TU

The m anagem ent of im pacted canines:

free physiologic eruption
DaCosta Clark, D M D , Provo, U tah

The free physiologic eruption o f impacted canines m a d e t h r o u g h t h e m u c o s a a n d p a l a t a l b o n e so t h a t a

requires the cooperation o f the general dentist, the p o r t io n o f th e lin g u a l s u r fa c e o f th e im p a c t e d c r o w n
oral surgeon, and the orth o d o n tist. The techniques w a s v is ib le . T h is o p e n in g w a s p a c k e d w i t h c o t t o n o r a
w hich have successfully brought impacted canines s u r g ic a l d r e s s in g t o keep th e re g io n o p e n u n t il th e
into the arch in 2,000 instances are described. t o o t h e r u p te d . T h is a t t e m p t o f t e n w a s f u t ile a n d w a s
fo llo w e d b y a s im ila r o p e n in g a n d th e p la c e m e n t o f
T h is d is c u s s io n c o n c e r n s t h e m a n a g e m e n t o f i m p a c t ­ e y e d s c r e w s o r i n l a y s , w i r e s , s p r in g s , o r o t h e r k i n d s o f
e d , e c t o p i c c a n in e t e e t h b y a p r o c e d u r e w h i c h u t i l i z e s d e v ic e s t h a t w o u l d e x e r t s u f f i c i e n t p r e s s u r e t o c a u s e
th e n a t u r a l e r u p tio n o f t e e t h w it h o u t a p p lie d fo r c e . e r u p t i o n o f t h e t o o t h . T h e s e w e r e s u c c e s s fu l a s lo n g
The p h ilo s o p h ic b e lie f on w h ic h th e tre a tm e n t is as th e r e w a s a d e q u a t e o p e n in g in th e b o n e a n d s o ft
based is t h a t t h e m a j o r i t y o f t e e t h w i l l e r u p t i f a ll t is s u e t o p e r m i t t h e to o th to c o m e d o w n . H o w e v e r ,
bony or s o ft tis s u e im p in g e m e n t or any o th e r we a re c o n v in c e d t h a t th e s e t e e t h w i l l c o m e d o w n
o b s tru c tio n s a re r e m o v e d fr o m th e p a t h o f e r u p tio n . a n y w a y , w i t h o u t w i r e s , s c r e w s , o r o t h e r d e v ic e s , p r o ­
The c a n in e to o th is o n e o f th e m o s t im p o r t a n t v id e d t h e y h a v e a n a d e q u a te u n r e s tr ic te d p a t h w a y .
te e th in th e d e n ta l arc h fro m th e s ta n d p o in ts of V a r io u s p r o b le m s a ro s e w ith a ll th e s e m e th o d s ,
f u n c t i o n a n d e s t h e t i c s . R e c e n t w o r k a ls o h a s e m p h a ­ a n d m o s t o f th e m to o k a g re a t d e a l o f tim e . W h e n

s iz e d t h e p r o p r io c e p t iv e f ib e r s a n d r e f le x e s r e la t e d to w ire s w e re p la c e d a ro u n d th e c e r v ic a l m a r g in , th e
t h i s t o o t h . 1 -3 C a n in e t e e t h , e s p e c ia lly t h e m a x i lla r y t o o t h fr e q u e n t ly w a s m o v e d to o r a p id ly a n d in v o lv e d
c a n in e s , m u s t b e r e g a r d e d a s v i t a l i n p r o t e c t i n g a n d d e v it a liz a tio n a n d lo s s o f c e r v i c a l b o n e b y th e tim e
s t a b iliz in g th e o c c lu s io n . th e t o o t h w a s b r o u g h t in t o th e a r c h . T h is w a s p a r tic ­
I t h a s lo n g b e e n th e a im o f t h e o r a l s u r g e o n s , th e u la r ly t r u e w i t h l a b ia l im p a c t io n s .
o r t h o d o n t is t s , a n d th e g e n e r a l p r a c t it io n e r s , t o b r in g The fre e e r u p tio n o f im p a c t e d t e e t h re q u ir e s th e
e c to p ic , im p a c te d te e t h in to th e d e n ta l a r c h f o r n o r ­ c o o p e r a tio n o f th e g e n e ra l d e n tis t, th e o r a l s u rg e o n ,
m al fu n c t io n a l and e s th e tic s t a b ilit y . M any p ro c e ­ and th e o r t h o d o n t i s t . H o w e v e r , e a c h m u s t e x e r c is e
d u re s and te c h n iq u e s have been used w ith v a ry in g p a r t i c u l a r c a r e a n d j u d g m e n t in t h e m anagem ent o f
d e g r e e s o f s u c c e s s a n d f a i l u r e . 3 -1 2 h is re s p e c tiv e r e s p o n s ib ilit y in s e e in g t h a t t h e t o o t h
T h e m a n a g e m e n t o f im p a c te d c a n in e s o t h e r t h a n h a s fr e e e r u p t io n . D u r in g th e p a s t 1 5 y e a rs th is c o ­
b y e x tr a c t io n h a s lia d a v a rie d h is t o r y . o p e r a tiv e e f f o r t h a s re s u lte d in t h e s u c c e s s fu l e r u p ­
One of th e fir s t m e th o d s used w as to uncover tio n o f m o r e th a n 2 , 0 0 0 te e th .
p a r t i a l l y t h e c a n in e in t h e p a l a t e . A s m a l l o p e n i n g w a s The im p a c te d to o th m ust be lo c a te d b y p ro p e r

836 ■ JADA, Vol. 82, April 1971

 F ig 1 ■ R a d io g r a p h o f p a la ta l im p a c te d , e c to p ic c a n in e s ( A ) ; b ila te r a l p a la ta l fla p s ra is ed (B ) ; b o n e
re m o v e d fr o m o v e r a n d a r o u n d im p a c te d c ro w n s (C ) ; p la s tic c ro w n s in p la c e w it h w in d o w s c u t in
p a la ta l fla p . R e m a in d e r o f f la p s u tu re d in to p o s itio n ( D ) ; p la s tic c ro w n s re m o v e d s h o w in g te e th
e r u p te d th r o u g h s o f t tis s u e o f p a la t e ( E ) ; b a n d s in p la c e s h o w in g m o v e m e n t o f c a n in e s ( F ) ; m o v e m e n t
o f c a n in e s p r a c t ic a lly c o m p le t e ( G ) ; c o m p le t e d c a n in e m a n a g e m e n t ( H ) .

c lin ic a l a n d r a d io g r a p h ic e x a m in a tio n s , a n d th e d e c i­ fro m th e in c is a l edge, th e m e s ia l and th e d is ta l

s io n r e g a r d in g th e tr e a tm e n t m u s t b e m a d e b y th e m a r g in s of th e c ro w n , and on th e l in g u a l to th e
p a r e n ts in c o n s u lta t io n w ith th e s u rg e o n , th e o r t h o ­ c e r v ic a l m a r g in o f th e t o o t h , th e r e b y p r o te c tin g th e
d o n t i s t , a n d t h e g e n e r a l d e n t i s t . I t is h e l p f u l t o h a v e bone on th e lin g u a l a s p e c t o f t h e u p p e r c e n t r a l a n d
m o d e ls and r a d io g r a p h s w h e n th e c o n d it io n is d e ­ l a t e r a l in c i s o r s . A t t h i s p o i n t i t is a d v is a b l e t o d e b r i d e
s c rib e d t o th e p a r e n ts a n d th e p a t ie n t. th e re g io n th o r o u g h ly , in c lu d in g t h e r e m o v a l o f as
m u c h as p o s s ib le o f t h e f o l l i c u l a r s a c f r o m a r o u n d t h e
to o th .
W hen th e in c is a l, m e s ia l, d is t a l, a n d lin g u a l p o r ­

Palatal im p acted canine tio n s of th e c ro w n a re c le a r ly v is ib le , a s m a ll or

m e d iu m s iz e gouge e le v a to r is p l a c e d o n th e la b ia l
a s p e c t o f th e t o o t h , o r t o th e m e s ia l o r d is t a l, w h i c h ­
If th e e c to p ic , im p a c te d c a n in e is in t h e p a l a t e a n ever a llo w s th e m ost e ffic ie n t access. T h e to o th is
in c is io n is m a d e in th e p a la t e lin g u a l t o th e upper lu x a te d s lig h tly a w a y fro m th e lin g u a l a s p e c t o f th e
a n t e r io r t e e t h . O n ly th e in te r d e n ta l p a p illa e a r e e x c is ­ u p p e r a n t e r i o r t e e t h . T h e c r o w n o f t h e t o o t h is a c t u ­
e d . T h e i n c i s i o n is m a d e f r o m t h e m e s i a l o f t h e u p p e r a lly m o v e d fr o m t h e c r y p t s o t h e r e is a d e q u a t e f r e e ­
fir s t m o la r to th e m e d ia n lin e on th e s id e o f th e d o m b e t w e e n th e lin g u a l a s p e c t o f th e u p p e r a n t e r io r
im p a c t e d to o th . I f b o th c a n in e s a re im p a c te d and te e th and th e b o n e , th u s p e r m it tin g fre e e r u p tio n .
e c to p ic in th e p a la t e , th e in c is io n is m a d e on th e T h is p ro c e d u re r e q u ir e s th e p iv o t in g o f th e to o th
o p p o s i t e s id e o f t h e m o u t h a t t h e s a m e t i m e ( F i g 1 ) . w ith th e apex o f th e r o o t r e p r e s e n t i n g t h e a x is o f
The n e u r o v a s c u la r b u n d le in th e n a s o p a la t in e f o r a ­ r o t a t i o n , t h e r e b y l i m i t i n g i t s m o t i o n a n d i n s u r in g it s
m en is not in v o lv e d , and th e m u c o p e r io s te a l fla p v ita lity (F ig 2 ).
fr e q u e n tly can be r e fle c te d aw ay fro m th e p a la te , I n m o s t i n s t a n c e s t h i s w i l l le a v e a s p a c e o f 1 t o 2
t h e r e b y e x p o s i n g t h e p a l a t e f r o m t h e c e r v i c a l m a r g in s m m b e tw e e n th e la b ia l a s p e c t o f th e im p a c te d to o th
o f t h e t e e t h d o w n t o t h e m i d l i n e ( F i g 1 ) . T h i s g iv e s a a n d it s b o n y i m p i n g e m e n t ( o r t h e r o o t s o f t h e u p p e r
fu ll v ie w o f th e bony s tru c tu re o f th e p a la te and a n t e r i o r t o o t h ) . T h i s s t e p m u s t b e o b s e r v e d c l o s e ly o r
o f te n e x p o s e s th e b u lg in g b o n e o v e r th e c r o w n o f th e t h e r e w i l l b e n o f r e e e r u p t i o n o f t h e t o o t h s in c e it is
im p a c t e d t o o t h . W it h th e m u c o p e r io s te a l fla p r e tr a c t­ n e c e s s a ry to m o v e th e c r o w n o f th e im p a c te d to o th
e d , th e b o n e o v e r th e im p a c te d to o t h c a n b e re m o v e d a w a y f r o m th e ro o ts o f th e a n t e r io r te e th .
b y h a n d p r e s s u r e w i t h a c h i s e l. T h e b o n e is r e m o v e d N o a t t e m p t is m a d e t o c a u s e d o w n w a r d m o t i o n o f

Clark: MANAGEMENT OF IMPACTED CANINES ■ 837

 c e m e n t s u c h a s z i n c o x i d e - e u g e n o l a n d is s e a t e d o v e r
th e c r o w n o f th e im p a c te d t o o t h . A n y e x c e s s c e m e n t
is r e m o v e d . I t is n o t n e c e s s a r y f o r t h e c r o w n f o r m t o
be p la c e d p a r a lle l to th e lo n g a x is o f th e to o th .
F r e q u e n t l y , t h i s c a n n o t b e a c c o m p l i s h e d a n y w a y in
h o r iz o n t a l im p a c t io n s , p a r t ic u la r ly i f t h e y a re b ila t e r ­
a l h o r i z o n t a l i m p a c t i o n s . I t is i m p o s s i b l e t o p u t t w o
c r o w n s in th e p a la te w h ic h a re p a r a lle l t o t h e lo n g
a x is o f t h e t o o t h .
An o p e n in g is n o w e x c is e d i n t h e p a l a t a l tis s u e
th a t is m o re th a n a d e q u a te to p e r m it th e p la s t ic
c ro w n to e x te n d d o w n th ro u g h it.
The p a l a t a l f l a p is r e t u r n e d t o p r o p e r p o s i t i o n b y
m e a n s o f in te r p r o x im a l s u tu re s . A 4 b y 4 s p o n g e is
p la c e d in th e m o u th o v e r th e c ro w n fo rm a n d th e
s u tu re d p a la ta l f la p . T h e s u tu re s a re r e m o v e d in fo u r
to fiv e d a y s . G o o d o r a l h y g ie n e is i m p o r t a n t , a n t i ­

F ig 2 ■ D o t t e d lin e s h o w s m o v e m e n t o f im p a c te d c a n in e b i o t i c s u s u a l l y a r e n o t n e e d e d . A n a n a lg e s ic m a y b e
a w a y fr o m r o o t o f a n t e r io r to o th . p r e s c r ib e d d e p e n d in g o n p a t ie n t n e e d s .
A f t e r p o s t o p e r a t i v e s y m p t o m s h a v e s u b s id e d , t h e
p a t ie n t re tu r n s e v e ry f o u r t o fiv e w e e k s . T h e s ta tu s o f
t h e t o o t h in t h i s l u x a t i n g p r o c e s s . A s a m a t t e r o f f a c t , th e c r o w n fo r m is c h e c k e d t o a s s u r e t h a t t h e r e is n o
it is a g o o d id e a to h o ld th e in d e x fin g e r o f th e s o ft t is s u e im p in g e m e n t a ro u n d o r o v e r th e c ro w n
o p p o s it e hand over th e cro w n to p r e v e n t its b e in g f o r m . I f t h i s s h o u l d o c c u r , i t is n e c e s s a r y t o e x c is e t h e
e x t r a c t e d b y t h e l u x a t i n g m o v e m e n t . T h i s is p a r t i c u ­ tis s u e a n d p u t o n a l o n g e r c r o w n f o r m .
l a r ly t r u e w i t h la b ia l im p a c t io n s . A s a r u l e , t h e e x i s t i n g d e c i d u o u s c a n in e s a r e l e f t i n
B e f o r e a p l a s t i c c r o w n f o r m is p l a c e d o n t h e t o o t h , p la c e u n t il th e o r t h o d o n t is t h a s m o v e d th e im p a c t e d
a b u r o r a c h is e l is u s e d t o c u t a t r o u g h i n t h e p a l a t e t o o t h o v e r n e a r t h e a l v e o lu s o f t h e d e c i d u o u s c a n in e .
b o n e fro m th e d is ta l a s p e c t o f th e e x p o s e d c r o w n to T h i s d o e s n o t le a v e a n o p e n i n g i n t h e c h i l d ’ s m o u t h
th e a l v e o lu s o f th e d e c id u o u s c a n in e . T h is 4 -b y -5 a n d saves a n y e m b a r ra s s m e n t h e m ig h t h a v e b e c a u s e
m m - w i d e c u t is m a d e t h r o u g h t h e c o r t i c a l p l a t e o f t h e o f t h i s m is s in g t o o t h .
p a la te a n d in to th e m e d u lla r y p o r tio n o f th e b o n e .
T h is tr o u g h d o e s n o t h e lp in th e fr e e e r u p t io n o f th e
to o th , but it a id s th e o r th o d o n tis t in m o v in g th e
t o o t h o u t o f th e p a la te a n d in to p r o p e r a lig n m e n t. Labial im pacted canine
A p la s t ic c r o w n n o w is p l a c e d o v e r t h e t o o t h t o
p r e v e n t a n y s o f t t is s u e o r b o n e f r o m f o r m i n g o v e r t h e
p o r t io n o f th e c r o w n w h ic h h a s b e e n u n c o v e r e d . T h is I f th e e c t o p i c i m p a c t e d c a n i n e is o n t h e l a b i a l , t h e
c r o w n m u s t b e lo n g e n o u g h to f i t o v e r th e c r o w n o f s a m e te c h n iq u e c a n b e u s e d . I t h a s b e e n o u r e x p e r i­
th e to o th and e x te n d dow n th ro u g h an o p e n in g e n c e t h a t t h is m e t h o d o f s im p le c o m p le t e e x p o s u r e
w h i c h w i l l b e c u t in t h e s o f t t is s u e s o f t h e m u c o p e r i ­ r e s u lts in e r u p t i o n w i t h m o r e c e r v ic a l b o n e th a n i f th e
o s te a l fla p of th e p a la te , th e re b y p e r m it tin g th e im p a c t io n is p u l l e d d o w n w i t h e y e s c r e w s , w i r e s , o r
h e ig h t o f c o n t o u r , o r w id e s t d im e n s io n , o f t h e p la s t ic o t h e r d e v ic e s .
c r o w n t o b e v is ib le b e y o n d th e s u rfa c e o f th e m u c o s a . A f l a p is r a is e d f r o m th e c e r v ic a l m a r g in s o f th e
T h is a s s u re s fr e e m o v e m e n t o f t h e t o o t h d o w n in t o a n t e r io r te e th (F ig 3 ). A v e r t ic a l cut is m a d e to
th e p a la te w ith o u t it s e r u p tio n b e in g re ta rd e d or c o n fo rm w ith t h e m e s i a l a n g le o f t h e p l a s t i c c r o w n
h a lte d b y fo r m a t io n o f h e a v y , f ib r o u s tis s u e , e it h e r w hen it is p l a c e d . An o p e n in g m u s t b e c u t in th e
o ve r o r a ro u n d th e c r o w n . I t is a d v is a b l e t o s e le c t a m ucosa so th a t th e c ro w n fo rm w ill e x te n d out
p l a s t ic c r o w n f o r m la rg e r th a n th e c r o w n b e in g c o v ­ th r o u g h th e s o ft tis s u e . T h e m u c o p e r i o s t e a l f l a p is
e r e d . T h is e n s u re s a la rg e enough o p e n in g fo r th e r e f le c t e d h ig h e n o u g h t o o b s e rv e th e la b ia l b o n e o v e r
e r u p tio n o f th e t o o t h . th e to o th . A b o n e c h is e l o r b u r is u s e d t o re m o v e
T h e c ro w n fo rm c a n b e c o n t o u r e d w i t h s c is s o rs t o s u f f i c i e n t b o n e t o f a c i l i t a t e t h e p l a c e m e n t o f a p l a s t ic
f i t a r o u n d th e c e r v ic a l m a r g in o f th e im p a c t e d t o o t h . c ro w n fille d w ith s u r g ic a l c e m e n t . A g a i n , t h e to o th
T h e fo rm is f i l l e d w i t h a s t i f f m i x o f s u r g ic a l p a s t e o r m ust be lu x a te d w ith a g o u g e e le v a to r a n d m o v e d

838 ■ JADA, Vol. 82, April 1971

 Fig 3 ■ Labial ectopic canine showing flap raised and bone removed fro m over canine (A ); ectopic
crown raised from c ry p t and plastic crown placed (B); w indow cut in labial flap; remainder o f flap
sutured in to position (C); free eruption o f ectopic canine and plastic crown (D ); treatm ent
o rth o d o n tica lly completed w ith le ft canine in correct occlusion (E).

Fig 4 ■ Excision o f half-m oon shaped tissue from lingual

aspect o f canines (A ); diagram showing excision o f half-m oon
tissue from lingual o f canine (B).

ante rio rly aw ay from the ro o ts o f the upper anterior
teeth. Fre q u e n tly the canines w ill be dow n between
the roots o f the lateral and central in cisors, or they
m ay be under the root o f the lateral in ciso r. It is
necessary to lift the crow n o f this tooth from its
c ry p t, out around the root o f the lateral in ciso r, so it
is labial enough to perm it its free erup tion and to
perm it the ap p licatio n o f a plastic crow n. Here again,
as on the palate, a trough is cut through the labial
plate o f the m axilla to the alveolus o f the deciduous
canine.
T h e p lastic crow n is placed, being careful that it
extends 3 to 5 m m b elow the crow n o f the e ctop ic
can ine, or far enough so that it exten d s through the
m ucosal flap after the opening is created. A labial
opening is made in the m ucosa that is large enough to
perm it the plastic crow n to extend out in to the
vestibule. The m ucoperiosteal flap is brought b ack
into position and sutured around the anterior teeth
and around the plastic crow n (F ig 3).
The degree o f success o f th is procedure is d ire ctly
p ropo rtionate to the freedom w hich the crow n has in
erup ting w ithout bone or soft tissue interference.
I f it should happen that the plastic crow n com es
o f f and fib ro u s tissue fo rm s, it is necessary to remove
this cic a trix b y cu ttin g a dou ghnut-shaped piece o f

C la r k : M A N A G E M E N T O F IM P A C T E D C A N IN E S ■ 8 3 9
tissue fro m around the crow n and place a new p lastic
crow n fo rm as before. The tooth w ill erupt i f there is
no soft tissue o r b o n y interference.
M uch credit for the success o f th is procedure m ust
be given to m y o rth o d o n tist colleagues. T h e ir e n co u r­
agement and help have been im portant to a united
and m utual e ffo rt.
O rth o d o n tists som etim es com p lain that the palatal
canines tend to d rift lin g u a lly after a retainer is
rem oved. T h is d rift can be elim inated b y cu ttin g a
crescent, h alf-m oo n piece o f tissue from the lin gu al
aspect o f the m oved canine. Th e cut is m ade 4 m m
fro m the lin gu a l aspect o f the crow n and tapers o ff
distal to the lateral in ciso r and m esial to the first
prem o lar. The tissue is rem oved to the bon e, and the
opening is p acke d w ith surgical paste and cotto n
w h ich is left in place fo r ten days ( F ig 4).
Conclusions
1. Fiedler, L.D., and A ilin g, C.C. M alpositioned mandibu­
lar right canine. J Oral Surg 26:405 June 1968.
2. Reiser, R.E. A technique for surgical o rth o d o n tic man­
agement o f Impacted teeth. J Pract O rth o d o n t 3:4 10 Aug
1969.
3. Mead, K.R., and Monsen, R.M. Surgical respositioning
o f developing impacted teeth. JA D A 7 1 :621 Sept 1965.
4. Harley, D.T. Clinical assessment o f unerupted m axillary
canine. In Transactions of British Society o f O rthodontists,
1955, p 82-90.
5. Cranin, IM.A. A iding eruption of m axillary cuspids. Dent
Radiogr Photogr 41:27 1968.
6. Arm brecht, E.C., and M iller, B.J. Bilateral impacted
cuspids o f the palate. West Virginia DJ 37:70 Oct 1963.
7. Salman, L. Surgical exposure o f the impacted and un­
erupted tooth as an aid to orthodontics. New Y ork State
Dent J 27:273 Sept 1961.
8. Klein, E.T. Sim plified method o f bringing unerupted
cuspids to the surface. J Colorado Dent Assn 4 5 :9 Dec 1966.
9. Adelman, A.B. Surgical and o rth o d o n tic management
o f ectopic teeth. Dent Dig 75:13 Jan 1969.
10. Rabinowitch, B.Z., and Rubin, B. A surgical inter-
ceptive procedure fo r impacted m axillary cuspids. Alpha
Omegan 61:67 A p ril 1968.
11. Blum, B., and Levin, S. A m odified technique fo r
surgical exposure o f impacted m axillary cuspids. New York
State Dent J 3 3 :83 Feb 1967.
12. Nanda, S.K., and Merow, W.W. O rth o d o n tic manage­
ment o f h o rizontally impacted m axillary incisor. J Dent
C hild 3 3 :2 8 0 Sept 1966.

O ver a perio d o f 15 years, 2,000 cases substantiate

the statem ent that every canine can be brought dow n
in to the arch b y means o f the m ethod described,
unless the to o th is erup ting into the nasal cav ity or
through the in ferio r border o f the m an dible.
T h e e cto p ic , im pacted cuspid m ust be p ro p e rly
uncovered and lu xate d slig h tly, u sing its apex as an
a xis o f ro tatio n to m ove it aw ay from an y b o n y or
tooth im pingem ent. P lastic crow ns, fille d w ith a sur­
gical paste or cem ent, exten d in g adequately through
the soft tissue, facilitate the eru p tion o f these teeth.
There must be some extension from the im pacted
tooth thro ugh the soft tissue to prevent scar tissue
fo rm in g over o r around the tooth . P la n n in g b y the
o rth o d o n tist, general dentist, and the oral surgeon is
o f utm ost im portan ce. It takes a p p ro xim a te ly six
m onths to a year fo r m ost teeth to come dow n far
enough so the o rth od o n tist can place appliances.
T o prevent the canines from d riftin g p a la ta lly,
after the o rth o d o n tist has brought them over in to the
arch and has rem oved the retainer, a half-m oo n wedge
Doctor Clark is an active staff member and chief o f the
o f tissue is cut from the lin gual aspect o f the canine oral surgery departm ent o f the Utah Valley Latter-day Saints
dow n to the bone to prevent this d riftin g. Hospital. His address is 1275 N University, Provo, Utah
84601.

840 ■ JA D A , V o l. 8 2 , A p r il 1 97 1