficient to give it a normal position, consequently they remain included in the maxillae.

II. DEFINITIONS:

1. The retained tooth:

It is a tooth prevented from erupting normally, although its eruptive potential is intact. 

2. The impacted tooth:

It is a tooth retained in the maxilla or mandible, beyond its normal date of eruption, whose pericoronal sac is related to the oral environment. 

3. The included tooth:

It is a tooth that has completed its maturation, its apex being closed, its position remaining high, whose follicular sac is not in communication with the oral cavity.

III. FREQUENCY:

Dental inclusion is more common in girls. The teeth at risk of inclusion are, in order:

• upper canines
• upper central incisors
• lower second premolars
• lower canines
• first molars

Its position is palatal in the majority of cases, it can be intermediate in some cases but very rarely vestibular.

VI. ETIOPATHOGENESIS:

1. Primary causes:

1.1. Hereditary and congenital factors:

Hereditary factors cannot be ruled out. Dental inclusion can have a hereditary tendency, certain family predispositions exist and determine a predisposition to inclusion. 

2. Secondary causes:

2.1. Tooth-arch or dento-maxillary disharmony:

• Primary skeletal etiology: lack of development of the premaxilla in brachymaxilli prevents normal development of the canines.

• Primary dental etiology: macrodontia.

2.2. Dimension of the nasal fossae: The intercanine distance depends largely on the width of the nasal fossae. 

3. Local causes:

3.1. Linked to the environment of the germ: by the presence of malformation of the germs, of supernumerary teeth, of transposition, of the presence of odontomas, of pericoronary and radiculo-dental cysts.

3.2. Reduction of the eruption space: following the persistence of the temporary canine, overflowing restorations and early extractions of temporary canines without special precautions.

3.3. Linked to the germ itself: by the presence of malformations, dystopias, ankyloses and root bends.

V. DIAGNOSIS:

1. Positive diagnosis 

1.1. Clinical examination  :

Questioning  : 

• Age: Exceeds the expected age of eruption which is over 14 years.
• Reason for consultation: pain, sinusitis, inter-incisor diastema, aesthetics.
• History: look for possible pathological and dental history as well as any contraindications to orthodontic surgery.
• Assessment of patient motivation: especially in the face of long and difficult treatment.

Oral exo examination:

The discovery is often fortuitous, the signs of canine inclusion are rare and relatively discreet.

Endo oral examination: 

Inspection: 

• Oral hygiene. 
• Persistence or not of the temporary canine.
• Absence of the permanent canine beyond its expected eruption age.
• Interincisal diastema.
• Percussion and vitality test of permanent incisors.
• Presence of tooth-arch disharmony.
• Condition of neighboring teeth: Presence of mobility or cavities.

Diagnostic study of impacted teeth

Palpation:

Palpation reveals the presence of a vestibular or palatal arch, except in the case of centro-osseous inclusion.

1.2. Radiological examination:

Several X-rays can highlight the canine inclusion and can provide essential information on the root and its environment: Panoramic X-ray, retroalveolar X-ray, frontal and profile teleradiography, cone beam, denta-scan.

The radiological examination informs us about:

• The depth of inclusion;
• The anatomical situation of the tooth;
• Its orientation relative to the planes of space;
• Its relations with neighboring organs. ; 
• Its shape; 
• Persistence of the pericoronary sac;
• The quality of the bone.

2. Differential diagnosis:     

The impacted canine is differentiated from the following anomalies:

• Agenesis: which remains rarer for canines (0.13%);
• The retained or impacted tooth;
• The eruption delay;
• Iatrogenic extractions

IV. COMPLICATIONS:

Mechanical complications:

• Root resorption of neighboring teeth;
• Ankyloses, coronal resorptions and ossifications of included teeth;
• Dental movements;
• Prosthetic problems;
• Periodontal disorders.

Infectious complications :

• Peri-coronary disease of the included canine;
• Genital cellulite;
• Thrombophlebitis;
• Maxillary  sinusitis ;
• Osteitis (rare in the maxilla);
• Eye disorders (rare).

Tumor Complications: 

• Coronal-dental cyst.

Neurological Complications : 

• Pain and aches.  

Prosthetic Accidents:

• Difficulty in making prostheses due to the arches; 
• Presence of traumatic ulcerations;
• Root resorption of permanent incisors. 

Diagnostic study of impacted teeth

  Untreated cavities can reach the nerve of the tooth.
Porcelain veneers restore a bright smile.
Misaligned teeth can cause headaches.
Preventative dental care avoids costly treatments.
Baby teeth serve as a guide for permanent teeth.
Fluoride mouthwash strengthens tooth enamel.
An annual checkup helps monitor oral health.
 

Diagnostic study of impacted teeth