Thick and Dense palatal mucoperiostium
Thick hard palate Bone
Long Distance to eruption
Last ant.tooth to erupt
Retained Primary canine
Root development completed before eruption
Eruption of Tooth is dependent on increase in
A Tooth wich Fails to Erupt into its Functional
position within expected time is called impacted
The surgical removal of a deeply seated
maxillary canine in relation to the maxillary sinus
and the nasal cavity is one of the most difficult
oral surgical procedures
•Maxillary canine is 20 times
more than mandibular canine
• More frequent in females than
• Palatal impaction is 3 times
more than buccal impaction
of impacted maxillary
Palatally Impacted canine
Buccally impacted canine
Impacted canine located in both the palatal and labial
Impacted canine located in the alveolar process.
Impacted canine located in an edentulous maxilla.
6) Class VI in aberrant position.
◦ Localization of impacted maxillary
Presence of distinct bulge
Deflection of crowns:
mostly of lateral incisors or premolars.
a) Intra-oral periapical films
b) Occlusal radiographs
Canine will appear as a round radioapaque
In This technique, the films are in the same
position while the cone is shifted,
if the canine moves with same direction of
the cone ,
it indicates that it is located far (palatally),
while if the canine moves opposite to the
direction of the cone ,
it indicates that it is near (buccally).
Sections are taken, if the
canine is impacted buccally ,
it's tip will appear first ,
while if impacted palatally,
the apex will appear first.
for the removal
of an impacted maxillary canine:
When it can be brought into normal position
surgical repositioning or
surgery and orthodontic
Factors complicating the removal of the
Close relationship to the roots of the
Intimate relation to the maxillary sinus.
Curvature or hypercementosis of the root.
Difficulty in localization most important
◦ SURGICAL REMOVAL OF IMPACTED MAXILLARY
Planning the operative procedure
Classify the impaction
Extent of the flap
Sectioning of the tooth is needed or not
Removal of palatally impacted canine:
1- If unilateral:
1. Reflection of flap from mesial of central
incisor to distal of first molar. The flap is
better to be envelop.
2. Bone removal by post stamp technique.
3. Decapitation removal of the crown.
4. A cryer elevator is used to push the root
to the empty space then remove it.
2- If bilateral:
- The flap will result in cutting of nasopalatine
vessels & nerves leading to hemorrhage &
numbness in order.
- However, regeneration of the nerve fibers will
occur later so if you don't have anyother option,
- Anther solution is to make the flap crossing
around the incisive papilla to avoid injury to the
- Upon suturing a palatal flap always place the
knots buccally to prevent irritation of the tongue.
Removal of labially impacted canine:
Easier since the buccal plate of bone is
thinner & better accessibility.
A pyramidal flap is preferred , followed by
similar steps as before..
Removal of impacted canine from
Usually open the flap in the area where the
crown is present (mostly buccally),So a buccal
flap is reflected first.
The type of the flap differs according to the
height of the impacted tooth e.g. if the tooth
is very high, do semilunar flap or pyramidal.
After opening a buccal flap, decapitate &
remove the crown, follower them by the root.
open the buccal flap finding the root
remove it first then do a palatal flap &
remove the crown (keep the buccal flap
open because you might need it)
If the other half of the tooth can't be
reached, push it from the buccal side to
the palatal side or vice versa until it can
be held & removed.
Removal of impacted canine in edentulous
The problem here is the pneumatization of
the maxillary sinus & should be in mind while
doing such impaction.
If the tooth need the buccal side, do buccal
If the tooth need the palatal side do palatal
Removal of impacted canine from unusual
These situations will be managed according
to the position.
The canine could be in: Zygoma, below orbit,
inferior turbinate of the nose, maxillary sinus.
For example: if canine is impacted in
maxillary sinus then Caldwell-Luck operation
will be performed
Surgical exposure of the impacted maxillary
canine for orthodontic treatment :
A flap is opened to expose the canine then a
bracket is placed over the exposed canine
with arch wire over the adjacent teeth
Replantation can be done i.e. remove the
canine & create a socket where you like to
place the tooth then do endo or retrograde
filling , be sure that the replanted tooth is in
vertical position & out of occlusion.
Exposure of the inferior alveolar canal.
Injury or compression to the inferior alveolar nerve resulting in
Injury to inferior alveolar vessels resulting in Hemorrhage
Fracture of roots and displacement into the maxillary sinus or
Necrosis of the flap due to improper placement.
Fracture of large segment of bone
Traumatization or dislodgement of adjacent teeth
Injury to the soft tissues from the instruments
Forcing a tooth into the maxillary sinus
Forcing maxillary third molar into the ptergopalatine fossa
Opening into the nasal cavity oro-nasal communication.
Fracture of the alveolar process
Fracture of the lingual plate of bone
Fracture of maxillary tuberosity.
complete fracture of the mandible
Extensive laceration of the soft tissues
Extensive exposure of the roots of the adjacent teeth
Pain of dry socket
Discoloration of the soft tissue due to ecchymosis
Necrosis of large segment of bone