4: Crowding and buccal upper canines

4 Crowding and buccal upper canines

Summary

Gemma, an 11-year-old girl, attends for a 6-month dental assessment at your practice with both upper permanent canines erupting buccally (Fig. 4.1). What is the cause and how may it be treated?

image

Fig. 4.1 Anterior occlusion at presentation.

History

Complaint

Gemma does not like the ‘squint’ appearance of her top and bottom teeth, in particular the position of the upper eye teeth, which she says ‘look like fangs’.

History of complaint

The crookedness of Gemma’s teeth has been getting worse for the past year. The appearance of her upper teeth has become of more concern to her in recent months when both upper eye teeth started to erupt. She is now teased at school and called ‘Fangs’, which annoys her.

Gemma’s mother reports that her daughter’s baby teeth were also slightly crooked. Both she and Gemma are very keen for treatment.

Medical history

Gemma has had asthma since she was 5 years of age and uses a salbutamol (Ventolin) inhaler; otherwise she is fit and well.

Dental history

Gemma has attended for routine dental examinations since she was 3 years, but has not undergone any active dental treatment.

Examination

Extraoral

Gemma has a Class I skeletal pattern with average FMPA. There appears to be slight facial asymmetry with the chin point deviated mildly to the right. The lips are competent.

No temporomandibular signs or symptoms were detected or reported.

Gemma and her mother were unaware of Gemma’s slight facial asymmetry and have noticed no change in her facial appearance over recent years.

image Would you be concerned by the mild facial asymmetry?

A mild degree of facial asymmetry is normal and as facial appearance is reportedly unaltered for several years there is no cause for concern.

Intraoral

image Gemma’s intraoral views are shown in Figures 4.1 and 4.2. What do you notice?

Generalized marginal gingival erythema.
Plaque deposits visible on several teeth, notably both 3’s.
There are no restorations and there is no obvious caries.
Gemma is in the late mixed dentition stage with the following teeth present: image (note image and image are partially erupted).
The lower labial segment is moderately crowded with image bodily displaced lingually and image slightly mesiolabially rotated.
image is distally inclined; image is mesially inclined.
The lower right buccal segment is also crowded with insufficient space for image; the lower left buccal segment is uncrowded with image present.
The upper labial segment is moderately crowded, with image slightly mesiolabially rotated and image erupting buccally; image is present. image is upright and image is slightly distally inclined. The upper buccal segments are aligned.
In occlusion, there is a Class I incisor relationship.
The overbite is average and complete.
The lower centreline is slightly to the right.
The right molar relationship is Class III and the left molar relationship is Class I.
image

Fig. 4.2 (A) Lower occlusal view.

image

Fig. 4.2 (B) Upper occlusal view.

image

Fig. 4.2 (C) Right buccal occlusion.

image

Fig. 4.2 (D) Left buccal occlusion.

image What are the possible reasons for 3’s erupting buccally?

• Crowding – buccal displacement of 3’s is often a manifestation of inherent crowding in the upper arch. A contributory factor is 3 being the last tooth to erupt anterior to the first permanent molars.
• Retention of the primary canine – this usually leads to slight buccal displacement of 3.

Key point

Buccal displacement of 3 is more usual in a crowded arch.

Investigations

image What investigations would you request and why?

A dental panoramic tomogram is required to provide a general view of the developing dentition and confirm the presence and position of all unerupted permanent teeth.

image Gemma’s dental panoramic tomogram is shown in Figure 4.3. What do you notice?

Alveolar bone level is normal.

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Jan 2, 2015 | Posted by in Orthodontics | Comments Off on 4: Crowding and buccal upper canines

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