When we talk about teeth on the palate we refer to the presence of teeth in the upper jaw, also called included teeth. We detail the causes, symptoms and treatments!
What is an impacted tooth?
An included tooth is one that remains totally or partially inside the maxilla or jaw (lower jaw) because its normal eruption period has been stopped or delayed.
The teeth included in order of frequency are wisdom teeth or third molars (eruption period between 18-25 years) and canines or fangs (eruption period ranges between 9-10 years for the lower ones and between 11-12 years for the upper ones).
In the case of canines included in the maxilla, its incidence is 20 times higher than in the mandible and it is twice as frequent in women than in men and in 8% of cases the inclusion is bilateral.
Causes
The eruption is a coordinated process and a local, systemic or genetic alteration can cause interruptions in it. Systemic reasons include endocrine deficiencies eg hypothyroidism or febrile illnesses. The existence of local factors, one or a combination of several of them, are:
- Macrodontia: tooth larger than usual, preventing its eruption due to lack of space.
- Dental arch insufficient in length to accommodate the teeth . It is an effect of the evolution of the human species: due to the increasingly soft diet, the volume of the jaws has been reduced and with it the number of teeth.
- Prolonged retention or early loss of the primary canine with space closure by movement of the lateral incisor and first premolar.
- Apical abscess: infectious process due to caries of temporary teeth.
- Abnormal location of the dental germ, ectopy.
- Temporary tooth ankylosis : it is fused with the bone preventing its fall.
- Premature closure of the root , the tooth does not migrate.
- cystic formation.
- Disturbances in the sequence of dental eruption.
- Mucosal barriers – scar tissue due to trauma or surgery, gingival fibromatosis or gingival hyperplasia, which make the tissue harder and prevent tooth eruption.
- Supernumerary teeth: hyperdontia is defined as that condition by which supernumerary teeth appear, those teeth in addition to the normal number, which may be present in both jaws and may interfere with the eruption of both temporary and permanent teeth. They can have diverse morphology.
- Idiopathic (the cause is unknown).
Diagnosis
It’s based on:
- Clinical evaluation.
- Absence of the permanent tooth or prolonged retention of the temporary one.
- Absence of a normal canine labial bulge noted during palpation, presence of a bulge on the palate.
- Migration or displacement of the lateral incisor.
- Radiographic verification.
- Precise location of affected canines and determination of their relationship to adjacent incisors and anatomical structures is part of the diagnostic process and is essential for successful assessment of treatment.
- Occlusal periapical radiographs may be useful, but orthopantomography and a dental CT scan are the tests of choice for diagnosis and treatment assessment.
Complications
The presence of a tooth included in the palate can cause migration of neighboring teeth with loss of space in the dental arch, dental malocclusion, formation of cysts or tumors, reabsorption of the roots of neighboring teeth, infections particularly with partial eruption causing more frequent pericoronitis in molars and referred pain.
Treatment
The treatment will depend on the will of the patient, the existence of symptoms and the risk-benefit of the treatment.
The extraction of wisdom teeth or third molar is very common. However, in an included third molar, it will be necessary to assess the location and the risks of its extraction. The surgery will be more or less complicated depending on the degree of inclusion:
- Full inclusion
- Partial
- If the tooth is at the subgingival level.
Surgical
Local anesthesia is used in the surgery. A small incision is made in the gum and osteotomy in case of total or partial inclusion, removing the bone until reaching the included tooth, removing the piece and suturing the wound.
In the case of an included canine, they are very important teeth from a functional point of view due to their position and length in limiting the lateral movements of the jaws and from an aesthetic point of view, since they are part of the anterior sector, which determines the smile, which goes from canine to canine.
Other options
- No treatment, if the patient does not want it . If so, the dentist will have to periodically evaluate the patient to detect any pathological changes. If the primary canine is present, the patient should be informed that the long-term prognosis is poor. This is because the root will eventually reabsorb, losing it.
- Bony fenestration: uncover the crown and let the canine descend on its own.
- Extraction of the impacted canine and movement of a first premolar into position.
- Translation or transplantation of the canine consists of extraction of the canine and placement in the corresponding dental alveolus, which is less and less common due to the non-assured survival of the canine.
- Extraction of the included canine and placement of an implant or fixed canine prosthesis.
- Surgical exposure of the included canine and orthodontic traction to bring the tooth to the line of occlusion. This is obviously the most desirable approach.
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