Dental Tribune United Kingdom Edition

T he impaction of maxil- lary canines is a com- mon problem. Research by Thilander and Myrberg es- timated the prevalence of im- paction at 2.2 per cent. Impac- tions are twice as common in females as in males, with up to 8 per cent of cases present- ing with bi-lateral impactions (Dachi et al.) In this case re- port I shall be describing the management of an impacted canine which was removed and replaced with an implant supported restoration. This lovely lady presented with a retained URC and an impacted UR3. She was aware of the impaction and wanted a cosmetic solution for the URC. Clinically, the URC was gr 2 mobile with no associated pathology. The canine could not be palpable labially and a midline/palatal impaction was suspected. Clinical examination re- vealed a minimally restored dentition with good oral hy- giene. She was medically fit and well and wasn’t taking any medication. To further as- sess the position of the UR3 a Sirona Galileos collimated CBCT was taken. This showed the UR3 to be almost horizon- tally impacted, with the crown tip in close proximity to the root apex of the UR2. The treatment options avail- able were: 1 Extraction of the URC and orthodontic alignment of the UR3 Due to the position of the UR3 orthodontic extrusion would be difficult and may take up to two years to com- plete. There is also a risk of resorption around the UR2. 2 Extraction of the URC with provision of a restorative replacement. This could be: A single tooth denture A resin retained bridge An implant retained crown After careful consultation the patient opted for extrac- tion of the UR3 under GA with an implant retained crown. Once the UR3/URC were ex- tracted the patient was pro- vided with a temporary partial denture. Two months after the extractions an Astra Tech 5.0 x 13mm implant was placed. Due to the canine impaction, there was a very thin ridge of bone present with a pro- nounced concavity. A Astra Tech osteotome was used to widen the alveolar ridge in or- der to place the implant. The buccal aspect of the implant was grafted with a bovine bone graft material (Gen-Oss) and covered with a porcine membrane. A 2 stage surgical approach was adopted and the implant buried. Despite the buccal fenestration of the im- plant, a primary stabil- ity of 35Ncm was obtained. It was decided to wait a full three months before expos- ing the implant and placing a healing abutment. At the sec- ond stage surgery a palatally positioned incision was made and the soft tissue pushed towards the buccal aspect. This was done in order to pro- duce a canine eminence and improve the emergence of the implant crown. A wide neck healing abutment was placed to support the new position of the gingivae. A fixture level impression in impregum was taken and an Astra Tech shaded Atlantis Zirconia Abutment ordered. The Virtual Abutment design system supplied by the Atlan- tis system allows for the tech- nician to liase directly with the dentist to ensure that the soft tissue emergence of the abut- ment is correct. A shaded A2 Zirconia abut- ment was used to ensure the E-max crown didn’t appear to bright when fitted. The abutment was torqued to 25Ncm and the crown ce- mented with temp bond. The excess cement was removed and a baseline LCPA was tak- en. The patient was very happy with the final result and the work has a very good long- term prognosis. DT Impacted canines - a case study Dr Nilesh R. Parmar discusses Maxillary canines Fig 1 - Galileos CBCT scan showing the position of the UR3 Fig 2 - Presentation 2 months after the URC & UR3 were extracted Fig 3 - Implant Stage 1: note the thin alveolar ridge Fig 1 Fig 2 Fig 3 Fig 6 Fig 7 Figs 6-8 - Buccal fenestration covered with Bovine bone graft and membrane Fig 8 Fig 9 - Closure with 5,0 PGA Fig 9 ‘xxxxxxxxxxxxx’ February 27-March 4, 201220 United Kingdom EditionClinical