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Management of the Palatally Ectopic Maxillary Canine Jamil Husain MSc BDS DOrth RCSEng MOrth RCSEng FDS (Orth) RCSEdin Consultant Orthodontist St Helens Hospital ST HELENS WA9 3DA Donald Burden PhD MSc BDS DOrth RCS MOrth RCS FDSRCPS FFDRCSI FDSRCS Professor of Orthodontics, Queen’s University Belfast and Consultant Orthodontist Belfast Health and Social Care Trust Royal Victoria Hospital School of Dentistry BELFAST BT12 6BP Patrick McSherry MSc BA BDentSc MDentSc MOrth RCS FDS (Orth) RCSEdin FFDRCSI Regional Consultant Orthodontist DUBLIN NE HSE IRELAND Management of the Palatally Ectopic Maxillary Canine Contents Introduction .......................................................................................................................................................................... 1 Sequelae of Ectopic Canines......................................................................................................................................... 1 1. Diagnosis and Management ................................................................................................................................. 1 1.1 History and examination ..................................................................................................................................... 1 1.2 Radiographic examination ................................................................................................................................... 1 1.2.1 Horizontal parallax 1.2.2 Vertical parallax 2. Treatment .................................................................................................................................................................... 2 2.1 Interceptive treatment by extraction of the primary canine...................................................................... 2 2.2 Surgical exposure and orthodontic alignment ............................................................................................... 2 2.3 Surgical removal of the palatally ectopic permanent canine ....................................................................... 2 2.4 Transplantation...................................................................................................................................................... 3 2.5 No active treatment/leave and observe .......................................................................................................... 3 Explanatory Notes ............................................................................................................................................................. 4 Section 2.1........................................................................................................................................................................... 4 Section 2.2........................................................................................................................................................................... 4 Section 2.3........................................................................................................................................................................... 4 Section 2.4........................................................................................................................................................................... 4 Acknowledgements ........................................................................................................................................................... 5 Further Reading .................................................................................................................................................................. 5 Levels of Evidence .............................................................................................................................................................. 6 Grades of Recommendations....................................................................................................................................... 6 References ............................................................................................................................................................................. 7 i Management of the Palatally Ectopic Maxillary Canine Introduction Sequelae of Ectopic Canines 1 1. Diagnosis and Management 1.1 History and examination 1.2 Radiographic examination15-20 Management of the Palatally Ectopic Maxillary Canine 1.2.1 Horizontal parallax 1.2.2 Vertical parallax 2.1 Interceptive treatment by extraction of the primary canine21-25 2.2 Surgical alignment exposure26 and orthodontic 2.3 Surgical removal of the palatally ectopic permanent canine 2. Treatment 2 Management of the Palatally Ectopic Maxillary Canine 2.4 Transplantation28-31 2.5 No active treatment/leave and observe 3 Management of the Palatally Ectopic Maxillary Canine Explanatory Notes Section 2.1 Section 2.3 Section 2.4 Section 2.2 4 Management of the Palatally Ectopic Maxillary Canine Acknowledgements Further Reading 5 Management of the Palatally Ectopic Maxillary Canine Levels of Evidence 1++ High quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias 1+ Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias 1- Meta-analyses, systematic reviews, or RCTs with a high risk of bias 2++ High quality systematic reviews of case control or cohort studies High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal 2+ Well-conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal 2- Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal 3 Non-analytic studies, e.g. case reports, case series 4 Expert opinion Grades of Recommendations A At least one meta-analysis, systematic review, or RCT rated as 1++, and directly applicable to the target population; or A body of evidence consisting principally of studies rated as 1+, directly applicable to the target population, and demonstrating overall consistency of results B A body of evidence including studies rated as 2++, directly applicable to the target population, and demonstrating overall consistency of results; or Extrapolated evidence from studies rated as 1++ or 1+ C A body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results; or Extrapolated evidence from studies rated as 2++ D Evidence level 3 or 4; or Extrapolated evidence from studies rated as 2+ 6 Management of the Palatally Ectopic Maxillary Canine References 7 Management of the Palatally Ectopic Maxillary Canine 8