Preplanning, surgical, and postoperative considerations in the removal of the difficult impaction.
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In this case report, an eleven-year-old female presented to a rural dental clinic for routine dental examination. Upon evaluation of the dentition, the attending dentist discovered an over-retained primary tooth. Radiographically, a compound odontoma was present, gingival to an unerupted permanent maxillary left central incisor (number nine) and apical to the erupted primary central incisor (F). The odontoma and its overlying primary tooth were removed by an oral surgeon. The extraction site has healed uneventfully and an Orthodontic treatment plan was formulated. The etiology of odontomas is unknown but thought to be caused by trauma, infection, inheritance and/or genetic mutation. These lesions are usually found in the second decade of life and are more common in male patients. Treatment consists of complete enucleation and curettage of the odontoma site.
When planning autotransplantation of impacted maxillary canines, it is advantageous to know not only the position but also the root anatomy. Radiographic and clinical findings on the root anatomy of 65 impacted maxillary canines were compared. The apices were judged as straight or deflected. The positions of the canines were also recorded. Twenty-eight canines (43%) had a straight and 37 (57%) a deflected apex. The radiographic diagnosis was confirmed in 49 canines, which means a diagnostic accuracy of 75%. The misinterpretation, consisting of seven false-positive and nine false-negative diagnoses, was due to insufficient radiographic examination (7 canines), observation errors (7 canines), and limitations of radiographic examination (2 canines). No association was found between the root anatomy and position. The results show than an optimal radiographic examination and knowledge of any apical deflection are valuable aids to operative assessment of impacted maxillary canines.