“Unveiling The Hidden”
Author: Theertha Sudhakaran (CRRI)
Guide: Dr. Ashwin Mathew George
Department of Orthodontics
Sathyabama University Dental College &
• 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.
• Canines play a role in functional occlusion and form the
foundation of an esthetic smile.
• As such, any factors that interfere with the normal
development of canines and their eruption can have
• Impaction of maxillary and mandibular canines is a
frequently encountered clinical problem.
• Maxillary canines are the most commonly impacted
teeth, second only to third molars.
Maxillary canine impaction occurs in approximately 2%
of the population.
• Twice as common in females as it is in males.
• The incidence of canine impaction in the maxilla is
more than twice that in the mandible.
• Of all patients who have impacted maxillary
canines, 8% have bilateral impactions.
• . The prevalence of impacted maxillary canines varies and is
reported as follows: 2%, 0.9% to 2%, 1% to 2%, 1.5% to
2%, 1% to 3%, with a palatal location 85% of the time and a
labial location 15% of the time.
• Unlike buccal displacement of maxillary canines, palatal
displacement of maxillary canines, and the frequent ensuing
impaction, most often occurs in cases in which adequate
perimeter arch space exists.
ETIOLOGY OF IMPACTED CANINE
Tooth size- arch length discrepancies
Failure of the primary canine root to resorb
Prolonged retention or early loss of primary
Ankylosis of permanent canine
Cyst or neoplasm
Dilaceration of the root
Absence of maxillary lateral incisor
Variation in timing of lateral incisor root
Malposed tooth germ
Presence of alveolar cleft
THEORIES OF CANINE
• Canine erupts along the root of
lateral incisors, which serve as a
guide, and if the lateral incisor is
absent or malformed, the canine
will not erupt.
• Genetic factors are primary origin
of palatally displaced maxillary
canine and include other possibly
associated dental anomalies, such
as missing or small lateral incisor.
SEQUELAE OF IMPACTED
Labial or lingual
neighbouring teeth and
loss of arch length
with partial eruption
Internal resorption or
external root resorption of
impacted or neighbouring
• Amount of space available in dental arch
for impacted canine is assessed in model.
• Gives clue of position of impacted tooth.
Contours of adjacent • Canine bulge present buccally or palatally.
Mobility of adjacent
• Root resorption.
• Indicated in individual with unerupted and non-palpable
canines after the age of 11 years.
• INTRA ORAL RADIOGRAPHS
• EXTRAORAL RADIOGRAPHS
• Lateral cephalometric
• DIGITAL IMAGING
• Clark’s rule tube shift technique.
• Locates canine positioned buccally or palatally to
other teeth in the arch.
• Determining position of canines relative to the
A periapical, panoramic, or occlusal view will not reveal the
presence of a canine that is outside their fields of view.
• Used to localize impacted teeth in all
• Realtionship of impacted canine with
other facial structures can be studied.
superimposition in the anterior and palatal regions of the maxilla may mask
the presence of a canine. In addition, the canine may not be adequately
visualized with conventional imaging to correctly identify its position.
3 DIMENTIONAL IMAGING
• 3-dimensional imaging modalities provide a volume of
information that can be used to assess and localize teeth within
the entire maxilla and adjacent regions without the limitation of
visualization with superimposed structures.
• Superior diagnostic tool.
• Early detection of root resorption.
• Accurate localization of impacted canine and
visualization of associated structures.
• Identify and locate the position of impacted canine
• Dentists can assess any damage to adjacent tooth
roots and amount of bone surrounding each tooth .
DETERMINING THE PROGNOSIS
• FACTORS INFLUENCING THE TREATMENT DECISION OF AN
Age of patient
Availability of space
Favourable position of canine
Presence of adequate width of attached gingiva
POSITION OF CANINE
CANINE ANGULATION TO MIDLINE.
VERTICAL HEIGHT OF IMPCATED CANINE.
POSITION OF THE CANINE APEX RELATIVE TO THE ADJACENT TEETH.
MESIODISTAL POSITION OF CANINE TIP TO ADJACENT TOOTH.
Treatment of labial impaction.
Treatment of palatal impaction
Methods of applying traction.
• When the clinician detects early signs of ectopic
eruption of canines, an attempt should be made to
prevent their impaction and its potential sequelae.
• Selective extraction of the deciduous canines as early
as 8 0r 9 years of age.
• Normalize the eruption of ectopicaly erupting
LABIAL IMPACTION OF UPPER
• Due to ectopic migration of canine crown over the root
of lateral incisor or insufficient space in the arch caused
by midline shift of dental origin.
• Arch length- tooth material discrepancy is the most
• Extraction of deciduous canine at early age of 8 or 9
years will enhance eruption and self correction of labial
Initial orthodontic treatment was aimed
at creating space in the maxillary arch
with fixed appliance therapy.
Surgical exposure and orthodontic
• Indicated when tooth does not erupt spontaneously
after creating space in the arch.
• Attempted 6 months after the root formation
• Flap designs should preserve the band of attached
gingiva and should guide tooth to erupt through its
natural path of eruption.
• Excisional approach
• Apically positioned flap
CLOSED ERUPTION TECHNIQUE
• Indicated if tooth is impacted in the centre of the
Flap is elevated
Attachment placed on impacted tooth
Ligature or chain placed over the
attachment to activate after a week
Raised flap is repositioned in its original
Permit eruption of impacted canine in
• Excisional technique must be parformed only when
sufficient gingiva is present, to provide atleast 2-3mm
of attached gingiva over the canine crown after it has
• If crown is positioned mesially and over the root of the
lateral incisor, the crown should be exposed completely
with an apically positioned flap.
PALATAL IMPACTION OF UPPER
• Crown is surgically exposed, an attachment is bonded
during the exposure, flap is sutured back, leaving a
twisted ligature wire passing through the mucosa to
apply orthodontic traction.
• A flap is raised, bone covering crown is
removed, small window or fenestration
is made, orthodontic attachment is
bonded and flap is sutured in to place.
• Elastic traction using lower fixed or removable
appliance as anchorage.
TUNNEL TRACTION TECHNIQUE
• For aligning deep infraosseous impacted
• Osseous tunnel provided towards the centre of
the alveolar ridge.
• Socket of deciduous canine can be used as
tunnel, for movement of impacted canine.
Relapse of rotations and spacing may occur after completion of the
orthodontic treatment of an impacted canine.
REMOVAL OF HALF MOON SHAPED WEDGE OF TISSUE ( To
prevent lingual drift of palatally impacted canine)
• Various surgical and orthodontics techniques may be used to
recover impacted maxillary canines.
• Proper management of these teeth requires appropriate surgical
techniques to apply forces in a favourable direction and to have
complete control for efficient correction, thereby avoiding
damage to the adjacent teeth.
• The management of impacted canine is a complex procedure
requiring a multidisciplinary approach.
• The clinician should communicate with each other to provide the
patient with an optimal treatment plan based on scientific
• GUIDE Dr Ashwin Mathew George, Professor & Head
Dr. V. Sudhakar, Reader
Dr Shrinivaasan N. R, Senior lecturer
• Dr Xavier, Senior lecturer
• Dr Navaneetha, Senior lecturer
DEPT OF ORTHODONTICS.