Impacted Canines - Treatment Planning

Maxillary Canines – Recipe for a Problem:

      - Develop high in maxilla

   - Complete their development late 

   - Long path of eruption

   - Erupt after adjacent teeth

The problem arises when canines become impacted within the alveolus of soft tissue and don’t erupt into the mouth without intervention.

The maxillary canine follows the longest (22mm) and most tortuous path of eruption of any tooth. At age 3 its high in the maxilla (right under the eye). From age 4-8 it travels mesially and palatally and you can’t usually palpate them. Between ages 8-11 the canine starts to move upright and move buccally and by age 10 you can usually feel a “buccal  bulge” above the primary canine if they are doing the right thing.

By age 9 or 10, you should be able to palpate the maxillary canine as it starts to move buccally and distally.

Bucally Impacted Maxillary Canines:
Labial impaction of the maxillary canine over the maxillary lateral incisor occurs occasionally. This type of impaction is due to one of two caues. Either the canine moves ectopically over the labial surface of maxillary lateral incisor root and fails to erupt, or the maxillary dental midline may shift toward the canine, causing it to be impacted labially.

96% of canines will erupt if cusp tip is distal to the lateral incisor (Sector 1).

 

Signs of Potentially Impacted Canines:

   - Over-retained primary canine.

   - Absence of labial canine bulge age 10.

   - Distal tipping and flaring of lateral incisor.

   - Abnormal eruption sequence.

   - OPG shows canine tip overlaps completely formed lateral incisor root.

   - Family history.

   - Small or missing lateral incisors.

Summary of Diagnosis and Recommendations for Maxillary Canines:

   - Before age 10, screen for impacted canines by palpation.

   - At age 10, Take OPG especially if :          

                a) Canine is not palpable (or if both canines aren’t symmetrically palpable on the labial).

        b) Lateral incisor is proclined or crown has distal tip.                                                         

        c) If lateral incisor is small or missing or primary lateral is still present.

Treatment:

Extraction of the deciduous canine is the treatment of choice to attempt correction of palatally displaced canines in individuals aged 10-13, provided that there is not excessive crowding. If improvement is going to occur, it will do so within the first 12 months. Removal of deciduous canines allows palatally displaced canines to assume a more normal erupive pathway in a majority of cases. This procedure is less successful if there is significant crowding. If the angulation of the impacted canine to the mid-sagittal plane exceeds 30 degrees, the likelihood of improvement is reduced. The more the canine is overlapped, the less likely it will self-correct after primary canine removal. If there is not significant improvement in impacted canine position 12 months after removal of the primary canine, then further improvement without orthodontic/surgical intervention is unlikely.

Once you have extracted the primary canine, however, you must see the treatment through. If the permanent canine still fails to erupt, the patient will have a gap requiring treatment.  Permanent palatal canine position should improve within 6-12 months after removal of primary canine.  If not, further intervention may be necessary.

Steps to bring in Impacted Canine

   - Locate.

   - Need space available and adjacent tooth roots out of  the way  (this often requires braces).

   - Surgical exposure and bond bracket to canine.

   - Orthodontic traction (good anchorage —TPA) to bring canine through attached tissue.