RADIOGRAPHIC ASSESSMENT OF

DENTAL ANOMALIES IN
PATIENTS WITH ECTOPIC
MAXILLARY CANINE

Presented by:
Dr. Bhawna Arora.
HELLE BUDTZ SORENSEN, LON ARTMANN, HELLE JUUL LARSEN &INGER KJER
Mentored by:
Dr. Vineet.I.S. Khinda
Source: International journal of pediatric dentistry 2009 Vol-19,
No.2, March Issue
Dr. Manjeet kaur.
Dr. Nitika.
1
Contents
 Introduction
 Materials and methods
 Results
 Conclusion
 Related journals

Radiographic assesment of ectopic

canines 2
 Introduction
 Ectopically erupted maxillary canines pose problem in
early prediction, diagnosis as well as treatment
 CT gives a more accurate result that whether they are
palatally or bucally erupted
 Altogether 8% of 505 longitudinally studied children (8-12
years) show signs of ectopic canine eruption.
 It is difficult to determine path of eruption before 10
years of age
 Variation in tooth germ position.
 changes in path during eruption.

 After the age of 11 years, 1.7% of children show eruption

disturbances.
Radiographic assesment of ectopic
canines 3
Etiology
Buccal Eruption
 Longest path of eruption
 Crowding
 Supplementary tooth.
 Supernumerary tooth.
 Abnormal dentoskeletal features.
 Other dental anomalies
 Insufficient Arch length.

Radiographic assesment of ectopic

Radiographic assesment of ectopic
canines 4
canines 4
Palatal eruption
Genetic Theory,
 polygenic multifactorial inheritance
Guidance Theory,
 Missing lateral incisors
 Peg shaped lateral incisors
 Transposition of teeth
 Retained deciduous and retarded eruption
of permanent teeth
 Other pathological lesions like odontomes
 Ankylosis
 Trauma to maxillary region
Radiographic assesment of ectopic
canines 5
Secondary Causes
1. Endocrinal disturbances
2. Vitamin D deficiency
3. Febrile diseases

Radiographic assesment of ectopic

canines 6
Bucally erupted canine

Palatally Erupted canine

Radiographic assesment of ectopic

canines 7
Canine transposition

* Canine–first premolar 71%;

* Canine–lateral incisor 20%;
* Canine to first molar site 4%;
* Lateral incisor–central incisor 3%;
* Canine to central incisor site 2%.

Radiographic assesment of ectopic

canines 8
Sequelae of canine impaction,
Ectopic eruption and Transposition
 Root resorption of impinging teeth
 Infection
 Referred pain
 Dentigerous cysts
 Self resorption.

Radiographic assesment of ectopic

canines 9
Maxillary canine puts excessive
pressure on lateral incisor resorbing
the roots

Radiographic assesment of ectopic

canines 10
 The pressure from the erupting canine might result is
resorption of incisors.

 The purpose of this study was to analyze radiographic

evidence of dental deviations in the maxillary incisor
region and the dentition in general in cases with palatally
or labially located ectopic canines.
Radiographic assesment of ectopic
canines 12
The maxillary incisor region develops from
frontonasal process of embryo has a different
origin at the neural crest rather than canine
premolar area

Radiographic assesment of ectopic

canines 13
Diagnosis
 Visual method
 Bidigital palpation
 Radiographic Localization

Radiographic assesment of ectopic

canines 15
 MATERIALS AND METHODS

 Panoramic and intra-oral radiographs from 69

patients with ectopic maxillary canines were
analyzed. The patient group constituted all patients
with palatally or labially located ectopic canines,
referred to as specialized surgery unit in the Arhus
Community Dental Service within a 2-year period.

 The radiographs were divided into three groups

according to dental deviations in the maxillary
incisor field and the dentition in general. Due to late
maturation, the third molars were not analyzed.
Group I: No deviations in the dentition,

Group IIa: Deviations in the dentition within the

maxillary incisor field only,

 Group IIb: Deviations in the dentition in general

Each of these three groups was divided according to

occurrence of palatally and labially located ectopic
canines.

Radiographic assesment of ectopic

canines 17
Group I : No dental deviations

Radiographic assesment of ectopic

canines 18
Radiographic assesment of ectopic
canines 19
Group IIa : dental deviations in the incisor region

Radiographic assesment of ectopic

canines 20
Group IIb : With dental deviations in in general including upper
incisor region

Radiographic assesment of ectopic

canines 21
How to assess radiographically the ectopically erupted
canine in relation to other teeth?

Radiographic assesment of ectopic

canines 22
Panoramic radiographs give valuable information that should
not be underestimated. Since they are taken routinely for
orthodontic records, they are an excellent screening tool for
detecting ectopically erupting canines. Sector location and
angulation of the unerupted canine can be analyzed from the
panoramic X-ray.

1. Angular Measurement:
A horizontal reference line is chosen, Warford et al used a
bicondylar line passing through the most superior point of the
condyles. The mesial angle formed by using the constructed
horizontal line and the long axis of the unerupted canine is
measured. The higher the angle the less tendency to ectopic
eruption and therefore the less tendency to impaction.
Warford et al, showed in their study angulation was higher for
non-impacted teeth, with a mean of 75.12° compared with
63.20° for impacted teeth.
Radiographic assesment of ectopic
canines 23
Radiographic assesment of ectopic
canines 24
2. Sector Measurement:

Three lines are drawn; one that coincide with the mesial
surface of the lateral incisor, the other line with the
distal surface of the lateral incisors, and the last one
bisect the lateral incisor into two halves. These lines
divide the area into four sectors; sector I, II, III, IV . If
canines are in sector I, they are not ectopically erupting.
Therefore, there is no risk of impaction. The risk of
impaction becomes higher in sector II, III, and IV.

Radiographic assesment of ectopic

canines 25
The dentitions in 69 cases with palatally and
labially erupted canines

Group I No dental Group IIa Maxillary Group IIb General

deviations incisor deviations* dental deviations**

N % N % N %

Palatal Female n=38 9 24 8 21 21 55

Male n=12 6 50 3 25 3 25

Labial Female n = 11 3 27 3 27 5 46

Male n = 8 3 38 4 50 1 12
Deviations in the dentition that was
noted:
1) Morphological: invaginations, screw
shaped crowns, taurodontic molars,,
short premolars and slender roots.
2) Agenesis
3) Eruptional deviations such as retarded
eruption
4) Ectopic eruption

Radiographic assesment of ectopic

canines 27
 Results
 50 patients had palatally located canines
 19 patients had labially located canines.
 The prevalence of ectopia is higher in females than in
males.
 Furthermore, it is documented that palatally as well as
labially located ectopic canines can occur in dentitions
without other dental deviations.
 Dental deviations occurred in approximately two-thirds of
all cases, more often in females and in cases with palatally
located canines.
The deviations in the incisor region were: invaginations (16
patients), narrow crowns (14 patients), and malformed roots
(19 patients). In the premolar /molar regions, taurodontic
roots shapes were registered in 16 patients and eruptional
deviation and short premolar roots in six patients.
Some other methods to examine
ectopic eruption of canine
 Modified occipito-mental view

Radiographic assesment of ectopic

canines 29
Occlusal view of ectopically erupted canine

Radiographic assesment of ectopic

canines 30
Intra oral periapical radiograph

Radiographic assesment of ectopic

canines 31
Radiographic assesment of ectopic
canines 32
Recent Advances in Imaging

1. Three dimensional C T
2. Computed tomography
3. Cone beam radiography
4. Scanography
5. Dentascan Imaging

Radiographic assesment of ectopic

canines 33
 Computed Tomography

• Can also be used to visualize an impaction.

•Technique which uses a series of radiographic axial

sections to produce a computer generated three
dimensional image.

• Most precise method of radiographic localization.

Radiographic assesment of ectopic

canines 34
Computed tomographic technique

Radiographic assesment of ectopic

canines 35
3D Computed Tomography
 Dentascan imaging
 It is nothing but a modification of panoramic imaging.

 Radiologist has to indicate the curvature of mandible and maxilla.

 Computer generates reinforced cross sectional and tangential images.

Limitation
Image requires compensation for magnification

Use
It is used in implant imaging

Radiographic assesment of ectopic

canines 37
 Treatment plan

 Leave and observe

Interceptive treatment with the extraction of primary

canine
 Extraction of canines
 Orthodontic positioning of permanent canines
 Surgical realignment, repositioning /alignment and
transplantation

Radiographic assesment of ectopic

canines 38
How to manage such cases?
We have a few case reports to see the management of such cases.

Radiographic assesment of ectopic

Palatally displaced 22 and totally bucally blocked out 23
canines 39
 Upper arch: 0.017 inch × 0.025 inch stainless steel arch wire, open coil to crea
space for 22, 23 and to correct midline.
Lower arch: 0.014 inch NiTi arch wire

Radiographic assesment of ectopic

canines 40
Upper arch: Extraction of 24. 23 allowed to drift down
Lower arch: 0.017
inch × 0.025 inch stainless steel
arch wire. Open coil to create space for 32, 33 and to correct
lower midline.

Radiographic assesment of ectopic

canines 41
Upper arch: 0.018 inch stainless steel main
arch wire. 0.017 inch × 0.025 inch TMA sectional wire with
closing loop for distalisation, palatal root torquing and then extrusion of
23
Radiographic assesment of ectopic
canines 42
Upper arch: 0.014 inch thermal NiTi arch wire to
align 23. 22 not bonded.
Lower arch: 0.019 inch × 0.025 inch
stainless steel arch wire. Open coil to create space for 32, 33
and to correct lower midline. Power chain to retract 43.
Radiographic assesment of ectopic
canines 43
Extraction of 34. 0.014 inch NiTi arch wire to align 32, 33

Radiographic assesment of ectopic

canines 44
0.019 inch × 0.025 inch stainless steel arch wire for
arch coordination and space closure.

Radiographic assesment of ectopic

canines 45
Finished occlusion

Radiographic assesment of ectopic

canines 46
Similarly for palatally impacted canines

Radiographic assesment of ectopic

canines 47
 Summary

Disturbances in the eruption of permanent maxillary canines are common.

 Careful supervision of the developing dentition and early diagnosis of ectopic

eruption may prevent impaction of these teeth and resorption of the
neighbouring incisors.

Protocol is; clinical and radiographic evaluation combined with primary

canine removal followed by maintaining the space.

 This protocol is effective when the condition is detected early , it is

important to evaluate the canine position no later than 10 years of age.

Radiographic assesment of ectopic

canines 48
 Radiographic assessment of maxillary canine
eruption in children with clinical signs of
eruption disturbance

Sune Ericson and Jüri Kurol,

Dr Jüri Kurol, Department of Orthodontics, The Institute for Postgraduate Dental
Education, J rnvägsgatan 9, S-552 55 JÖNKÖPING, Sweden

 The positions of maxillary canines were radiographically

investigated in children .

 Altogether 8 % of 505 longitudinally studied children,

aged 8–12 years at the start of the project showed clinical
signs of canine eruption disturbances.

Radiographic assesment of ectopic

canines 49
 In children aged 10 years and younger, it was found that
attempting to determine the path of eruption

 This may be due to the large variation in tooth germ

positions and because of changes in the path during
eruption.

 In children aged 11 years and older, altogether 1.7 % of

the canines showed eruption disturbances, mostly with a
palatal path of eruption.

 The radiographs showed that when the lateral incisor

root was in close contact with an erupting canine, 35 per
cent showed an absence of the lamina dura.
 Early Timely Management of Ectopically
Erupting Maxillary Canines
 Peter Ngan
Peter Ngan , Robert Hornbrook†,
, Robert Hornbrook†, Bryan Weaver‡
Bryan Weaver‡

The
The European
European Journal
Journal ofof Orthodontics
Orthodontics 19881988 10(1):115-120;
10(1):115-120doi:10.1093/ejo/10.1.115
doi:10.1093/ejo/10.1.115
©© 1988
1988 byby European
European Orthodontic
Orthodontic Society Society
 Diagnosis and treatment of ectopically erupting permanent
 maxillaryand
Diagnosis canines require
treatment timely management
of ectopically by themaxillary
erupting permanent orthodontist.
canines
Potentially
require timely impacted
management maxillary canines may be inadvertently
by the orthodontist..
overlooked in the mixed dentition due to the variations in eruption
 patterns and timing.
Periodic examination Periodic
starting at age examination starting
8, including clinical at age
intraoral 8,
palpation
including
and selective clinical intraoral
radiographs, maypalpation
aid in theand selective
early radiographs,
diagnosis of uneruptingmay
and
aid in theimpacted
potentially early diagnosis
permanent ofcanines
unerupting and potentially impacted
permanent canines. When such a diagnosis is apparent, timely
 . interceptive
When such a therapy
diagnosismay then betimely
is apparent, instituted. This therapy
interceptive article may
reviewed
then be
the incidence,
instituted. etiology, and development of the maxillary canine.
The rationale for early management of potentially impacted
maxillary canine is discussed together with the treatment for
 labially
This andreviewed
article palatally the
impacted canines.
incidence, etiology, and development of the
maxillary canine. The rationale for early management of potentially impacted
maxillary canine is discussed..

Radiographic assesment of ectopic

canines 51
CT diagnosis of ectopically erupting
maxillary canines—a case report
Sune Ericson and Jüri Kurol
Dr Jüri Kurol Department of Orthodontics The Institute for Postgraduate Dental education Järnvägsgatan 9 S-552 55 Jönk ping Sweden
1

This case report describes the use of high-resolution computed

tomography (CT) in the diagnosis of both the location and extent
of root resorption of permanent incisors

.The CT image proved to be superior and more information was

obtained than when conventional radiographic methods, including
polytomography, are used.

 As the skin entrance dose is also low and the exposure of radio-
sensitive organs can be avoided

 we consider that the advantages of CT clearly warrant its use in

this type of patient with a potential resorptive canine/lateral
situation due to ectopic eruption of the maxillary canines.
 Reference
1 .Helle budtz sorensen, lone artmann, helle juul larsen & Inger kjaer:
radiographic assessment of dental anomalies in patients with ectopic
canines. International journal of paediatric dentistry 2009;19:108-114

2.Patric .f.mcsherry,:the ectopic maxillary canine: a review. British journal of

orthodontics Vol 25/1998/209-216

3.Grace Richardson, kathy A. Russel:A Review of impacted permanent

maxillary cuspids- diagnosis and prevention. J Can Dent Assoc 2000;66:497-
50

4. Sune Ericson, Juri Kurol: Incisor Resorption caused by Maxillary Cuspids A

Radiographic Study.  Angle Orthodontist, 1987 No. 4, 332 – 346.

5.John H Warford, Ram K Grandhi and Daniel E Tira: Prediction of maxillary canine
impaction using sectors and angular measurement.  Am J Orthod Dentofacial Orthop.
Volume 124, pages 651-655, Dec 2003.
6. Hessa M Alkhal, Bakr Rabie and Ricky W K Wong:
Orthodontic tooth movement of total buccally blocked-out
Radiographic canine
assesment of ectopic
Cases Journal 2009, 2:7245 doi: 10.4076/1757-1626-2-7245
canines 53
THANK YOU

Radiographic assesment of ectopic

canines 54