A diagnosis of included canines is reached after we do an orthodontic study with clinical and radiological examination; this will determine the possibilities for treatment using orthodontics and/or surgery.
The upper canine usually erupts at the age of 12. Its absence in the arch can make us suspect a problem, especially if the canine on the other side is present.
We will suspect the existence of a canine included in the palate if we observe the following:
- In adults, if the baby canine is still present, or if both are missing (the baby canine and the permanent one).
- In children, if palpation of the canines is asymmetrical (only one is felt) or if they are not palpated in patients over age 11.
- They are palpated in the palate.
- The lateral incisor is loose in the absence of a canine on the same side.
If we observe one of the points of the clinical examination, and if according to the patient’s age the canine should be present in the mouth, we immediately proceed to radiological examination to find out where the canine is (position in the palate, height, slant, etc.), its relationship to the roots of neighboring teeth and what problem it presents.
The first test is the digital orthopantomography, or panoramic X-ray. This X-ray is excellent for giving us enough information to know the position of the canine. However, a dental CAT, a cone beam computed tomography (CBCT), is nearly a must in order to know its three-dimensional location with millimetric accuracy, as well as its condition and its relationship to the roots of neighboring teeth — necessary information for the fenestration, or surgical exposure of the canine.
The panoramic X-ray is also necessary for a prognosis of the viability of orthodontic treatment and of the canine, evaluating its position with respect to the dental midline, its slant and height.
This fantastic tomographic study and the impressive 3D images were taken at the DIO diagnostic center in Barcelona. (This center specializes in diagnosis by specific imaging for dental medicine; they process and study cases with odontological criteria.)
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