How was that missed? (Impacted teeth) 6

I recently had a request to show some missed and/or misdiagnosed cases.  I oddly enough came across one of these cases shortly after that request and decided to start with two cases of missed impacted teeth.

Case 1

This case was shown to  me of how you can miss things if you are not looking carefully.  There is an impacted mandibular canine near the inferior border of the mandible slightly to the patients’ left of the midline.  I realize this is not a great radiograph (the joys of scanning a print out of a digital image – sorry) but you should note a horizontal radiopaque entity with the crown and follicle to the patients left (inferior to the first molar/second premolar region).  It is very subtle and hence it was missed for 2+ years before it was noticed.

Case 2

This case was presented to me as a possible implant case and trying to determine whether or not the patient would require a cone beam CT.  There is an impacted tooth (it appears to be a mandibular canine) horizontal in the right mandible.  The enamel of the crown is V shaped and at the medial aspect of the external oblique ridge.  It again is very subtle and thankfully caught before any implants were attempted to be placed in this location.

While these are both simple cases of impacted teeth that were missed on the radiographs and were not life threating, I hope it helps remind you to examine your radiographs closely.  I will be presenting some other cases in the next couple of weeks on entities that were not only missed but also misinterpretated as to the final diagnosis.

If you have any questions, please let me know. Thanks and enjoy!

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6 thoughts on “How was that missed? (Impacted teeth)

  • Ahmad Assari

    Thank you Dr. Gonzalez. Very interesting and very informative as always.
    I cannot wait to see more of this.
    How is it possible for a right canine to be impacted in the right side? very interesting again.

      • Dr. Shawneen Gonzalez

        Surgically moving a tooth depends on the location and whether it would cause more harm than good to move it. When a tooth is that far inferior it is difficult to expose and place a bracket on it due to the attachment of the lips. Also rotating it can be tricky without pressing on other adjacent teeth and possibly causing external resorption. Many times the tooth will be left alone as long as it is not interfering with any other treatment. Great questions.! 🙂

  • Ahmad Assari

    Thank you Dr.
    What I meant is extracting the canine from that area and re implanting it at its site. Assuming the patient want a permenant canine.
    Would this be better than an implant?

    • Dr. Shawneen Gonzalez

      Transplantation is an option, but one that is not used very often in the states. One concern would be room for the permanent canine as the primary canine is much smaller and the adjacent permanent teeth are in close proximity. Not sure if a transplanted tooth would be better than an implant, I will need to look into it and see if there is any research on that topic. Thanks for the continued great questions. 🙂