Canine impaction 1

Why cuspids are so essential?
Esthetic smile
Functional occlusion.
Functionally, the lack of canine guidance has
negative consequences on joint dynamics.
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Impaction
 Impaction is defined as the total or partial lack of
eruption of a tooth well after the normal age for
eruption
 Maxillary canine impaction is suspected when it doesn’t
erupt even after 14 yrs of age.
 Palatal : Buccal is 3:1
 Female: Male is 3: 1 -Oliver et al-(JO 89)
2.5: 1 Becker et al- Angle 81

DEVELOPMENT OF CANINE
First evidence of canine development: 30 weeks
Calcification: 4-5 months
Normal eruption : 11-12 years
» Longest period of development
Location: High in the infant maxilla at the lateral
margin of the piriform aperture & travels 22mm.
» Longest path of eruption

Class I - Palatally impacted maxillary canine
-Horizontal, vertical, Angulated.
Class II - Labially impacted canine
-Horizontal, vertical, Angulated.
Class III - Impacted canine with crown on the palatal side
and root on the buccal side or vice versa.
Class IV - Vertically impacted canine between lateral
incisor and 1st
premolar.
Class V - Canine impacted in the edentulous maxilla.
Class VI - Maxillary canines in unusual position.
CLASSIFICATION OF IMPACTED CANINE

Classification of palatal canine impaction - Olive Aus ortho02
Sector I - Distal to the outline of the root of the lateral
incisor
Sector II - Mesial to sector I, but distal to the midline of
the root of the lateral incisor.
Sector III - Mesial to sector II ,but distal to the mesial
outline of the root of the lateral incisor.
Sector IV - Mesial to sector III.

I. Primary causes:
1. Rate of root resorption of deciduous teeth.
2. Trauma of the deciduous tooth bud.
3. Disturbances in tooth eruption sequence
4. Discrepancy of space in the arch.
5. Rotation of tooth buds.
6. Premature root closure.
7. Canine eruption into the cleft area
II. Secondary causes:
 Abnormal muscle pressure.
 Febrile diseases.
 Endocrine disturbances.
 Vitamin D deficiency
- Bishara et al (AJO-1992)
Etiology

SEQUELAE OF IMPACTION
• Migration of the neighboring teeth and loss of arch length.
• Labial or lingual malpositions of the impacted tooth.
• Internal & external root resorption.
• Dentigerous cyst formation.
• Referred pain.
SHAFER et al 1963

CLINICAL METHOD FOR DIAGNOSIS
 Delayed eruption of permanent canine.
 Prolonged retention of deciduous canine.
 Absence of normal labial canine bulge.
 Presence of palatal bulge (Abnormal).
 Delayed eruption, distal tipping or migration
of lateral incisor.

RADIOGRAPHIC METHOD FOR DIAGNOSIS
I. Qualitative radiographs
Periapical Occlusal Extraoral
Maxillary arch
Lateral ceph
Max. anterior occlusal
O.P.G
P.A view
True (vertex) occlusal

Parallax method
II. 3-D diagnosis of the position
C T scanning
Radiographic views at right angles

Various treatment options:
No treatment, but with periodic evaluation for
pathologic changes.
Interceptive removal of the deciduous canine (Ericson
and Kurol, 1988).
Surgical exposure of the canine and orthodontic
alignment (Bishara, 1992)
Auto transplantation of the canine (Shaw et al., 1981,
Sagne et al., 1986
Prosthetic replacement

I. Surgical techniques for exposing impacted
canines
1. Window approach (gingivectomy).
2. Apically repositioned flap (ARF).
3. Flap closed eruption technique (FCET).
4. Tunnel traction (TT).

Window approach
excision of a full thickness flap to expose the
incisal 1/2 to 2/3 of the crown.
Apically repositioned flap
A pedicle flap with adequate attached gingiva
overlying the impacted tooth is reflected and
repositioned apically & sutured so as to expose
1/2 to 2/3 of the crown.

Full Flap Closure: (Closed eruption technique)
This procedure was proposed by MC Bride (1979) ,
A buccal surgical flap was raised as high as necessary
to expose the unerupted canine. An attachment was
then bonded to the tooth, and the flap was fully
sutured back to its for original place.

 Full thickness flap raised ( Impacted tooth exposed)Full thickness flap raised ( Impacted tooth exposed)
↓↓
 Deciduous canine extractedDeciduous canine extracted
↓↓
 Socket is extended and widened sufficiently to allow passage ofSocket is extended and widened sufficiently to allow passage of
fine wire through itfine wire through it
↓↓
 An eyelet attachment on steel mesh is threaded withAn eyelet attachment on steel mesh is threaded with
0.011’’ligature wire bonded on impacted canine0.011’’ligature wire bonded on impacted canine
↓↓
 Surgical flap resutured to its former positionSurgical flap resutured to its former position
↓↓
 Formed tunnel is used for tractionFormed tunnel is used for traction
↓↓
 Traction phase started after one week and directed to the centerTraction phase started after one week and directed to the center
of the alveolar ridge.of the alveolar ridge.
Tunnel traction of infraosseous impacted canines
A. Crescini et al(1994)

Bonding
Composites - Hydrophobic functional monomers
Glass ionomer cements - Hydrophilic functional
monomers.
A hybrid compomer (Dyract) - Robert . Miller JCO 1996
J.M. Cobo&. Moro. used a third-generation hydrophilic
adhesive, Multiadhesion Scotchbond, in blood
contamination situation.
II. Bonding an attachment after surgical
exposure

III. Attachments used for the exposed canine
{a} Lasso wires: (b) Threaded Pins:
{c} Orthodontic bands {d} Standard orthodontic
brackets:

{e} A simple eyelet:
-.
f) Elastic ties and modules
{f} Magnets:

IV. Methods of applying traction
considerations
 The use of light forces (60 grams of force)
 creation of sufficient space in the arch
 Maintenance of the space by either continuous tying of the
teeth mesial and distal to the canine
 Provision by the arch wire of sufficient stiffness (e.g.,
0.018 × 0.022 inch) to resist deformation by the forces
applied to it as the canine is extruded .

BALLISTA SPRING
• Harry Jacobay (1979)
A J O 1979

22
2) Active palatal arch (Becker1978)
It consist of fine 0.020 inch removable palatal arch wire carrying an
omega loop on each side. End of the wire is doubled for Friction fit
in lingual sheath. It is activated by elevating downward and
hooking the pigtail ligature around it

23
3) Light Auxiliary Labial Arch (Kornhauser1996)
It is made up of 0.014 inch round SS wire with vertical
loops in the area of impacted canine on both sides. This loop has a
small helix. This wire is tied with the basal arch wire in piggyback
fashion. If basal arch wire is not used it will lead to extrusion of
adjacent tooth and cause alteration of occlusal plane .

Mandibular removable appliance (Orton1996)
It consist of clasps through which elastic is applied
from clasp to the pigtail ligature wire. This provide
the necessary extrusive force for the eruption of
canine

Canine Extrusion Auxiliary
SEONG-SENG TAN, have devised a Begg
auxiliary to extrude palatally impacted canines,
resembles a reverse torquing auxiliary with
power arms to the impacted cuspids .It is tied
with steel ligatures to the centrals and pinned
with the main archwire to the laterals.

Cantilever System jco 2000 nov
A typical cantilever design is a wire fully engaged in the
bracket of one tooth and tied in a point contact to another
tooth . A moment and a force are created at the tooth in which
the wire is fully engaged, whereas only a single force is
developed at the other end of the cantilever—the single-point
contact

TMA BOX LOOP
• TMA .017 X .025 wire used.
• Produce sagittal and horizontal
corrections while continuing
vertical eruption.
Surendra Patel J C O 1999

NICKEL TITANIUM CLOSED-COIL SPRING
Loring L.Ross (1999)
• 0.009”X 0.041” spring
• Provides 80 gm of force when stretched to twice its resting
length
JCO Feb 1999www.indiandentalacademy.com

THE MONKEY HOOK
S. Jay Bowman (2002)
• It is a simple auxiliary with an open loop on each end for the
attachment of intra oral elastic or elastomeric chain or for
connecting to a bondable loop button.
JCO July 2002www.indiandentalacademy.com

THE K- 9 SPRING
•Varun Kalra (2000)
• Made in 0.017”X 0.025”TMA wire
Adv:
• Simple in design
• Low cost
• No patient compliance
• Light continuous eruptive and distalizing forces
JCO Oct 2000

AUSTRALIAN HELICAL ARCHWIRE
• Christine Hauser (2000)
• Made in special plus .016” arch
wire
• Force should not exceed 200
gm
• Activation by twisting the
steel ligature wire every two
weeks
JCO Sep 2000www.indiandentalacademy.com

Implant supported deimpactor system (ISDS)
- Aldo Giancotti
Type I -. .032 ” TMA springs
inserted in each lingual sheath for
maxillary molar distalization. Two
.040” stainless steel arms are
soldered to the mesial portion of
the steel cap for initial extrusion.
Type II - .032” TMA springs are
inserted in the lingual sheaths as
cantilever arms to produce
extrusion of impacted canine in
the vertical plane.
An orthosystem palatal implant is used for
anchorage in the treatment of impacted maxillary canines

WHEN TO EXTRACT AN IMPACTED CANINE
 If it is ankylosed & cannot be transplanted.
 If it is undergoing external or internal root resorption.
 If the root is severely dilacerated.
 If there are pathologic changes {cystic formation,
infection}
Which patients are good candidates for autogenous
transplantation procedure?
Adults have finished vertical growth of their alveolus and
therefore if the tooth is transplanted, there should be no
subsequent changes in vertical level of the dentition following
the transplantationwww.indiandentalacademy.com

RETENTION CONSIDERATIONS
Evaluation of post treatment alignment by Becker et al
• Incidence of rotations and spacings
1. Impacted side- 17.4%
2. Control side 8.7%
To minimize rotational relapse, options available are
1. Fiberotomy
2. Bonded fixed retainer

complicationscomplications

Orthodontic management of impacted canines can
be very complex and requires a carefully planned inter-
disciplinary approach

Canine impaction 1

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Canine impaction 1