axi

JBnk@ing,

examination of ectopically ewhpti canines

une Ericson, D.D.S., Odont. Dr., and Jiki Kurol, D.D.S., Odont. Dr.
Sweden

This study analyzes the need for and possibility of obtaining further information from different radiographic procedures in 125 children with potential ectopic eruption of the maxillary canines. After clinical examination of 3,000 IO to 15-year-old children, it was found that 7% needed radiogra~~~o examinations for determination of the canine position. Eighty-four children (2.8%), with a total of 125 potential ectopically erupting maxillary canines diagnosed clinically and by means of peria~ic~l radiographs, were selected and a stepwise extended radiographic diagnostic procedure was used. Most canines in ectopic eruption were positioned palatally; the positions could be assessed with sufficient accuracy from conventional periapical films in 92% of the cases. Only in 37% of the cases, however, could the lateral incisor be projected free from the ectopic canine by the intraoral technique. The lamina dura of the lateral incisor facing the canine was often found to be interrupted. For 29% of the ectopic canines, the lateral incisors could neither be projected free nor judged free from resorptions and a supplementary polytomographic investigation was believed to be necessary. The number of resorbed teeth was doubled by polytomography and altogether 12.5% of the ectopic canines caused resorptions. A stepwise radiographic procedure including polytomography is describe and recommended in cases of ectopic eruption of maxillary canines for determining the correct position and ruling out or confirming resorptions on incisors, thereby optimizing the o~hodo~t~c treatment planning. (AM J ORTHOD DENTOFAC ORTHOP 1987;91:483-92.) ey words: Canine, orthodontics, radiology, resorption, tooth eruption, ectopic, tomography

ecause of the risk of problems associated with the eruption of maxillary canines, careful supervision and early diagnosis of disturbances in eruption have been considered important.- For most children the supervision can safely be limited to clinical inspection and digital palpation of the alveolar process in the region of the canines provided the general occlusal development and somatic maturity are also taken into account.7 However, it has been reported that in about 8% to 10% of children the clinical investigations must be supplemented with radiologic procedures if the disturbances in eruption are to be identified early and injurious complications avoided (Ericson and Kurol, 1986).. Examples of complications that may be discovered radiographically are ectopic eruption, resorptions of adjacent teeth, and cystic or even tumorous lesions of the follicle. 9-1oBecause of discrepancies in radiographic procedures and in interpretation and diagnostic criteria, it is difficult to obtain a reliable opinion of the magnitude of the problem and how and when the eruption disturbance and complications are most effectively diagnosed.5*7*8~11~2
From the Departments of Maxillo-Facial Radiology and Orthodontics, Institute for Postgraduate Dental Education, Jiinkbping, Sweden. The

The objectives of this study were to study radiologically the positions of the maxillary canines in cases in which they were clinically suspected to erupt abnormally in order to determine the prevalence of and types of complications occurring during such ectopic eruption, and to compare the information obtained from different radiologic procedures. MATERIAL AND METHODS The material of the study consisted of 84 children with ectopic eruption of 125 maxillary canines and was derived from clinical examinations of almost 3,000 children, varying from 10 to 15 years of age. The children were divided into six age groups with an average of 500 children in each. The subjects, who were all children in their respective age groups from a selected school district at the time of the investigation, were examined clinically concerning their osclusal development in relation to somatic maturity. The examination was performed twice with an interval of 1 year and according to a previously described procedure.7 If disturbances in eruption were clinically suspected, the children were radiographed. A radiographic examination was indicated in the canine region if: 1. Asymmetry was present between the right and left

Fig. 1. Stepwise radiographic examination of ectopic eruption of the left maxillary canine. conventional intraoral film shows the position of the canine vis-a-vis the adjacent incisors but does not rule out resorptions due to the overlapping. 8, The orthopantograph gives only a rough impression of the relation between the canine and neighboring teeth. C, Lateral tomography through the crown of the maxillary canine perpendicular to the underlying lateral incisor with 2 mm between the cuts. O~timai orientation of the cuts is shown vis-a-vis the lateral incisor. There is no evidence of resorption. B, Frontal tomography parallel to the tangent of the dental arch in the region of the lateral incisor to investigate the relation between the crown of the maxillary canine and the central incisor. The lamina dura is partially missing but the central incisor is not resorbed. The lateral incisor is not ~~ter~retabla in this tomographic cut because of the positions of the teeth.

sides concerning the possibility of palpating the canines buccally, or if there was any other marked differ rence in eruption between the two sides. 2. The 6 :anines were not palpable in their normal sites

in spite of advanced general occlusal de! ielopment and somatic maturity. 3. The maxillary lateral incisor was late Ed opting or proclined.

Volume 91 Number 6

Maxil1ar-y

canines

Fig. 2. Five cases with central and palatai canine positions illustrating overlapping, the appearance of the lamina dura, and the dental follicular width in periapical and axial intraoral radiographs. A, The left maxillary canine is not palpable and is in a palatal position overlapping the lateral incisor. Even lateral incisor root contour and intact lamina dura are present; there are no indications of resorption. left maxillary canine is not palpable and is seen in a palatal position overlapping the lateral incisor. Root contour is intact but interrupted lamina dura and a widened dental follicle are present. Superficial resorptions may be present but tomography revealed no such resorptions. C, The right maxillary canine is not palpable and in the axial projection can be seen in a slightly palatal position, Note that the canine position relative to the dental arch cannot be accurately estimated from the periapical radiographs. The lamina dura is missing but the lateral incisor root contour is intact.

Following these indications, primary x-ray films were made of 7% of the 3,000 investigated children. In 84 children (2.8% of the initial material) signs of ectopic eruption of 125 maxillary canines were found in periapical radiographs. These children were subjected to an extended x-ray investigation consisting of a detailed determination of the positions of the canines vis-a-vis neighboring structures and an analysis of resorptions of adjacent teeth. ~adi~gr~~h~~ ~xa~i~at~on The radiographic examination was performed stepwise as follows: 1. When disturbances in eruption were suspected, a basic examination was made comprising two

or three conventional intraoral per&pica1 films of each canine concerned. When the rnax~l~a~ canine was misplaced, the periapical films were supplemented with a vertex axial projection with the x-rays parallel to the roots of the central incisors of the region. Further, an o~ho~a~to~ gram of the jaws was taken to present a survey of the dental situation in the jaws. Lateral head films were taken in those cases needing extensive orthodontic treatment. 2. If the question of resorptions on neighboring teeth could not be ruled out from these films, the basic examination was supplemented with sagittal or frontal polytomography using a Philips Polytome with hypocycloid movements.

Ericson

and

Kurol

Am. J. Onhod.

Dent&c.

Orthop. June 1987

Fig. 2 (Contd). D, The right maxillary canine is not palpable and can be seen in a centrai positron in the dental arch, slightly buccal of the tipped lateral incisor root with slight overlapping. The lamina dura is missing and a widened dental follicle can be seen. E, The left maxillary canine is palpable and positioned centrally relative to the dental arch but slightly buccal of the root of the adjacent lateral incisor. The lamina dura is missing but the lateral incisor root contour is even. There are no indications of resorption.

on the relation between the canine and the lateral incisor, sagittal or frontal cuts were chosen. The distance between the six exposed cuts was 2 mm, covering the whole root area concerned. Examples of the radiologic examination are shown in Fig ~ 1, A through D. The following factors were studied: the exact position of the canine, the number, location, and extent of resorptions on adjacent teeth, and cystic transformation of the dental follicle of the canine. When establishing whether or not a neighboring tooth was resorbed by the erupting canine, the three factors taken into account were (1) the degree of overlapping, (2) tbe appearance of the lamina dura structure, and (3) the appearance of the root contour. A tooth was considered not resorbed if there was no overlapping and the root contour was even (Fig. 2) and if, in cases with partial overlapping of teeth, there was also a clear unbroken lamina dura and even root contour with no structural loss (Fig. 2, A). In all other cases, step two was performed.
pending

For statistical analysis of data, conventional methods have been used13including the chi-square test with Yates correction.

The positions of the 125 maxillary canines after completed radiographic investigation are given in Table I. Approximately 70% of the canines had abnormaI positions and 30% were in more no mal signified a central position in the tooth arch, slightly distal or distobuccal to the ~eigbbo~ng lateral incisor. An incidence of I ..5% of e~to~i~~ly erupting maxillary canines in the whole clinically examined material of 3,000 children was found. The ectopically erupting canines (primarily falsely diagnosed) in the conventional periapical radiographs were found in children with late dental and somatic maturities with the canines situated high up in the alveolar process. The true position of the canine to the adjacent incisors and their location in the dental arch were established by combining the information from all radiograpb~c methods used. The abilities of the three basic x-ray methods to reproduce the true position of the canine one-by-one in relation to the adjacent lateral incisor and position in the dental arch are compared in Table II. None of the methods gave the correct positions in all our cases. The positions of the canines could be assessedwith sufficient accuracy from the co~ve~tionaI p&apical films in 92% of the cases studied. Difficulties in de-

Volume 91 Number 6

I. Position of maxillary canines with clinical suspicion of ectopic eruption in relation to the root of the Iateral incisor (N = 125)
Lingual Distolingual Distal Distobuccal Buccal *Three of 17 were not palpable at the clinical 27 42 32 7 17 (21%) (34%) (26%) (6%) (14%)

investigation.

Table II. Comparisons among the three radiographic methods used

Correct assessment of position canine of

Conventional x-ray films Axia! vertex films Qrthopantograms

periapical x-ray

92% 72% 29%

60% 80% -

termining the position occurred when the laterals were tipped or proclined. Axial films or orthopantograms showed the relation to the lateral incisor less clearly. For assessment of the position of the canine in the dental arch, the axial projection was superior to the conventional periapical technique and orthopantograph (Table II, Fig. 2). N~~o~~r~a~~in~ projections The ability to project the lateral incisor free from the adjacent canine and the appearance of the lamina dura were specially investigated to determine the need for supplementary radiologic information (from tomograms) to detect p;athologic resorptions. Table II1 shows the ability to project the lateral incisor free from the canine. This was accomplished by intraoral techniques in only 55% of the cases; a varying degree of overlapping was noted in 45% of cases. The overlapping was most pronounced when the crown of the canine was lingual or buccal to the lateral incisor, but even in other positions it was difficult to project the teeth free because of crowding or a tipped lateral incisor. If the analysis was restricted to the true ectopic positions, only 37% of the lateral incisors were projected free in the periapical films. The premolars were projected free and the root contours were intact in all cases.
The left two radiographs show a slightly paiatal position of the maxillary canine with a missing lamina dura and a superficial resorption in the cervical third af the lateral incisor root. To the right, a control radiograph taken 15 months iater shows the defect of the root and regenerated lamina dura. The left two radiographs show a mesially erupting canine with a centrally positioned canine crown relative to the dental arch. The lamina dura is missing and the uneven root contour indicates resorption. To the right, a control radiograph taken 18 months later shows the defect and extent of resorption and regenerated lamina dura. C, Intraoral periapical radiographs show both maxillary canines with overlapping and uni~ter~r~table lamina dura. Note especially the right canine in which the radiolucent area mesial to the canine crown resorptive situation lingual to the lateral incisor tomography of the right maxillary canine shown intact lateral incisor root contour. Resorptions can be excluded,

Fig. 3. A,

Lamina dura (periodontal incisor)

contour of th

The demarcation of the alveolar socket of the lateral incisor on the films (periodontal contour) was specially

Ericson

and Km-01

Am. J. Orrhod.

Dent&c.

Qrthop. June 1987

Fig. 4. Two cases, A through D and E through H, in which the left maxillary canine is palpable buccal to the lateral incisor root. The intraoral periapical and axial radiographs show an almost ~de~t~~al situation with completely overlapped lateral incisors. There are no signs of resorption but the possibility of resorption cannot be ruled out from these intraoral radiographs. Sagittal tomographs, D and H, show the canine position buccally relative to the lateral incisors. In D, the periodontal contour is missing but the root is intact. in H, a profound resorption extending into the pulp (arrows) is visible.

Talale Ill. Frequency of overlapped lateral incisors in conventional periapical and axially exposed films (N = 125)
Position Lateral incisor Free Lingual 1 Distolingual of maxillary canine Distal vis-d-vis root of adjacent incisor

Distobuccal

Buccal 6 11

Total

25 17

31 1

6 1

69 (55%) 54 (45%)

Overlapped

26

Table IV. Appearance of the lamina dura structure at the neighboring lateral incisor during eruption of the maxillary canines (N = 125)
Position

of maxillary

canine

vis-&vis

root

of adjacent

incisor

Intact

iamina

dura lamina dura

16 11

14 28

18 14

4 3

9 8

61 (49%) 64 (51%)

Interrupted

Table V. Relation overlapped lateral the appearance of erupting maxillary

Lateral
itlCiXT

between the free projected or incisor in intraoral films and the lamina dura in cases with canines (N = 125)

-1

Total

Free

29 (23%) 31 (25%)

40 (32%) 25 (20%)

69 56

Overlapped

studied as part of the investigation of resorptions (Table IV). An intact periodontal contour along the distal root surface of the lateral incisor was found in only 49% of the teeth; the lamina dura contour was interrupted in no fewer than 5 1%. In six lateral and one central incisor, a rough root contour indicated resorptions of the root ( Fig. 3). No correlation was found between the absence of the periodontal contour and the positions of the canines vis-a-vis the lateral incisors (Table IV). The periodontal contour could be missing in any position, especially during the final part of the eruption phase.

Volume 91
Number 6

Maxillary

canines

Table VI. Position of 32 maxillary canines and the distribution of resorptions on adjacent lateral incisors diagnosed by polytomography

Resorbed Resorbed Nonresorbed

lateral central

incisors incisors

1 1 I 2

12 1 19 32

5 lateral incisors 9

2 8

1 2

10 11

Polytomographed

Table VII. Comparison between conventional dental x-ray examination and tomography concerning the reproducibility of resorptions of the root of the maxillary lateral incisors in cases with overlapping maxillary canines (N = 32)
Resorptions

Conventional intraoral x-ray films Poiytomography

25 19

3 13

Absence of the periodontal contour (distal to the maxillary lateral incisor) during the eruption of the maxillary canine was thus commonly found (Fig. 2, D). Twenty-five percent of the lateral incisors could not be projected completely free but were judged intact as both the root contour and the lamina dura could be seen distinctly and unbroken through the crowns of the canines (Table V, Fig. 2, A). In this group of teeth, minor resorptions may not be shown. In these cases the axial projection could to some extent be used to exclude resorptions. For 29% of the canines in ectopic positions, the lateral incisors could be neither projected free nor judged free from resorptions in accordance with the previously stated conditions (Table V). For these teeth supplementary tomographic investigation was carried out to determine if there were undiagnosed resorptions.

the orthopantograms for any of the teeth. Altogether, approximately 0.5 % of the primary clinically examined maxillary canines needed polytomographic examination for an accurate diagnosis. The positions of the maxillary canines and the dirjtribution of the resorptions on adjacent incisors are given in Table VI. Resorptions were found in 13 cases and were significantly more common when the canines were in a lingual or distolingual position in relation to the lateral incisors, x2 = 3.10, dfl, P < 0.05. EISWever, resorptions were also seen buccally and distobuctally. When the polytomograms were compared with the conventional intraoral dental x-ray films, it was found that the tomographic examination had not only reproduced the resorptions more fully, but also showed new unseen lesions (Table VII, Fig. 4). The number of resorbed teeth was increased by almost 100% by polytomography. Root resorptions Twelve maxillary lateral incisors and one central incisor were resorbed; seven had severe lesions penetrating into the pulp (Fig. 4). The accuracy of the radiographic diagnosis was confirmed either at surgery, after extraction of the lateral incisor, or at the followup during orthodontic treatment. All reso

Of the I25 maxillary canines with ectopic eruption, 32 were tomographed. Besides the 25 overlapped lateral incisors with uninterpretable root contours in the intraoral films (Table V), another seven lateral incisors were polytomographed (Table VI). Three of these were already diagnosed as having resorptions and four were tentative cases. However, the extent of the resorptions was not fully interpretable in the intraoral films or in

Ericiorz and Kurol

unilateral and the frequency was the same on both sides. This meant that 12.5% of the ectopically erupting maxillary canines caused some degree of resorption on the adjacent incisors. The age of the children with severe resorption varied from 11.5 to 12.8 years and that of those with slight resorption between 10.3 and 12.3 years. Girls had resorptions on lateral incisors significantly more often than boys, with a ratio of 12 : 1.

idth of the dental follicle of the canines was on intraoral films. Nineteen percent of the canines had a maximum width of between 3 and 5 mm and 81% a maximum width below 3 mm. No indication of cystic or tumorous transformation was found. No relationship was found between a widened dental follicle (over 3 mm) and resorptions on the lateral incisor root.

This investigation dealt with the diagnostic problems and findings associated with ectopic eruption of the maxillary canines and shows the need for an individually differentiated diagnostic procedure including periapical and vertex axial projections and, in some well-defined cases (20%)) also polytomography (Table V). The orthopantograph was found to be unreliable for the purposes of (1) determining the position of a misplaced canine in the dental arch or to the adjacent lateral incisors, and (2) showing resorption on adjacent teeth. Its value lies in giving a panoramic view of the mouth before starting orthodontic treatment. The observations in this study were restricted to those of children between 10 and 15 years of age because it has been shown that radiographic examination before the age of 10 does not provide a reliable basis for prognosis of a future unfavorable eruption path of the maxillary canines. ,*, The radiation hazards and the absence of severe complications caused by aberrant eruption before the age of 10 also warrant restricted use of radiography.6,4 The incidence of ectopically erupting maxillary canines in this study (1.5%) was somewhat lower than usually stated, but is still within the limits of normal variation. 14-17 However, there may be a slight deviation of the number of complications found in this study compared with a randomly selected population sample. As in most earlier studies, ectopically erupting canines were more frequently seen in girls than in ~OyS~3J7,19 Lingual positions were in the majority and in accordance with earlier reports.14,L9-2Twenty percent of the crowns of the ectopic maxillary ca-

nines were situated buccally to the adjacent lateral incisor. This figure is higher than reported by Dachi and Howell,17 Noss,~~ and Wolf and Mattila,~ but agrees with the reports of Rohrerg and Thilander and Jakobsson.4 A common observation was an i~te~~ted lamina dura of the lateral incisor facing the erupting canine. This occurred so frequently that in our opinion it is to be considered a normal finding, especially during the final part of the eruption of the maxillary canine, and in itself is not a sign of resorption of the adjacent teeth. It was noted that an intact lamina dura was seen at the lateral incisors in a few cases even when the root of the lateral incisor was severely resorbed (Fig. 4). The uncertainty involved in the use of the periodontal contour as a diagnostic aid to exclude injuries during eruption of the canines in intraoral radiologic investigations has not received sufficient attention. Together with the limited possibilities of projecting the roots of the lateral incisors free in cases with aberrant eruption, it means that resorptions may never be detected or be detected too late (Fig. 4). Fu~be~ore, when the resorbed area is located lingually or buccally in the middle third of the lateral incisors root, which we have found to be common, even injurious resorptions may be missed. Polytomography doubled the number of teeth with diagnosed resorptions compared to intraoral films and orthopantograms alone. Tomography also gave a more reliable indication of the extent of the lesions. In several cases the increased information was crucial for the therapeutic decision, which motivates selective use of the method. Measurements of absorbed doses of radiation at polytomography to different organs in the skull and neck regions have shown small absorbed doses.* It may be surprising that energy imparted (integral dose) in a polytomographic investigation of the kind presented in this report is equivalent to three or four ordinary periapical dental films. This is explained by the use of a very narrow collimation of the x-ray beam and the use of high sensitive screens. The stepwise use of the radiographic technique on strict indications according to earlier recommendations will result in optimal diagnosis at a low radiation risk. However, the recommended radiographic procedure means for a few children additional costs, which are balanced by orthodontic benefits and a better prognosis in the long run. Stereoscopic methods are sometimes used in radiographic diagnoses of misplaced teeth We believe that in cases with extensive overlapping e absorption of the x-rays is too high to facilitate accurate diagnosis of resorptions (see Figs. 1 and 4).

Maxillary

canines

The number of persons with resorptions on incisors in the radiologically examined material was high (12.5%), more than double that reported by Hitchin (1956),23 and considerably higher than found by Thilander and Jakobsson ( 1968),14 Bergstrom ( 1977),24 and blow-~ordenram and Anneroth (1982).6 The prevalence of resorption on incisors can be estimated from this material to be 0.6% to 0.8% in children between 10 and 13 years of age, which is earlier than in some previous reports on detection of resorption.~2~25 The sex distribution (with a marked predominance of females) for root resorption is also in accordance with mat reported by Sasakura and associates (1984).26 The differences in frequency were caused by the more reliable diagnostic information provided by the advanced radiologic techniques used in this study. This investigation thus confirms previous suggestions that root resorption caused by ectopic canines occurs more often than is generally assumed.,25 There is some uncertainty concerning the situations in which resorption injuries occur. In our material resorption on adjacent incisors was most common. In most cases the canine was lingually or distolingually situated with the crown directed toward the root of the lateral incisor. The situation was not unequivocal as resorptions also occurred with the canines in other positions-for example, in buccal positions via the lingual cusp of the canine. The role of different etiologic factors in the occurrence of resorption injuries on adjacent teeth will be investigated in more detail in a separate study.
ND RECOMMENDATIONS

served for patients in whom o~hodo~tic treatment is considered; polytomography of the canines should be restricted to patients in whom the state of the lateral incisors cannot be determined in other ways and the risk of injury is great. The optimal age for radiologic investigation is IO to 13 years, depending on the individual childs somatic development.
REFERENCES 1. Kettle MA. Treatment of the unempted maxillary canine. Bans Br Sot Study Orthod 1957;74-84. 2. Rayne J. The unerupted maxillary canine. Dent Pratt 1969; 19:194-203. 3. Becker A; Smith P, Behar R. The incidence of anomalous maxillary lateral incisors in relation to palataily-displaced cuspids. Angle Orthod 1981;51:24-9. 4. Brown ID, Matthews RW. Apical resorption of a maxi!hq lateral incisor from a misplaced canine in 17-year oPd. A case report. Br J Orthod 1981;8:3-5. 5. Williams BH. Diagnosis and prevention of maxillary cuspid impaction. Angle Orthod 1981;51:30-40. 6. Olow-Nordenram M, Anneroth G. Eruption of maxillary canines. Stand J Dent Res 1982;90: l-8. 7. Ericson S, Kurol J. Longitudinal study and analysis of clinical supervision of maxillary canine eruption. Community Dent Oral Epidemiol 1986;14:172-6. 8. Ericson S, Km01 .I. Radiographic assessment of maxillary canine eruption in children with clinical signs of eruption disturbance. Eur J Orthod 1986;8:Aug. 9. Stafne EC. Oral roentgenographic diagnosis. 3rd ed. Philadelphia: WB Saunders Company, 1969. 10. Pindborg JJ. Pathology of the dental hard tissues. Copenhagen: Munksgaard, 1970. 11. Hotz R. Orthodontics in daily practice. Bern: Hans Huber Pubiishers, 1974:339-53. 12. Jacoby H. The etiology of maxillary canine impactions. AM J ORTHOD 19831841125-32. 13. Nie NH, Huh CH, Jenkins JG, Steinbrenner K, Bent DH. SPSS-Statistical package for the social sciences. 2nd ed. New York: McGraw-Hill Company, 1975. 14. Thilander B, Jakobsson SO. Local factors in impaction of maxillary canines. Acta Odontol Stand 1968;26:145-68. 15. Shah RM, Boyd MA, Vakil TF. Studies of permanent tooth anomalies in 7886 Canadian individuals. I. Impacted teeth J Can Dent Assoc 1978;44:262-4. 16. Thilander B, Myrberg N. The prevalence of malocclusion in Swedish schoolchildren. Stand J Dent Res 1973;81:12-20. 17. Dachi SF, Howell FV. A survey of 3874 routine fullmouth radiographs. II. A study of impacted teeth. Oral Surg Oral Med Oral Path01 1961;14:116-9. 18. Azas B, Shteyer A. Resorption of the crown in impacted canine: A clinical radiographic and histologic study. Int J Orai Surg l978;7:167-71. 19. Rohrer A. Displaced and impacted canines. INT J ORMOD 1929;15:1003. 20. Moss JP. Unerupted canine. Dent Pratt 1972;22:241-8. 21. Wolf JE, Mattila K. Localization of impacted canines by panoramic tomography. Dentomaxillofac Radio1 1979;8:85-91. 22. Ericson S, Eckerdal 0, Kurol J, Carlsson C, Helmrot E. Riktlinjer for klinisk och rontgenologisk Bvervakning av iiverk%kshomtandemas eruption hos barn och ungdomar me&n 8 och

Radiologic examination may be limited to cases in which clinical signs of aberrant eruption are found. By individualizing the radiologic investigation according to a stepwise program, it is possible to minimize the total radiation exposure without losing essential information. In uncomplicated cases with aberrant eruption, the radiologic examination may be limited to 2 or 3 conventional intraoral films exposed in different projections. This allows reliable assessment of the position and eruption pathway of the canines in most children. The need for supplementary investigations will be determined by the diagnostic problems caused by overlapping and interrupted lamina dura and the risk of resorption as shown by this study. In cases of ectopic eruption and when therapeutic or prophylactic orthodontic measures are considered, the 2 or 3 films procedure should be supplemented with a film in an axial projection so that the position of the tooth in the dental arch and in relation to adjacent teeth can be assessed more accurately. ~~ho~a~tograms and facial profiles should be re-

23.

15 ar. Jonkiiping: Odontologiska Institutionen (ISSN 02826151), r984. Hitchin AD. The impacted maxillary canine. Br Dent J
1956;100:1-14. -

Root resorption of upper permanent incisor caused by impacted canine. An analysis of 23 cases. Int 5 Qral Surg 1984;13:299306. Reprint requests to: Jtiri Kuroi Department of Orthodontics The Institute for Postgraduate Dental Education Jarnviigsgatan 9 S-552 55 J&ki$ing, Sweden

24. Bergstrom K. An orthopantomographic study of hypodontia, supernumeraries and other anomalies in school children between the ages of 8-9 years. An epidemiological study. Swed Dent J 1977;1:145-57. 25. Leivesiey WD. Minimizing the problem of impacted and ectopic canines. J Dent Child 1984;51:367-70. 26. Sasakura H, Yoshida T, Muryama S, Hanada K, Nakajima T.

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