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
