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Other than third molars, the maxillary canine teeth are the most commonly impacted teeth.
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Surgical intervention and coordination of care with the orthodontist will lead to improved outcomes.
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Various surgical procedures are used depending on the position of the impacted tooth.
Atlas of the Oral and Maxillofacial Surgery Clinics
Volume 21, Issue 2, September 2013, Pages 199-210
Evidence-Based Surgical-Orthodontic Management of Impacted Teeth
Section snippets
Key points
Incidence and etiology
Studies reporting the incidence of impacted teeth vary considerably in their conclusions, likely due to regional genetic differences, the dental health of the population studied, and interpretation of what constitutes impaction.
Aside from third molars, maxillary canines are the most commonly impacted teeth.1, 2 There is a 2:1 incidence among females over males and a 2 to 3 times higher likelihood of palatal versus labial impaction.3 The incidence of maxillary impaction has been reported to be
Early diagnosis
After the age of 9 or 10 years when patients often first consult with the orthodontist, there are well-established warning signs of potential canine impaction.12Clinical signs include: Absence of the canine bulge with palatal impactions (Fig. 1) Peg-shaped or missing lateral incisors A constricted maxilla with dental crowding Female patients 2:1 higher incidence Class I occlusion in the mixed dentition Lateral or central incisor overlapped by the erupting canine Enlarged follicular sac of the erupting canine Lack of
Radiographic signs include (Fig. 2)13:
Interceptive treatment
Interceptive treatment may reduce the incidence or severity of canine impactions. Although inconclusive, some studies have shown an improved spontaneous eruption of developmentally delayed canines when the primary canine is extracted.18 It is not fully understood why this strategy expedites canine eruption, although removing an obstacle to eruption is the prevailing orthodontic rationale. However, the “Regional Acceleratory Phenomena”19, 20, 35 may be an underlying contributory factor. This
Summary
Ideal management of the impacted canine is a complex process involving a carefully orchestrated effort on the part of the orthodontist, surgeon, and others. Communication among clinicians is an essential component of successful treatment. This communication should include which type of surgical approach is to be used for the specific case. The surgeon needs to understand the various treatment options.
Evidence-based diagnosis, treatment planning, and appropriate technique can result in a highly
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Cited by (8)
Dentoalveolar Surgery
2023, Journal of Oral and Maxillofacial SurgeryOrthodontic and Surgical Considerations for Treating Impacted Teeth
2020, Oral and Maxillofacial Surgery Clinics of North AmericaCitation Excerpt :If the crown of the impacted canine is apical to the mucogingival junction, an excisional technique is not recommended because there would not be any gingiva on the labial surface following eruption. An apically positioned flap is the preferred technique for periodontally compromised patients and is specifically indicated in those where there is a need for widening or preserving the zone of attached gingiva.21 If the crown of the canine is positioned over the root of lateral incisor, the apically positioned flap procedure is recommended.19,21
Dentoalveolar Surgery
2017, Journal of Oral and Maxillofacial SurgerySurgical management of the impacted canine
2023, Oral and Maxillofacial Surgery, Medicine, and Pathology for the ClinicianNovel Use of Tranexamic Acid to Reduce Time Taken During Bracket Placement for Orthodontic Traction of Impacted Teeth: An Observational Study
2022, Journal of Maxillofacial and Oral SurgeryA Conservative Approach to Traction of Impacted Maxillary Canines in Adults with Severe Incisor Root Resorption
2020, Journal of Clinical Orthodontics
Disclosures: The author has nothing to disclose.
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