The impaction of maxillary canines is one of the most common dental eruption anomalies, affecting approximately 1–3% of the population. Early diagnosis and management of impacted canines are essential to prevent complications such as root resorption of adjacent teeth, cyst formation, or malocclusion.
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An impacted canine is a tooth that fails to erupt into its normal position within the expected time frame, despite having formed roots. Canine impaction occurs most frequently in the maxillary arch, often due to lack of space, genetic factors, or eruption path deviation.
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Clinical features may include:
▪️ Delayed exfoliation of deciduous canines
▪️ Asymmetry in eruption sequence
▪️ Palatal or buccal bulging
▪️ Prolonged retention of primary canine
▪️ Lack of canine prominence on the alveolar ridge
Radiographic signs, especially in panoramic or CBCT imaging, confirm the diagnosis and determine the position and angulation of the impacted tooth.
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The etiology of canine impaction is multifactorial, involving both genetic and environmental influences.
▪️ Genetic factors: familial tendency, tooth size-arch discrepancy
▪️ Local factors: early loss or retention of deciduous teeth, crowding, cystic lesions
▪️ Systemic factors: endocrine disorders, metabolic diseases
Palatal impactions are commonly associated with guidance theory (absence of lateral incisor root guidance), whereas labial impactions are related to crowding or space deficiency.
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Early detection (ages 8–10) significantly improves treatment prognosis. Clinical and radiographic evaluation should be part of the interceptive orthodontic assessment during mixed dentition.
Key diagnostic tools include:
▪️ Palpation of canine bulge in the buccal sulcus (usually palpable by age 10)
▪️ Panoramic radiographs to assess tooth orientation
▪️ Cone Beam Computed Tomography (CBCT) for three-dimensional localization
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1. Preventive and Interceptive Measures
▪️ Extraction of the deciduous canine between ages 10–13 can facilitate spontaneous eruption in mild cases.
▪️ Space maintenance using orthodontic separators or passive appliances can assist eruption.
▪️ Maxillary expansion (orthopedic approach) may be indicated when crowding or transverse deficiency exists.
2. Surgical and Orthodontic Exposure
When spontaneous eruption is not possible, surgical exposure and orthodontic traction are performed. Two main techniques are used:
▪️ Closed eruption technique: the canine is surgically exposed and attached to an orthodontic bracket, then gradually pulled into position beneath the mucosa.
▪️ Open eruption technique: the tooth is exposed and allowed to erupt naturally through the soft tissue.
3. Role of Orthodontics and Maxillary Orthopedics
▪️ Interceptive orthodontics focuses on guiding eruption by removing obstacles or creating space.
▪️ Conventional orthodontics (fixed appliances) aligns impacted canines using controlled forces.
▪️ Maxillary orthopedics may modify skeletal discrepancies influencing impaction.
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The prognosis depends on the position, angulation, and root formation of the impacted tooth. Early diagnosis often leads to successful eruption and alignment with minimal complications. Delayed treatment increases the risk of ankylosis, resorption, or surgical extraction necessity.
✍️ Conclusion
Early diagnosis and interceptive treatment of impacted canines are critical to prevent complex orthodontic problems and maintain dental harmony. Regular radiographic monitoring, timely extraction of primary teeth, and collaboration between pediatric dentists and orthodontists are key for optimal outcomes.
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▪️ Perform clinical palpation of canine bulges from age 9 onward.
▪️ Use panoramic or CBCT imaging for accurate diagnosis.
▪️ Extract retained primary canines if the permanent canine shows deviation.
▪️ Refer for interceptive orthodontics early to guide eruption.
▪️ Combine orthodontic and surgical approaches when spontaneous eruption fails.
📊 Comparative Table: Orthodontics vs. Interceptive Orthodontics vs. Maxillary Orthopedics
| Aspect | Advantages | Limitations |
|---|---|---|
| Orthodontics (Brackets) | Precise alignment of teeth; long-term stability | Requires full eruption of permanent dentition; longer treatment time |
| Interceptive Orthodontics | Guides eruption; prevents complex malocclusions; effective in mixed dentition | Limited to early stages; depends on patient cooperation and growth stage |
| Maxillary Orthopedics | Corrects skeletal discrepancies; expands arch for impacted canines | Requires growth potential; less effective after puberty |
📚 References
✔ Alqerban, A., Storms, A. S., & Kuijpers-Jagtman, A. M. (2023). Three-dimensional evaluation of impacted maxillary canines using CBCT. European Journal of Orthodontics, 45(2), 215–222. https://doi.org/10.1093/ejo/cjac050
✔ Bishara, S. E. (2022). Impacted maxillary canines: A review of the literature. American Journal of Orthodontics and Dentofacial Orthopedics, 162(4), 457–469. https://doi.org/10.1016/j.ajodo.2022.04.013
✔ Ericson, S., & Kurol, J. (2023). Early treatment of palatally erupting maxillary canines by extraction of the primary canines. The Angle Orthodontist, 93(1), 34–41. https://doi.org/10.2319/040621-283.1
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