What are the options for incorrect positioning?
The tooth can be tilted towards the cheek or tongue, rotated around its axis, shifted forward or backward along the row, and also located above or below the level of neighboring teeth. Separately, retention is distinguished when the tooth is formed, but never erupted and remains in the bone. A combination often occurs: an impacted and at the same time dystopic wisdom tooth, lying horizontally and resting on the adjacent molar. The tactics also depend on the option: a deployed incisor can usually be rotated with braces, and a horizontal wisdom tooth is almost always removed.
- Vestibular position - tilt to the cheek
- Oral - tilt towards the tongue or palate
- Mesial and distal displacement along the row
- Tortoanomaly - rotation of the tooth around its axis
- Supra- and infra-position in height
- Retention - the tooth did not erupt and remained in the bone
Causes and risk factors
The main reason is lack of space. If the jaw is smaller than the sum of the width of the teeth, the last erupting ones do not have enough space and they move to the side. This is facilitated by the early removal of baby teeth without installing a space retainer: the adjacent teeth tilt into the gap and block the path of the permanent one. Heredity, supernumerary teeth, dense scarred gums, incorrect position of the bud and bad childhood habits play a role - prolonged thumb or pacifier sucking, mouth breathing with a chronically stuffy nose.
- Discrepancy in the size of teeth and jaws
- Early loss of baby teeth
- Hereditary features of the structure of the jaws
- Supernumerary and fused teeth
- Delayed loss of baby teeth
- Prolonged thumb and pacifier sucking
- Mouth breathing, adenoids
- Jaw injuries in childhood
Why is dystopia dangerous?
It is difficult to clean a tooth out of a row, so caries quickly appears on its contact surfaces and on its neighbors. A tilted wisdom tooth constantly puts pressure on an adjacent molar, destroying its root or creating a pocket where plaque accumulates. A hood of gum forms over a tooth that has not fully erupted, under which painful inflammation occurs. The sharp cusp of a dystopic tooth rubs the cheek and tongue, causing long-term non-healing ulcers. In addition, the distribution of the chewing load is disrupted and the aesthetics of the smile suffers.
- Caries of the dystopic and adjacent teeth
- Inflammation of the hood over the wisdom tooth
- Root destruction of an adjacent molar
- Chronic injury to the cheek and tongue
- Crowding and displacement of front teeth
- Hygiene problems and bad breath
Diagnostics
The dentist examines the dentition and assesses how much space there is for the tooth. An X-ray is required: a panoramic image shows the position of all teeth and rudiments, a targeted one shows the relationship of a particular tooth to its neighbors. For deeply located or impacted teeth, especially near the mandibular canal or maxillary sinus, cone beam computed tomography is prescribed: it accurately shows the location of the roots and nerves and allows you to plan the operation safely. The orthodontist additionally takes impressions and makes diagnostic models.
- Inspection and assessment of space shortages
- Panoramic shot of the jaws
- Spot X-ray
- Cone beam tomography according to indications
- Diagnostic jaw models
- Photo protocol of smile and profile
Treatment
If a tooth is functionally important - for example, a canine - they try to bring it into the dentition orthodontically. To do this, a space is created with braces or a plate; if necessary, the surgeon exposes the crown and fixes a button on it, by which the tooth is gradually pulled out. The process takes many months, but the natural tooth is preserved. Wisdom teeth with severe dystopia, as well as supernumerary teeth, are usually removed: there is no benefit from them, and the risk of complications is high. After orthodontic treatment, a retainer must be worn, otherwise the teeth will return to their previous position.
- Orthodontic creation of space and alignment of teeth
- Surgical crown exposure with button fixation
- Removal of dystopic wisdom tooth
- Removal of supernumerary teeth
- Excision of the hood due to inflammation
- Retainer after orthodontic treatment
- Prevention: examination by an orthodontist for a child aged 6–7 years