Technique Clinic

A Novel Technique to Expose Journal of Indian Orthodontic Society

53(2) 146–147, 2019

Impacted Canine by Using Punch © 2019 Indian Orthodontic Society

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Biopsy Instrument DOI: 10.1177/0301574219840949
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Vijaylaxmi Mendigeri1, Praveenkumar Ramdurg2,

Sanjay Ganeshkar1, and Ravichandra Handral1

Abstract
In orthodontics, the impaction of maxillary canine is a common problem. Treatment for this clinical hitch usually requires
surgical exposure of the impacted tooth, followed by orthodontic traction to align the tooth in the arch. To expose labially
impacted canine, several methods are used in literature. In this article, we throw light on an innovative technique showing the
surgical procedure for uncovering impacted canine by using a punch biopsy instrument.

Keywords
Impacted canine, punch biopsy instrument, surgical E

Introduction Here, we presented a novel technique of surgically

Maxillary canine is the most frequently impacted tooth after
the third molar. In orthodontic patients 1% to 2% labial
tooth impactions are seen.1,2 The exposure of the impacted
canine allows for bonding, which could advance treatment
competence rather than merely waiting for the tooth to erupt.
Depending on the impacted tooth position, various surgical
techniques have been used for their exposure. Excisional
gingivectomy (simple window excision) and the placement
of an apically positioned flap are the most common methods
used for uncovering labial impaction.3-6 The disadvantage
of these techniques is that orthodontists need to depend on a
surgeon for exposing the impacted canine.
uncovering the mandibular right impacted canine (Figure 1),
which can be performed by an orthodontist himself/herself by
using a punch biopsy instrument.
A punch biopsy instrument is a sharp, hollow, circular
instrument. It is available in various sizes ranging from 1
to 8 mm. The blade is directly attached to the handle.7 This
instrument is mainly used in the punch biopsy of mucosa
(Figure 2).
Procedure
This procedure was carried out by cleaning the mucosa
around the impacted right mandibular canine, and then, local
anesthesia was administered. A punch biopsy instrument
with 6 mm size was selected for this procedure. To expose
the impacted right mandibular canine, the punch biopsy

1
Departments of Orthodontics, PMNM Dental College and Hospital, Bagalkot,
Karnataka, India.
2
Departments of Oral Medicine and Radiology, PMNM Dental College and
Hospital, Bagalkot, Karnataka, India.

Corresponding author:
Vijaylaxmi Mendigeri, Department of Orthodontics, PMNM Dental College
and Hospital, Bagalkot, Karnataka 587101, India.
Figure 1. Impacted right mandibular canine Email: vijuortho@gmail.com

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Mendigeri et al. 147
instrument was placed vertically over the gingival covering
of right mandibular canine, and the smooth twisting motion
was used. Once the instrument reached the impacted tooth,
the instrument was removed. The tissue was lifted out with
tissue-holding forceps. The excision of the tissue on the
impacted tooth was enough to bond a bracket. Curved Begg
bracket with 0.009″ twisted ligature wire was attached on the
exposed canine. Traction for the impacted right mandibular
canine was done with 0.009″ ligature wire (Figure 3). The
canine fully aligned in the arch after 8 months (Figure 4).
Figure 2. Punch biopsy instrument
Figure 3. Curved Begg bracket with 0.009” ligature wire attached
Figure 4. Canine in occlusion after 8 months
Indications for This Technique
Following are the indications for this technique:
1. Adequate zone of attached gingival present for
erupting canine
2. Labially placed canine
3. Canine is palpable with blanching of tissue on finger
pressure
4. Panoramic radiograph showing crown eruption
beyond the dento-alveolus.
Advantages of This Technique
The technique is easy, cost-effective, requires a disposable
instrument, and an orthodontist can do this simple procedure.
Further studies are required to evaluate the long-term
efficiency of such a procedure.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research,
authorship, and/or publication of this article.
References
1. Bass TB. Observations on the misplaced upper canine tooth.
Dent Pract Dent Rec. 1967;18:25–33.
2. Johnston WD. Treatment of palatally impacted canine teeth.
Am J Orthod. 1969;56:589–596.
3. Vanarsdall RL, Corn H. Softtissue management of labially
positioned unerupted teeth. Am J Orthod. 1977;72:53–64.
4. Duncan WK, Ashrafi MH, Meister F Jr, Pruhs RJ. Management
of the nonerupted maxillary anterior tooth. J Am Dent Assoc.
1983;106:640–644.
5. Boyd RL. Clinical assessment of injuries in orthodontic
movement of impacted teeth. II. Surgical recommendations.
Am J Orthod. 1984;86:407–418.
6. Bishara SE. Impacted maxillary canines: a review. Am J Orthod
Dentofacial Orthop. 1992;101:159–171.
7. Zuber TJ. Punch biopsy of the skin. Am Fam Physician.
2002;65:1155–1158, 1161–1162, 1164.