CANINE IMPACTION

DR MAMOON KHATTAK
HOUSE OFFICER
 Impaction
 Impacted tooth is one that fails to erupt and will not attain
its anatomical position beyond the chronological eruption
date even after its root completion.
 Impacted canine

 Impaction of maxillary and mandibular canines is a

frequently encountered clinical problem.
 Maxillary canines are the most commonly impacted teeth,
second only to 3rd molars
 Incidence
 Max canine impaction occurs in approx 2-3% of the
population.

 Twice as common in females as it is in males

 The incidence of canine impaction in maxilla is more than

twice that in the mandible.

 Of all pts who have impacted max canines 8% have

bilateral impaction.
 Etiology of Impacted Canine
 Localized

 Systemic

 Genetic
 Localized causes
 Tooth size arch length discrepancy
 Early loss of primary canine or prolonged retenton
 Ankylosis of primary canine
 Cysts or neoplasm
 Absence of lateral incisor(permanent)
 Idiopatheic causes
 Systemic causes
 Endocrine deficiences

 Febrile diseases

 Irradiations
 Genetic causes
 Hereditary

 Malposed tooth germ

 Presence of alveolar cleft

CLASSIFICATION OF CANINE IMPACTION
 Archers classification

 Class I Palatally impacted canines

Horizontal Vertical Semi vertical

 Class II Bucally impacted canines

Horizontal Vertical Semi vertica
l
 Class III
Between palatal and buccal surface area
 Class IV
Located in the alveolar process.

 Class V
Located in edentulous area

 Class VI
Located in aberrant position i.e sinus
 Erikson and Kurol classification
  Theories of Canine Impaction
 Guidance Theory

 Genetic Theory
 Sequelae of Impacted Canine
 Resorption of adjacent teeth.
 Proclination of lateral incisors, due to pressure
from erupting cuspids.
 Cysts (dentigerous cyst)
 Loss of vitality of incisors.
 Internal resorption.
 Infection particularly with partial eruption.
 Evaluation
 Clinically

 Radiographic

 Because of high possibility of ectopic eruption of

canine it is recommended that :
They must be examined in routine dental
checkup after age of nine years .
 Clinical evaluation
 Palpation:
Buccal and distal to lateral incisors are with good
prognosis for normal eruption.

 Mobility:
Mobility of adjacent teeth gives idea about root
resorption.
 Radiographic Evaluation

 Conventional canine position was assessed in 2 dimensions

but now it is seen in 3 planes of space .

 Common views are :

1. OPG
2. Periapical
3. Vertex occlusal
4. Standard upper occlusal
5. Lateral ceph
6. Parallax technique ( tube shift technique )
7. CBCT
 Determining the Prognosis

1.Age of patient
2. canine angulation to midline
3. Vertical height of canine crown
4. Antero posterior position of canine root apex
5.Canine –crown overlap of adjacent incisor
6. Root resorption of adjacent incisor
7. Labio- palatal position of canine crown
8. Labio-palatal position of canine apex
 Conventional Way of Canine Localization

 SLOB RULE

 Same lingual opposite buccal

 Take 1st radiograph at 90 degree

 Take 2nd radiograph at 45 degree

 Either move mesially or distally slightly

 Determining the Prognosis
 Age of Patient.

 Availability of space.

 Favorable position of canine.

 Angulation of impacted canine

 Vertical height of impacted canine
MANAGEMENT
 GENERAL TREATMENT OPTIONS :

1. Interceptive removal of deciduous canine

2. Surgical removal and prosthetic replacement of impacted

canine

3. Surgical exposure and orthodontic alignment of impacted

canine

4. Auto-transplantation of canine

5. No treatment
1. Interceptive removal of Impacted
deciduous canine

 Selective extraction of deciduous canines as early as 8 or

9 years of age.

 Normalize the eruption of ectopically erupting permanent

canine.
2. Surgical Management
 If the impacted tooth is in unfavourible position so
we will remove the tooth and put an implant or
resin based bridge

 Extraction of permanent canine can be considered

when lateral and 1st premolar are in contact and
midline is on with good appearance
USE OF LASER FOR SURGICAL EXPOSURE

 A new innovation is the surgical exposure of

impacted canine

 This can then be followed by traction of the canine

 Laser surgery offers a more accurate, bloodless

and a somewhat painless substitute to the
conventional surgery.
 Surgical
exposure of
canine using
lasers
3. Exposure and orthodontic alignment
 This is the treatment of choice for well motivated
patient if impaction is under these limits

A. Canine crown overlapping no more than half

width of central incisor root
B. Canine crown no higher than the apex of adjacent
incisor root
C. Canine apex in line of arch
 Applying Traction
 Ligature wires.
 Rubber bands.
 Power chain.
 Mini implants.
 Rubber band traction
 Power chain traction
Mini-implants traction
 4. Auto-transplantation

 It is selected if the orthodontic treatment is to be

avoided

 There must be adequate space for canine in the arch

 Canine should be removed intact with minimum of

root handling
 Major cause of failure is root resorption

 The success rate is appropriate in few case i.e

about 70% for 5 years
 5. Leaving un-erupted canine in situ
 Sometimes the tooth is left as such

 Cases where root resorption of adjacent incisor is

expected

 The patient is kept on annual radiographic follow-

up
 A) BUCCAL DISPLACEMENT
 Usually associated with crowding

 More likely to erupt than palatal displacement

 Managed by :
Relief of crowding
Buccal canine retractors (mesial inclination)
Fixed appliance (distal inclination)
 Severe crowding cases may require extractions
 Rarely may require surgical exposure and orthodontic
traction
 B) PALATAL DISPLACEMENT
 Option 1 : surgical removal of canine

 Option 2 : surgical exposure and orthodontic alignment

 Space creation by preliminary orthodontics

 Either allow the tooth to erupt for 3 months

 Or start traction at the time of surgery

 Or start traction 2 days after pack removal