Download Lingually Displaced Mandibular Canine Teeth in Young Dogs

A Removable Orthodontic Device for the Treatment of
Lingually Displaced Mandibular Canine Teeth in Young Dogs
Leen Verhaert,
DV\{
Sutnwary:
Tl4e v,Lnlocclwsion of ti,.ngwntly d.isptaced. rnand,ibwlar cnnine teeth is a. c07,tr.tmon ot'thod.ontic problenoin the d,orwestic dog. Sepernl treattuent wtethod,s haye been
tlescribed., and. their nd'ttantages and disnd.vanta.ges ha.ye been extensively reviewed. This
nrticle rl'escribes a funct'ional tecbn'ique used.'in 3B d.ogs of d.ffirent breeds for correction
of the r'nnlocclusion. The techn,iqwe co,tosists of stiwulat,ing the dog to play with speciflc
toys. It is n sitnph, inexpensive, non-invasive techniqwe that has a. saccess rate cuvnpa,rable to conventionnl orthod,ontic techruiqwes for trea.tflxerct of this cononoon rualocclwsion.
J Vet Dent 16(2); 69-75, 1999.
lntroduction
The malocclusion of lingually displaced mandibular canine teeth is a relatively common orthodontic
problem in the dog.l-o This malocclusibn may be
due to a dental abnormality, a skeletal abnormality,
or a combination of both.7'8 The palatal contact of
the mandibular canine crown tips frequently causes
discomfort and pain, and may lead to mucosal ulceration, infection, and even oronasal fis6lx1ie1.7-10
Several treatment methods have been described to
correct the abnormality or to relieve the discomfort
of the animal.4,8'I0-13 Movement of the maloccluded teeth may be undertaken using orthodontic appliances: inclined plane (direct or indirect),14-18 talescoping inclined plane,l8 or active force devices
(expansion screw, W-wire, modified euad helix).z,a,tl
The majority of these are fixed appliances, though
removable appliances are also described. Othtr
treatment options include surgical repositioning,I3'2o,zru surgical crown reduction anil extracfi91.8,10,r1,r3,
All ofthese techniques have advantages and disadvantages) which have been reviewqd extensively.4,6,lz
All of them require anesthesia on at least one occasion, with some techniques requiring multiple anes-
thetic episodes.
This paper describes a very simple, inexpensive,
animal- and owner-friendly technique for correction
of lingually displaced mandibular canine teeth when
no other sbvere malocclirsion is present.
Additionally, the technique enhances the animalowner bond. The technique can be described as a
behavior modification tecFniqug using a removable
orthodontic device.
Technique
This technique for correcting uncomplicated
of lingually
cases
displaced mandibular canine teeth
involves stimulating the dog to play, as often as possible, with specific rubber toys of an appropriate-size
and shape. Correct diagnosis is critica-l-for success of
treatment. No major jaw length discrepancy should
be present. The diastema berween the maxillary
third incisor and canine teeth should be wid6
enough to accomodate the mandibular canine tooth
in its corre_cted position. Playing with and chewing
on a suitable object forces the mandibular canine
teeth into a comfortable and more normal occlusal
position.
The most appropriate objects ro use are toys with
a round or oval shape. Toys with ropes or handles
should not be used, since dogs tend to take toys in
their mouth the easiest way, e.g., by the rope if it is
present. The size is important. Too small a toy will
not touch both mandibular canines at the same time,
and also might be taken too deeply into the mouth.
Too large a toy (i.e., one that lies on top of the
canine crown tips) might cause intrusive ra[her than
lateral tipping pressure and might be uncomfortable,
causing the dog to give up playing. The correct size
of toy sits in between and just behind the canine
teeth, and is larger than the distance between the
canine te.eth. and thus applies principally lateral pressure to the reeth while the dog plays.
In some dogs very large toys are needed, because
the dog holds objects between its carnassial teeth
rather than the canine teeth.
In that
case
the toy
needs to be so large that it does not fit between the
carnassial teeth, as this is likely to result in some
Figure l: D9g, with rubber ball (A) and dog with rubber chew toy in its
mouth (B). The potential beneficial effect of the toy on lingually displaced
mandibular canine teeth can be clearly seen. The toy subjects tl\e teeth to
tipping pressure in a labial direction.
J. VET DENT. VoL 16 No. 2 June 1999
69
2: Case 17 at initial presentation, left lateral (A) and right lateral (B) views.
Although the displacement of the left mandibular canine tooth is only moderate,
clinically the situation is severe, with the tip of the crown of the mandibular canine
tooth sitting in the periodontal space of the maxillary canine tooth.
Figure
of rostral, as well as lateral, tippurg of the
In selected cases, where rostral as well
as lateral tipping is required, carrying the toy
between the carnasial teeth can be useful in some
degree
canine teeth.
cases
but undesirable in others.
The composition and consistency of the object are
important. Tl"re toy should be hard rubber, slightly
deforming on chewing. Too soft a toy is unlikely to
create enough pressure and would be rapidly
destroyed b), chewing. Toys that are too hard or
abrasive could damage the teeth. The toy should
have a smooth surface to avoid excessive tooth wear.
Active play for 15 minutes, 3 times per day is the
recommended minimum; however, longer and more
frequent episodes are prefbrable. The owner is
advised to play with the dog as often as possible and
to take away all other toys. Assuming a I week
learning phase before the treatment becomes effective,2 additibnal rveeks are needed before any benefit from the treatment is likely to be seen. Occlusion
is checked 3 weeks following the start of treatment,
then again at monthly intervals as necessary. If no
movement is seen after 3 weeks, other treatment
In 14 dogs with no other malocclusion
present,
the mandibular canine teeth displacement had been
corrected within 2 months, treatment sometimes
taking as little as 2 weeks. The time required for correction was recorded for 26 dogs, and ranged from
2-12 weeks. For dogs aged 5 months at the start of
treatment, the time required for correction ranged
from 2-B weeks (median 3 weeks); for dogs aged SVz
months) time required was 2-6 weeks (median 4
weeks); fbr dogs aged 6 months) time required was
3-4 weeks (median 3.5 weeks); for dogs aged 6Vz
months, time required was 2-7 weeks (median 4
weeks); for dogs aged7-9 months) time required was
5-12 weeks (median 7 weeks).
methods should be considered.
Results
Thirty-eight dogs, most of them of large and giant
breeds, are included in this series of referral cases
seen during a2-year period. The results are summarized in Table 1. The extent of displacement of the
mandibular canine teeth has been divided into slight,
moderate, and severe. Slight displacement indicates
that the tips of the mandibular canine teeth contact
the buccal half of the diastema between the rnaxillary
third incisor and upper canine teeth. Moderate displacement indicates that the canine crown tips press
into the palatal half of the diastema, and severe displacement is used for those dogs in which the crown
tips of 'the canine teeth impact onto the
Table
I
palate.
also includes information on the presence or
absence of other malocclusions. Mandibular retrognathia was present in several cases and the severity
has been divided into either slight (less than 3mm)
or significant (more than 3mm gap between the
maxillary and mandibular incisor teeth).
Cases were followed
for 2 weeks up to 2
years.
One case was lost to lbllow-up. Long-term followup in most cases was done by telephone contact with
the owner or throllgh the referring veterinarians.
No relapses were reported following use of this techruque.
70
Figure 3: Case 17 after 17 days of treatment, left
lateral (A) and right lateral (B) views. The
mandibular canine crown tips have moved 4mm
labially
.
J. VET. DENT. Vol. 16 No. 2 June 1999
Figure 4: Case 24 at initial presentation, right
lateral (A) and left lateral (B) views.
Four dogs had retained deciduous canine teeth
present in the mandible. The deciduous teeth were
extracted. The malocclusion was corrected in these
four dogs. One of these dogs also had rostral
(incisor) crossbite.
Eight dogs had slight to severe narrowing of the
mandible (unilateral or bilateral). In a normal occlusion, the mandible needs to be slightly smaller than
the maxilla. The buccal face of the mandibular first
premolar tooth falls just palatal of the palatal face of
the maxillary first premolar tooth. If the mandible is
narrow as compared to the maxilla, a gap can be
seen between the mandibular and maxillary first pre-
'
.
molar teeth when looking at the jaws in a ventrodorsal view. The difference between slight and
severe was made in an arbitrary way. The lingual displacement of the canine teeth in six of these dogs
was corrected in 2 rveeks to 2 months. In one, a
Staffordshire terrier, the lingual displacement of the
canine teeth Was corrected only on the least affected
side, and crorvn reduction was performed on the
canine tooth on the severely affected side. In another dog, an Airedale terrier, the tooth moved 3.5mm
in 3 weeks, and then continued to move at a rate of
0.5mm per month.
Eight dogs had slight or severe mandibular retroganthia, and these had the worst outcome in the
series of cases. Three of them, with slight mandibular retrognathism,_were corrected.in 2-3 weeks. One
was moving slowly (0.5mm per month), one was
unilaterally corrected, and in three dogs the canine
teeth did not move. One of these dogs, an Airedale
terrier with a severely narrowed and slightly retrognathic mandible, did'not want to play wlth any toys.
A combination of acrylic inclined planes attached to
the maxillary canine teeth and gingivoplasty of the
maxillary third incisor-canine diastema were used to
provide relief of the animal's discomfort.
One bull terrier with a wry bite and severe narrowing and retrognathism of the right mandible
showed no movement of the mandibular canine
tooth over a period of 2 months. One Bichon Fris6
had a malpositioned righr mandibular canine.tooth.
The root of the mandibular right third incisor tooth
blocked any labial movement of the canine tooth,
and this incisor tooth was extracted. The malpositioned (ectopic) canine tooth was only half erupted.
The root was not exposed after extraction of the
incisor, but the remainder of the crown (still in the
alveolar bone) was exposed. The canine tooth
moved into normal position over a period of 4
months. One mixed breed dog showed a more complex malocclusion. Left mandibular and maxillary
deciduous canine teeth were retained. With the
J.VET. DENT.Vot.16 No.2 June 1999
Qase 24 four months later, left lateral (C) and
right lateral (D) views.
mandible being 2mm longer than the maxilla, the
permanent mandibular canine teeth were touching
the palatal sides of the maxillary third incisor teeth.
The left third incisor tooth had already moved buccally, being inclined 45" compared to a normal position. The right third incisor tooth was still in a normal position. To give this dog a more comfortable
bite, the left third incisor tooth was extracted. On
the right side, only the retained deciduous canine
teeth were extracted, and the dog was given a rubber
ball to play with. Although the left mandibular
canine tooth seemed to be trapped behind the maxillary third incisor tooth) it moved into a normal
position over a period of 5 weeks.
Discussion
Lingually diplaced mandibular canine teeth are a
common malocclusion, reported in many breeds.r 6
Several orthodontic treatments have been
described. The most widely used are inclined planes,
attached to the maxillary teeth) in different forms:
direct acrylic inclined plane,l5,rz,ta indirect acrylic or
metal inclined plane.ra'r0 In young, growing dogs
the use of a telescoping inclined plane is preferable,
to overcome the problem of inhibited jaw growth
resulting from use of lixed appliances.ro'22 These are
all functional devices, which rely on the dog to create orthodontic force when it closes its mouth.
Active devices are also used, placed in the mandible.
Examples are expansion screws) W-wire, and modi-
fied
quad-he1ix.2,8,10,13,1e Surgical repositioning is
anothtr technique that has been used for movement
of maloccluding teet6.ra'zo'zr For these treatments
no major jaw discrepancies should be present. When
major jaw discrepancies are present) surgical crown
reduction (including partial pulpectomy, pulp capping, and surface restoration) of the mandibular
ianine teeth is often the best treatment, although
extraction is another option.l0,ll {Jse ofan external
fixator for forward movement of mandibular canine
teeth has been described in a case of mandibular retrognathia.23 Some of these techniques are more
appropriate and have fewer adverse effects than otheis. Fbr successful use of any orthodontic appliance,
a cooperative dog and owner are necessary.4,S'10,r2
Good oral hygiene is necessary to reduce mucosal
inflammation around the appliance, and frequent
examination is recommended. All toys should be
removed to avoid loss or breakage of the appliance.
In the rubber-ball technique, cooperation is also
necessary. The owner needs to actively play with the
dog and the dog needs to be willing to play. In most
cases, when working with young dogs, interest in
playing is not a problem. Toys other than the round
71
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VET. DENT. Vol. 16 No. 2 June 1999
73
or oval rubber chew toy should be taken away, and
several toys,inay induce-more play activity tt .i-""iy
one. In m.ukiple dog househojds, many ioy, rn"y bt
necessary because tlie older dogs steai toy, fr"i" u
younger one.
All the commonly used orthodontic
techniques
require multiple anesthesias with the associated'iisk
and expense. The rubber toy technique is inexpen_
sive and avoids the necessiry ilf
It wbuld
be advisable to obtain full'pre-"n"sth'iria.
a"a p*1_lr"atment
impres.sions and radiographi, as with'any-orthodon_
bur some owners are not ;lti;t;;
l:have!.:hliqye,
rheir dogs. ane.sthedsed just to take
impressi"ons.
As a compromise, hard wax bite wafers can be used
to record crown tip positions in most conscious
dogs.
.Photographs .an be taken to."."ia th. .*t.rri
ot malocclusion, taking a rostral, left and right view
ofeach case.
_The rubber ball technique has several other maior
advantages.as compa.red to working *rt,.in. pi.'"i_
ously described appliances, which lan cause several
problems.2.4.6.8,t0.t2 In young dogs, jaw growth
might be inhibited .by afplian"ces tE"i'iemJrrt th.
and'iniiior teeth in fi*.J
p"rt_
laxilllJV..canine
sep.o.ru.22
When teeth are not fully erupted ai the
time a fixed appliance is placed, ;t ii titeli ttrrt .onl
trnued eruprion will result
in displacement of the
applrance.s Pressure from applianies might lead to
soft tissue trauma. Good oraihygiene iiri"t
-urra"l"ly f"l successfi_rl ourcome whe"n using ihe rubber
Datl
techntque. (Jral soft tissue traumi from
pres_
su.r;, inflammation. and ulceration are very ,nfil;ly
wrth this technique . unless rhe dog is allergic to rub_
Der.. law growth is not inhibited as is seen with some
ot the fixed applianccs.
, People obiiin dogs for their pleasure, but often
cto nor spehd enough qualiry time with them. In a
world where'ume is money and work is often stress_
$1, r_o time is left for th. .o-p*iorr-that *a,
intended to relieve stress in tne nr'.t pta.i. I often
Vounq dogs that are bored aid lazy. Th;
f-!!
moment the owner starts ro actively play with the
dog, th9 dog's character changes drimlJlally;;^;
strong bond berween owner-and dog is formea.
(Jnce owners are used.to playing,_they
often will go
on doing so because theyied.t#'U."!ni""a .;i"i)^
ment for the dog and themselves.
qlay ti.pe required for this technique
ffnimum
not
I<norvn.
_
is
.Compliance u.i_th specific timing recom_
mendad.ons in this group of dogs.is not knoivn. The
rubb.er ball tethnique could be considered to be a
modrhcarton of'a technique formerly used in chil_
dren with reverse bite in ihe incisor,;gi;;itp;i;L
biting')-z+ Children were taught t3- cGse their
f"u+,in a specific yay 9l a *obden rongue sparu_
ta and bite on it lor 5 to I0 minures, 3,timEs p.i dry.
This was.attemqted for 2 weeks, u".i f
i"rrection
was made, another technique was used.
"" These time
schedules were used as guidelines. In thqte;hnG;;
described here, examiniiion is ,..o--.rrd.d aftei 3
weeKs because most owners and animals need I week
of learning the technique.
age of the animal is an imporranr facror.
--Jh.
when teeth are only
pardy erupted,- the toy needs
onty to^gurde the erupting tooth in the correct directron. Once erupted, the tooth needs to be redirect_
r.-?t,., appropriate position. The technique .
:_111-,
w9lksd
m tully erupted teerh as well as in te6th
whrch were still e rupting; however, rhe time
re.quired for correction was longer in the'fully erupt_
ed teeth.
74
After orthodontic treatment) a retention period is
ofthi tooth to its
tormer posrtlon.
using conventional ortho_
^V\4ren
usually necessary to prevent return
oonuc.apptlances fo1 treatment, a retention period is
generally considered necessary. In the casb of lin_
cllsplaced mandibular canine teeth, a retention
peri.od is usually nor necessary since the natural den_
tat lnterlock retains the canine teeth in t]-re desired
position.4,8,r0,r3 With the technique deicribed in
this article, additional rerenrion i, p.o"iJ.J-bt;";_
gLta.lty.
tinued use of the toy. It appears iirut th.r. ii tittle
risk of overcorrection (labioversion) oF-the canine
teeth. This did not happen in any bf tfr. ag ;"rii,
:,.f:jl.q he.re, even whin very lar[e toys wcre pro_
\.loeo long-term.
fu wirh any technique, correcr diagnosis is critical
^ success of treatment. No
for
major jaw discreoancv
should be presenr.
the .rr. o'f , ii""i.ly i.'t
.ln
nathic. mandible, the ourward movemeni of "gl
th"e
mandlbular canine tooth is inhibired by rhe maxillary
'*.
canine tooth. In less severe cases,
t.inniqu!
does seem to work if a very large rubbeiU"tt ls ,rr'eJ
.1" tip the canine te6th ,iot only laterally, bui
:p ], rosrrally
also
to a certain exrent. The diaiiema
berw.een maxillary third incisor and canine teeth
needs
to be rvide enough to
accomodate the
mandibular canine teerh.
Lingually displaced mandibular canine teeth have
.been
described as being primarily caused by reten_
tion of deciduous canind 1s.dr.o,r.i,rs In this ieries of
-mandibular
38 cases, only four dogs had retained
oectduous canlne teeth. More than 50% of the dogs
reported here had a cliniqally clctecrable
;"* t."gif,
or width abnormality. Skel'etal malocclirsions
?re
considered inherited unless a developmintal cause
can
reliably identified.8 Owners bf tt es. aogs
need,be
ro be advised about the heritabiliry of thls
condition, and informed that the treated a,ig,houd
not be bred.
To date.,,there have been no reports of the fre_
quency with which lingually displaced canine teeth
as jaw growth contiiues. Early fixed-device
:",:,1..1
orthodonuc
treatment is not recommended.6,s,r0,22
AJthough treatment as described here
-av not h"u.
been necessary fbr some of these dogs,
tLrere is no
reason not to encourage the owner to play with the
dog.
The success of this very simple and functional
that more iesearch is needed
technique _suggesrs
regarding hedtability and environmental influences
on.Jaw development. Some of the minor skeletal
niato.cluslons may be produced by lack of function.
JtucLes tn dogs have shown an influence of occlusal
forces on jaw growth.zs
.It has been shown in exper_
rments in rats that food consistency influences'jaw
development.26 Feeding commdrcialvlaurit"Ut.
dlets may have an influence on jaw develobment and
occlusion, because of the lack oifunction.'p;";dil;
S.
d"g. ym something to- chew
,nlpf"y
work wrrh, could be beneficial to"n,
"nE
jaw gror.r.th and
occlusion.
. In.properly selected cases (young dogs, no major
jaw discrepancies). the .rubbei toyrte.h",riq;e
is suc_
wlth correcdon of the maiocclusion within 4
in most caies. This technique eliminates the
need for more involved orthod6nti. t..fr"iq".i,
which. require multiple anesthetic episodii. The
techntque also encourages developme'nt of a strong
bond between owner aid animal'du.i"g rh. course
cessful
weeks
of treatment.
J. VET. DENT Vot. 16 No. 2 June 1999
The authorlhanks D. A' Crossley for his advice
while writing thid article.
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75
J. VET. DENT. Vol. 16 Na. 2 June 1999
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