Orthotown September 2017 - 16

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eruption and perio status of the Md canines? I have been looking for evidence for/against early
treatment in cases like these where the canines are due to erupt next but lack space. I would
like to keep Phase I treatment to a minimum without errors of omission. Thanks for posting. ■
5/14/2017

fesdds
Member Since: 05/22/08
Post: 6 of 15

Generalized anecdotal statement, but just don't see much issues with tissue on L3s. Not
saying never, but like I tell people virtually every day, the area I typically see tissue issues is
the L2-2 area. ■
5/14/2017

ssp
Member Since: 03/16/15
Post: 7 of 15

Except she may not have a maxillary left lateral incisor in a couple of years. At the least, this
patient needs to be observed closely for maxillary lateral incisor root resorption caused by the follicle
of her ectopic maxillary canines, with follow-up X-rays every three to four months (periapicals).
Up from that is to remove her primary Cs and Ds and continue to follow up with pa X-rays. If
canine trajectory doesn't change, I would start Phase I treatment or a full treatment if she's close
to all other erupting by then. But to say not to do anything right now is a disservice to her. ■
5/24/2017

NickTi
Member Since: 12/04/10
Post: 8 of 15

What objective observation are you making to suggest the upper left canine is erupting ectopic? I
see no overlap with the lateral root. Thanks, perhaps an opportunity to learn something new here. ■
5/24/2017

BracesDude
Member Since: 04/28/08
Post: 9 of 15

charlestonbraces
Member Since: 06/05/09
Post: 10 of 15

I would monitor and do nothing. Count me in the "disservice" group. ■
5/27/2017

I ended up going with a LLHA and told mom that we would probably selective extract some
baby teeth as time goes on to help "coax" better eruption. But I also warned her that extraction
of permanent teeth may be necessary. ■
5/29/2017

ssp
Member Since: 03/16/15
Posts: 11-15 of 15

Monitoring is doing something, which takes you out of the disservice group.
I'd be glad to elaborate. Her records show a few red flags that should be monitored closely.
She is 9 years old with winged maxillary lateral incisors and her adjacent permanent canines are
angled toward them. A normal alignment of these canines on a 9-year-old child would be for
them to be straight up and down with the adjacent teeth. Yes, they are not crossing them at this
point, but their path should be followed up as she develops. But crossing the root of the lateral is
not the worst issue that could develop-it's root resorption if the follicle becomes enlarged while
it tries to make room for its eruption as the canine hits a wall, so to speak, by not crossing. The
most likely cause of this canine angle is a reduced transverse dimension, or arch constriction.
If by age 9 she hasn't gotten the correct width to match the dental mass, most likely she will
not get enough adequate transverse growth. But, some children do. In 21 years of practice, I
have seen this too many times where a reduced transverse width causes the canine to grow at an
angle to the lateral's root. But even then, not all of these produce resorption of the lateral's root.
It's the minority, fortunately.
For this patient, the good news is that the canine's follicle is not enlarged yet. Most of the
times, we would see these canines erupt prominently on top (or close to that effect) of the lateral.
We are entrusted with knowing what's normal and abnormal during growth and must follow
up with the information we discover in their records and evaluation. I see lateral root resorption
cases in my practice about once every two years and every time, the canines were angled like

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