unilateral Loss of a Maxillary primary canine

Cause: resorption (ectopic eruption of lateral incisors)

When a primary canine is lost in the maxilla due to root resorption caused by ectopic eruption of a permanent lateral incisor, it is a strong indicator of an underlying tooth size-arch length discrepancy (TSALD). First, check the contralateral side for canine mobility. If mobile, go back and classify this as a bilateral canine loss case. Management options are as follows:

    • Pros: may prevent midline shift, maintain arch symmetry, and allow for spontaneous resolution of crowding.

    • Cons: may enhance deleterious dimensional changes (collapse) of the arch.

    • Pros: minimize current costs and burden of care, may need extraction of permanent teeth in the future anyway.

    • Cons: May miss opportunity to space maintain, complicating future orthodontic treatment.

You’ll notice that space maintenance with a Nance is not recommended as a management option.  We find that space maintenance tends to be of little if any value in this scenario. It is likely that orthodontic care will be needed in the future to resolve the malocclusion.

Since management of this situation can be challenging and very patient specific, Dr. Jeff likes to air on the side of caution and refer to a specialist to create a comprehensive long-term plan when uncertain.