Impacted teeth

Introduction :

Dental inclusion is an anomaly that is either:

situational anomalies
eruption anomalies

Definition :

A tooth is impacted when it is retained in the maxilla beyond its normal eruption date, devoid of a pericoronal sac and without communication with the oral cavity .

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

The inclusion can be unilateral or bilateral, palatal or vestibular, but palatal inclusion is 3 times more frequent than vestibular inclusion.

Etiologies:

Primary causes:

-Heredity: This is a fairly marked factor; children from the same family may have the same dental inclusion or the inclusion of a different tooth.

At the “congenital” stage of morphogenesis:

The distance from the site of germ development to the site of eruption of the upper canines is the longest of all permanent teeth.
Anomaly in the development of the tooth germ.
Embryological anomaly of cleft lip and palate

Supernumerary tooth
Delay or absence of root formation of the impacted tooth.

During the establishment of occlusion:

Class II Division 2
Brachygnathia
DDM due to relative macrodontia.

Secondary causes

Dental trauma to the corresponding temporary tooth

Premature extractions of the temporary tooth
Cystic or tumor formation
Lack of space (severe DDM)
Dental ankylosis.

General causes

Syndromes (Crouzon syndrome and cleidocranial dysostosis)

Diagnosis:

Clinical examination:

Inspection:

Persistence of the temporary canine after its normal date of loss
the symmetrical permanent canine being present on the arch.
Marked reduction of the diastema at the level of the impacted tooth
Version and rotation of neighboring teeth.

Palpation:

Palatal or vestibular arch (subgingival or submucosal inclusion)
Absence of canine arch or bump for a high palatal impacted canine.

X-ray examination:

– Panoramic radiography: It allows the inclusion to be detected and the degree of rhisalysis of the corresponding tooth to be estimated.

– The occlusal bite: These images provide valuable information on the vestibulo-lingual situation of the included tooth and its

relationships with neighboring teeth.

– Profile teleradiography: This allows us to specify the anteroposterior orientation of the root and the position of the tooth in relation to the floor of the maxillary sinus.

Treatment :

Preventive treatment:

Avulsion of the temporary canine.
Maintaining space.
Avulsion of supernumerary teeth.
Transverse expansion of the maxillae.
Therapeutic closure of inter-incisor diastemas.

Curative treatment:

Therapeutic abstention:

– This solution can be used when the aesthetics of the smile are preserved.

– The reasons for abstention may come from the patient who refuses orthodontic treatment even though the impacted tooth, due to its position, does not present any threat to its environment.

– This decision may also be linked to the impossibility of placing the included tooth, due to its position or its ankylosis and the desire to avoid an avulsion that would be too damaging at the bone level or of the adjacent teeth.

– Surgical techniques promoting dental eruption:

– Marsupialization: It allows the resorption of the pericoronal cyst, the tooth evolves at its own pace.

– Conductive alveolectomy: This involves removing the portion of bone that is preventing the tooth from erupting. It is mainly indicated for the maxillary canine in a mesial position.

– Surgical straightening: It is indicated for the immature included canine in a high vestibular position, when the tip of the crown abuts the apex of the lateral incisor. It allows the axis of the tooth to be modified, while leaving the tooth included.

‐ Avulsion: Avulsion of the included canine is the ultimate solution, it is only performed as a last resort; when the latter is responsible for pericoronitis, cellulitis, neuralgia, headaches, or causes tilting of the prosthesis.

Combined or ortho-surgical treatment:

Orthodontic treatment alone: This involves creating sufficient space on the arch to encourage the emergence of the canine.

Ortho-surgical treatment:

Pre-surgical orthodontic time:

The orthodontic phase allows the necessary space to be created on the arch to receive the crown of the impacted tooth.

Pre-surgical orthodontic means: In mixed dentition by:

– Space maintainer.

– Disjunction (if endognathism)

‐ Quad’Helix (if endoalveolus).

In permanent denture : opening of the space by different approaches:

– Closure of diastemas

– Lateral sector retreat

‐ Advancement of the incisor group

– Increase in arch perimeter

– Stripping of the proximal faces if the lack of space is not significant.

– Extractions.

Surgical phase
Orthodontic phase: The tooth is moved to its site on the arch using traction aids (elastic, chain).

Impacted teeth

Untreated cavities can cause painful abscesses.
Untreated cavities can cause painful abscesses.
Dental veneers camouflage imperfections such as stains or spaces.
Misaligned teeth can cause digestive problems.
Dental implants restore chewing function and smile aesthetics.
Fluoride mouthwashes strengthen enamel and prevent cavities.
Decayed baby teeth can affect the health of permanent teeth.
A soft-bristled toothbrush protects enamel and sensitive gums.

Impacted teeth