Orthodontic Surgery

Impacted Canines and Teeth – Removal, Exposure or Chain Bracketing

Adult canines (also known as eye-teeth or teeth numbers 6, 11, 22 and 27) are the second most impacted teeth in jaws after third molars (a.k.a. wisdom teeth). Perforation or intimate relationship with nearby anatomic structures such as the nasal floor, maxillary sinus or roots of other teeth can create potential for surgical complications during access of these teeth.

The utilization of advanced imaging via 3-dimensional cone-beam computed tomography (CBCT) overcomes the limitations of 2-dimensional imaging. This 3D rendering technique produces high-resolution images that proves pivotal in diagnosis of the impacted tooth’s position, potential associated pathology (such as adjacent tooth root resorption, cysts, nerves, ankylosis) as well as the surgical treatment plan (approach, risk, complication, benefit, predictability). Ultimately, this improves the guidance of the surgery and reduces chance of complications that might have been avoided due to incomplete viewing of the tooth within the facial skeleton in traditional 2-dimensional imaging (such as a panoramic radiograph, occlusal radiograph or periapical film).

Consider that people are exposed to background radiation daily, including cosmic radiation from airline flights and/or living at high altitudes. This exposure exhibits the same potential health effects of exposure as diagnostic ionizing radiation. There is no high level of convincing evidence for carcinogenesis (cancer-causing effect) at the level of dental exposures, even though such a risk exists and every exposure cumulatively increases the risk of cancer induction. Consequently, our office follows the radiology principle of A.L.A.R.A (As Low As Reasonably Acceptable) to determine the if imaging is needed, the particular imaging technique, imaging field of view and exposure. For both children and adults, we are aware about the radiation dose considerations regarding the potential harmful deterministic effects of ionizing radiation associated with cellular death by high doses over short periods of time; however, these radiation doses are never reached for a single exposure within this treatment’s diagnostic range. Most maxillofacial CBCT examinations impart a fraction of medical CT effective dose, often below 1,000,000 mSv. Since these doses vary considerably among CBCT units, our office has invested in the most up-to-date CBCT scanner with ultralow dose (lowest dose possible).

For more detailed information, please feel free to access the following literature below.

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