Impacted canine

Presented By : Dr. Ahmed Shihab

Supervised By : Dr. Sarah
Introduction
Impaction of maxillary and mandibular canines is a frequently encountered
clinical problem, the treatment of which usually requires an interdisciplinary
approach.

The orthodontic treatment of impacted maxillary canine remains a challenge to

today’s clinicians.

Early diagnosis and intervention could save the time, expense, and more
complex treatment in the permanent dentition.
Prevalence and Etiology
Prevalence and Etiology
Etiology
Several etiologic factors for canine impactions have been proposed:
1. Tooth size–arch length discrepancies.
2. Failure of the primary canine root to resorb
3. Ankylosis of the permanent canine
4. Cyst or neoplasm
Tooth size–arch length discrepancies
Cyst or neoplasm
Etiology
5. Dilaceration of the root
6. Absence of the maxillary lateral incisor
7. Variation in root size of the lateral incisor (peg-shaped lateral
incisor)
8. Variation in timing of lateral incisor root formation
Dilaceration of the root
Theories Associated With Palatally Displaced Maxillary
Canines

Guidance Theory
The guidance theory proposes that the canine erupts along the root of the
lateral incisor, which serves as a guide, and if the root of the lateral incisor
is absent or malformed, the canine will not erupt.
Theories Associated With Palatally Displaced Maxillary
Canines

Genetic Theory
The genetic theory points to genetic factors as a primary origin of
palatally displaced maxillary canines and includes other possibly
associated dental anomalies, such as missing or small lateral incisors.
Diagnosis of Canine Impaction
Clinical Evaluation.

Radiographic Evaluation.
Clinical Evaluation
the following clinical signs might be indicative of canine impaction:
1. Delayed eruption of the permanent canine or prolonged retention of the
deciduous canine beyond 14–15 years of age.
2. Absence of a normal labial canine bulge.
3. Presence of a palatal bulge.
4. Delayed eruption, distal tipping, or migration (splaying) of the lateral
incisor.
Clinical Evaluation
Radiographic Evaluation
Periapical films

Occlusal films

CBCT
Periapical films
A single periapical film provides the clinician with a twodimensional
representation of the dentition.

In other words, it would relate the canine to the neighboring teeth both
mesiodistally and superoinferiorly.

To evaluate the position of the canine buccolingually, a second periapical

film should be obtained by one of the following methods.
Periapical films
Tube-shift technique or (SLOB) rule
Periapical films
Buccal-object rule
Occlusal films
CBCT
Interceptive Treatment
When the clinician detects early signs of ectopic eruption of the canines,
an attempt should be made to prevent their impaction and its potential
sequelae.

Selective extraction of the deciduous canines as early as 8 or 9 years of age

has been suggested by Williams as an interceptive approach to canine
impaction in Class I uncrowded cases.
Interceptive Treatment
Treatment alternatives
The clinician should then consider the various treatment options
available for the patient, including the following:
1. No treatment if the patient does not desire it.
2. Autotransplantation of the canine.
3. Extraction of the impacted canine and movement of a first premolar in
its position.
4. Prosthetic replacement of the canine.
5. Surgical exposure of the canine and orthodontic treatment to bring the
tooth into the line of occlusion.
Autotransplantation of the canine
When to Extract an Impacted Canine
The extraction of the canine, although seldom considered, might be a
workable option in the following situations:
1. If it is ankylosed and cannot be transplanted,
2. If it is undergoing external or internal root resorption,
3. If its root is severely dilacerated,
4. If the impaction is severe (e.g., the canine is lodged between the roots of
the central and lateral incisors and orthodontic movement will
jeopardize these teeth),
When to Extract an Impacted Canine
5. If the occlusion is acceptable, with the first premolar in the position of
the canine.
6. If there are pathologic changes (e.g., cystic formation, infection)
7. If the patient does not desire orthodontic treatment.
Surgical Exposing & Orthodontic Alignment
Replacement flap technique
Surgical Exposing & Orthodontic Alignment
Surgical Exposing & Orthodontic Alignment
Excisional exposure
Surgical Exposing & Orthodontic Alignment
Apically repositioned flap