Treatment Options

• 1. No active treatment
• 2. Interceptive Orthodontics
• 3. Surgical Options
• 4. Extraction Only
1. No active treatment(observation only)

• Indications:
– 1. Patient does not want treatment
– 2. Canine high above roots of incisors
– 3. No evidence of resorption of adjacent teeth or
pathologies
– 4. Good prognosis for deciduous canine
 2. Interceptive Orthodontics
• Extraction of the deciduous canine
• Serial extraction in the case of missing dec.
canine in crowding
– Step 1: Extraction of primary 1st Molars
– Step 2: extraction of 1st premolars
– Step 3: Fixed appliance treatment
– Step 4: Retention
Serial extraction: Step 1
Serial extraction: Step 2
 Serial Extraction: Continuation
• Step 3

• Step 4
• Ericson and Kurol : suggested that removal of the deciduous
canine before the age of 11 years will normalize the
position of the ectopically erupting permanent canines in
91% of the cases if the canine crown is distal to the midline
of the lateral incisor. On the other hand, the success rate is
only 64% if the canine crown is mesial to the midline of the
lateral incisor
• Ericson S, Kurol J. (1988a) Early treatment of palatally erupting maxillary canines by extraction of the primary canines. Eur J Orthod. 10:
283–295.
 3. Surgical Options
• Open Surgical Exposure
• Open surgical Exposure with auxiliary
attachment
• Closed surgical exposure with bonding an
attachment
 Open Surgical Exposure
• Open eruption technique: A simple palatal
impaction (cusp tip of the canine at the same
level of the cemento-enamel junction of
lateral incisor or central incisor) usually
requires open surgical exposure.
 Attachments
• Buttons/ Eyelets
– Closed Niti Coil
– Ligerature Wire
– Elastics
– Chain
Open Surgical Exposure With attachment

• Gold Chain attachment

 Cantilever Spring
• Two-couple system: Molar Intrusion and
Canine Extrusion
 Cantilever Spring Continuation
• Need: TPA + 0.019 x 0.025 SS + 0.019 x 0.025
TMA spring to the molar
 Piggy Back
• NiTi wire (0.012or
0.014) placed through
the canine bracket of
the Impacted canine
• SS 0.018 or 0.019 X
0.025 base Arch Wire
• Side effect: double
friction of wires
 Open Surgical Exposure With attachment

• Ballista Spring: for palatally impacted canines

made from 0.014, 0.016 or 0.018 SS round
wire
 Open Surgical Exposure With attachment

• Dr Bowman and Dr Carano created the Kilroy Spring

made from 0.016 SS or SE wire
– Bowman, S.J. and Carano, A.: The Kilroy Spring for impacted
teeth, J. Clin. Orthod, 37(12):683-8 2004
• Kilroy Spring: for Palatally impacted canines
• Kilroy 2 Spring: for Bucally impacted canines
Kilroy Spring
Kilroy 2 Spring
 Side effects
• Dr Bowman (2004) has even
said that the Kilroy 2 can have
impingement on gingiva
• Lena Sezici Y, Gediz M, Akış AA, Sarı G, Duran GS,
Dindaroğlu F. Displacement and stress
distribution of Kilroy spring and nickel-titanium
closed-coil spring during traction of palatally
impacted canine: A 3-dimensional finite element
analysis. Orthod Craniofac Res. 2020;23:471–478
 Closed Surgical Exposure With bonding an
attachment
• closed surgical technique : Is usually favored
when the tooth is more deeply embedded in
the bone since open surgical exposure may
necessitate excessive removal of the
surrounding bone.
 4. Extraction Only
• The case where the patient does not want
active treatment but presents a malpoistion of
the impacted canine, extraction is highly
advisable due to resorption of the neighboring
teeth
 CASE STUDIES:
Class 1 Skeletal: 15 F Yr
Class 1 Skeletal
End of Treatment
Class 1 Skeletal: 26 years old
End of Treatment
Mild Class 3 Skeletal : 14 yr
Radiograph