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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 5  |  Issue : 1  |  Page : 63-65

Unerupted ectopically position canine causing mobility of the lateral incisor: Noninvasive management through palatal expansion


1 Department of Preventive Dentistry, Riyadh Elm University, Riyadh, KSA; Department of Pediatric Dentistry, Ministry of Health, Kuwait City, Kuwait
2 Department of Preventive Dentistry, Riyadh Elm University, Riyadh, KSA

Date of Web Publication12-Mar-2018

Correspondence Address:
Wasmiya Ali Alhayyan
Riyadh Elm University, P.O. Box: 84891, Riyadh 11681, KSA

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjos.SJOralSci_6_17

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  Abstract 


Early orthodontic treatment remains controversial in literature. Delayed eruption and impaction of the canine are the common phenomena. However, a unerupted mandibular canine causing mobility of the permanent lateral incisor is a relatively rare case. An 11-year-old Saudi girl presented with a complaint of mobility of the lower left permanent lateral incisor. An ectopically erupted permanent left mandibular canine and a narrow maxilla were evident upon examination. Rapid palatal expansion was started to expand the maxilla for 2 weeks and it was retained for 6 months, after which the patient was followed for a year. At the end of a year, the lower permanent left canine erupted and there was a reduction in anterior crowding. At the end of 2 years, the child demonstrated no relapse of crowding. Expansion of the maxilla can be a useful technique to facilitate the expansion of the mandible.

Keywords: Early orthodontic treatment, mandibular arch crowding, maxillary expansion


How to cite this article:
Alhayyan WA, Al-Kharsa S. Unerupted ectopically position canine causing mobility of the lateral incisor: Noninvasive management through palatal expansion. Saudi J Oral Sci 2018;5:63-5

How to cite this URL:
Alhayyan WA, Al-Kharsa S. Unerupted ectopically position canine causing mobility of the lateral incisor: Noninvasive management through palatal expansion. Saudi J Oral Sci [serial online] 2018 [cited 2018 Nov 15];5:63-5. Available from: http://www.saudijos.org/text.asp?2018/5/1/63/227135




  Introduction Top


Early orthodontic treatment (EOT) is controversial as a concept. While some authors have suggested that there is little evidence of the benefits of EOT,[1],[2] others have shown that it has specific benefits in scenarios such as[3],[4] Class III occlusion,[5],[6],[7] crowding,[8],[9],[10] and disturbances of tooth eruption.[11] In addition, psychological benefits of EOT such as enhancement of self-esteem and reduction of negative social experiences have been documented.[12]

Recent data show an increase of the prevalence of malocclusion in the mixed dentition.[13],[14] This emphasizes the need for enhancement of the awareness of EOT among both dental-care providers and parents. EOT is an effective solution in specific situations, so clinical decisions should be made on case by case basis and on empirical judgments.[15],[16]

One of the most commonly occurring dental anomalies is the impaction of maxillary canines, with incidence ranging between 0.8% and 2.8%.[17],[18],[19] In comparison, the impaction of mandibular canines is less frequent, with an incidence 20 times lower than that of the maxillary canines.[20]

Canine impaction is related to various factors; however, the exact etiology is unknown. Arch length deficiency was correlated with impaction of the teeth.[21],[22] Palatal expansion as a treatment option is common in the maxilla. However, despite the documented fact that mandibular growth is secondary to that of the maxilla, the technique of using maxillary expansion to expand the mandible is not commonly utilized. This case report documents the successful use of maxillary expansion to relieve crowding in the mandible and facilitate the expansion of the mandibular canines.


  Case Report Top


An 11-year-old Saudi female presented to the pediatric clinic at the Riyadh Elm University to receive dental treatment. The patient complained of mobility in the permanent lower left lateral incisor. Medical and dental histories of the patient were taken. Extraoral and intraoral examinations were performed. The patient had Angle's Class II malocclusion with subdivision on the right side. The patient had 5 mm overjet and 4 mm overbite [Figure 1]. Periapical and panoramic radiographs revealed that an ectopically position unerupted permanent lower left canine was detected which was causing root resorption of the permanent lower left lateral incisor [Figure 2]. Space analysis was performed to the patient using Onyx Orthodontic software (Onyx Corp., Bellevue, WA, USA), which indicated 5 mm space loss of the upper arch and 7 mm for the lower arch [Figure 3]. Index of orthodontic treatment need was performed for the patient and the patient malocclusion was classified as Grade 4 (requiring dental treatment).
Figure 1: Preoperative intraoral images

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Figure 2: Preoperative radiograph images (panoramic image/periapical)

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Figure 3: Postoperative intraoral images (1-week recall)

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Given that the nature of crowding, an approach of using maxillary expansion was decided [Figure 4]. As a result of expansion of the upper jaw, the lower jaw gained space due to muscle action which created the place that was required for the eruption of the permanent lower left canine. Furthermore, placement of lower lingual holding arch space maintainer after the extraction of all primary second molars teeth to facilitate the eruption of permanent succedaneum teeth, which allowed the usage of leeway space, was recommended and performed.
Figure 4: Postoperative intraoral images (1-year follow-up)

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After 3-month follow-up of the patient, lower left canine showed signs of eruption, and at 1-year follow-up, the left lower canine was fully erupted. The patient was referred to the Orthodontic Department at Riyadh College of Dentistry and Pharmacy to proceed with orthodontic alignment. At the end of 2 years, the patient's lower anterior teeth were in stable occlusion.


  Discussion Top


While there is a lot available in literature on the management of the unerupted maxillary canines, literature on the mandibular canine is scarce. This is due to the fact that the impacted mandible canine is a rare event with an occurrence between 0.1% and 0.5%.[19],[23],[24] Most impacted canine cases remain asymptomatic even tough chronic inflammation with fistula, and other symptoms include pain and swelling have been reported.[25],[26],[27] Mobility of lateral incisor due to an ectopic eruption of mandible canine has not yet reported in literature. Most of reported cases are associated with an ectopically erupted maxillary canine.[28],[29]

Early diagnosis and interceptive therapy are critical factors in the management of an impacted canine. The success rate of an interceptive treatment depends on the patient age and the degree of impaction. EOT in the case of impacted canines can range from extraction of the primary canines to expansion appliances.[30],[31] Using of rapid palate expansion to treat an ectopic eruption mandible canine is a relatively underutilized approach.

The maxilla acts as a safety valve for the growth of the mandible, both restricting and regulating its growth.[3] While there is little evidence that mandibular expansion produces stable results, the concept of expanding the maxilla to facilitate the growth of the mandible is documented in orthodontic literature.[3]

This case highlights how timely interceptive care can provide preventive extensive orthodontic treatment. The fact that the child had to still undergo fixed orthodontics suggests that interceptive orthodontic treatment is an adjunct and not an alternative to fixed orthodontic therapy. Practitioners need to be aware of the factors that regulate postnatal mandibular growth and should realize that manipulation of the maxilla will affect the growth of the mandible. In this case, the influence was used to a positive effect.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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21.
McConnell TL, Hoffman DL, Forbes DP, Janzen EK, Weintraub NH. Maxillary canine impaction in patients with transverse maxillary deficiency. ASDC J Dent Child 1996;63:190-5.  Back to cited text no. 21
    
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25.
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Wright DM. A case report. Forced eruption of an impacted lower canine in a 48-year-old man. J Am Dent Assoc 1995;126:1025-7.  Back to cited text no. 26
    
27.
Milano M, Barrett L 2nd, Marshall E. Extraction of a horizontally impacted mandibular canine through a genioplasty approach: Report of a case. J Oral Maxillofac Surg 1996;54:1240-2.  Back to cited text no. 27
    
28.
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29.
Saldarriaga JR, Patiño MC. Ectopic eruption and severe root resorption. Am J Orthod Dentofacial Orthop 2003;123:259-65.  Back to cited text no. 29
    
30.
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31.
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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