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Canines – what I wish I’d known John Scholey. BOS 2021. Episode 134. September 29th 2021

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Hosted by
Farooq Ahmed

Join me for John’s lecture looking at impacted canine, mechanics he now uses, interceptive treatment and referrals

 

Mechanics to align canines

o   Piggy back mechanics

o   Including pushcoil with NiTi piggy wire to direct canine

o   Not keen on elastomeric as flicks off

o   TMA auxiliary archwires

o   Sling shot to achieve

o   TADs

o   Specific direction of tooth movement

§  Buccal  3 close to 2, place between 5-6 and distal force

o   TPA with hooks for distal traction

§  However can cause trauma to tongue

o   Ballista spring – perpendicular to occlusal plane

o   Downset in NiTi wire

 

Resist the urge bond when initially erupt

o   When a canine begins to erupt , excessive tissue – John recommends removing gold chain and waiting 1-2 visits for passive eruption, reduces anchorage loss especially in growing patients

 

Interceptive treatment

o   Extraction of primary C

o   Interceptive treatment not reliable

o   Cochrane Review Parkin: depends on patient

§  Patient population – younger patient cohort

§  Create space

§  Review

 

Risk versus benefit

o   Removal of canine

o   Low gingival margin – consider extraction of canine for moderate to severe canine

o   Severe canine displacement

 

Referral of patients

o   Should be consider late referral of canines as negligent treatment

o   John’s audit age of referral 14.7 years

o   Management

o   Letters to dentists

o   Teaching courses

o   NO DIFFERENCE – 50% referrals late

o   Score of canine

o   Age 14 or less better position

o   Age 14 or greater poor position

o   MCN cut off age 14 for canine referrals

o   Now uses the ‘stick’ approach, warnings to local practitioners if not headed then discussion with commissioners

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