A 9-year-old female presented with an impacted maxillary right central incisor and canine. The crowns were surgically exposed and Multi-Purpose Attachments (MPAs) with hooks were bonded to apply light eruptive forces and align the teeth over 20 months. MPAs helped avoid soft tissue laceration during incisor eruption and prevented occlusal interference during canine retraction. At the 43-month follow-up, lingual retainers bonded to MPAs had successfully aligned and retained the impacted teeth.

1. IMPACTED
MAXILLARY CANINE
UNDER THE GUIDANCE OF
DR. MRIDULA TREHAN
Dr. DEEKSHA BHANOTIA
MDS SECOND YEAR
DEPARTMENT OF ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS

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3. • AN IMPACTED TOOTH IS ONE THAT FAILS
TO ERUPT INTO THE DENTAL ARCH WITHIN
THE EXPECTED DEVELOPMENTAL WINDOW.
• BECAUSE IMPACTED TEETH DO NOT ERUPT,
THEY ARE RETAINED THROUGHOUT THE
INDIVIDUAL’S LIFETIME
UNLESS EXTRACTED OR EXPOSED
SURGICALLY.
• TEETH MAY BECOME IMPACTED BECAUSE
OF ADJACENT TEETH, DENSE OVERLYING
BONE, EXCESSIVE SOFT TISSUE OR A
GENETIC ABNORMALITY.
INTRODUCTION

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PREVALENCE AND ETIOLOGY

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11. SYSTEMIC
GENETIC

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SEQUELAE OF CANINE IMPACTION

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14. DIAGNOSIS OF CANINE IMPACTION

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RADIOGRAPHIC EVALUATION

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WHEN TO EXTRACT AN IMPACTED CANINE

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PREVENTION OF MAXILLARY CANINE
IMPACTION

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ORTHODONTIC CONSIDERATIONS

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Different ways to distance the canine from the incisor before one can start traction out in the alveolar
crest. One-way is to start with a transpalatal arch for anchorage and solder a sectional arch with a loop for
an elastic band (a) or place heavy wires soldered to the bands. These wires can be 0.8 or 0.9 mm and
provided with eyelets. With this appliance, it is easy to change the direction of the traction with an elastic
band (b and c). For the direction straight backwards, solder a loop directly on the transpalatal arch and add
an elastic band, white arrow (d).

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RETENTION CONSIDERATIONS

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55. A 9-YEAR-OLD FEMALE PRESENTED WITH AN
UNERUPTED MAXILLARY RIGHT CENTRAL INCISOR
ON CLINICAL EXAMINATION, THE INCISAL EDGE WAS
PALPABLE IN THE VESTIBULE.
RADIOGRAPHS CONFIRMED THAT THE TOOTH WAS
ORIENTED HORIZONTALLY IN THE ANTEROPOSTERIOR
DIRECTION, AT A DISTANCE OF 18MM FROM THE
OCCLUSAL PLANE, THUS CLASSIFYING IT AS SEVERELY
IMPACTED.
THE MAXILLARY RIGHT PERMANENT CANINE WAS
ALSO IMPACTED ABOVE THE ROOT OF THE LATERAL
INCISOR. PRIOR TO SURGICAL EXPOSURE OF THE
IMPACTED TEETH, BRACKETS WERE BONDED TO THE
THREE UPPER INCISORS AND MPAS WERE BONDED TO
THE UPPER FIRST INCISOR.
CASE REPORT

56. THE CROWNS OF THE TWO IMPACTED TEETH
WERE SURGICALLY EXPOSED, AND MPAS
WITH LIGATURE-WIRE HOOKS WERE BONDED
TO THE PALATAL SURFACE OF THE CENTRAL
INCISOR AND THE LABIAL SURFACE OF THE
CANINE.
THE FLAP WAS SUTURED CLOSED.
Vashi N, Vashi B. Eruption and alignment of impacted teeth with Multi-Purpose Attachments. Journal of clinical orthodontics: JCO. 2012 Aug 1;46(8):486-90.

57. Vashi N, Vashi B. Eruption and alignment of impacted teeth with Multi-Purpose Attachments. Journal of clinical orthodontics: JCO. 2012 Aug 1;46(8):486-90.

58. MPAs with hooks bonded to impacted
teeth; central incisor MPA tied loosely to
archwire.
After one month of treatment, ligature tie
activated to begin incisor extrusion.
Vashi N, Vashi B. Eruption and alignment of impacted teeth with Multi-Purpose Attachments. Journal of clinical orthodontics: JCO. 2012 Aug 1;46(8):486-90.

59. After six months of treatment, new MPA bonded to labial surface of right
central incisor
Vashi N, Vashi B. Eruption and alignment of impacted teeth with Multi-Purpose Attachments. Journal of clinical orthodontics: JCO. 2012 Aug 1;46(8):486-90.

60. As the tooth moved incisally over the following five months,
the labial surface was increasingly exposed. Instead of a
conventional bracket, a new MPA was bonded to avoid
laceration of the labial mucosa.
Eight weeks later, an upper .016" stainless steel wire was
placed, and the canine MPA hook was tied to the upper right
first molar’s MPA to begin eruption of the canine. An open-
coil spring was placed on the maxillary archwire between the
right lateral incisor and the right first molar MPA to open
adequate space for the canine
Vashi N, Vashi B. Eruption and alignment of impacted teeth with Multi-Purpose Attachments. Journal of clinical orthodontics: JCO. 2012 Aug 1;46(8):486-90.

61. After 10 months of treatment, conventional bracket bonded to right central
incisor; MPAs bonded in lower arch to avoid occlusal interference during canine
retraction.
Vashi N, Vashi B. Eruption and alignment of impacted teeth with Multi-Purpose Attachments. Journal of clinical orthodontics: JCO. 2012 Aug 1;46(8):486-90.

62. After 20 months of treatment, conventional brackets bonded to
remaining teeth for finishing.
Vashi N, Vashi B. Eruption and alignment of impacted teeth with Multi-Purpose Attachments. Journal of clinical orthodontics: JCO. 2012 Aug 1;46(8):486-90.

63. • AFTER SEVEN MORE WEEKS, THE RIGHT CENTRAL INCISOR
HAD REACHED A MORE VERTICAL POSITION, AND A
CONVENTIONAL TWIN BRACKET WAS BONDED.
• A BRACKET WAS ALSO BONDED TO THE RIGHT FIRST
PREMOLAR, AND THE CANINE MPA’S LIGATURE-WIRE HOOK
WAS ATTACHED TO THE FIRST PREMOLAR BRACKET.
• AN OPEN-COIL SPRING WAS PLACED ON THE MAXILLARY
ARCHWIRE BETWEEN THE RIGHT LATERAL INCISOR AND FIRST
PREMOLAR BRACKETS.
• DURING TRACTION OF THE UPPER CANINE, MPAS WERE
BONDED TO THE LOWER TEETH TO AVOID OCCLUSAL
INTERFERENCE FROM THE DEEP BITE.
Vashi N, Vashi B. Eruption and alignment of impacted teeth with Multi-Purpose Attachments. Journal of clinical orthodontics: JCO. 2012 Aug 1;46(8):486-90.

64. Patient after 43 months of treatment, with lingual retainers bonded
to MPAs on canines
Vashi N, Vashi B. Eruption and alignment of impacted teeth with Multi-Purpose Attachments. Journal of clinical orthodontics: JCO. 2012 Aug 1;46(8):486-90.

65. CONCLUSION

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67. REFERENCES
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