This document discusses canine impaction, including its causes, prevalence, classification, diagnosis, and management. It begins by introducing canine impaction and noting that it is usually diagnosed during routine dental exams. It then covers developmental considerations, etiology, prevalence, potential sequelae, and various classification systems for impacted maxillary and mandibular canines. The document outlines methods for clinical and radiographic diagnosis, and concludes by discussing various treatment options for impacted canines, including no treatment, interceptive treatment, extraction, auto transplantation, and surgical exposure with orthodontic alignment.

1. CANINE IMPACTION
AND ITS
MANAGEMENT
BY
MALA. M
2ND MDS
DEPT. OF OMFS
GUIDED BY
Dr. SANTOSH A NANDIMATH

2. CONTENTS
 Introduction
 Developmental considerations
 Aetiology
 Prevalence
 Sequelae
 Classification
 Diagnosis
 Management
Maxillary canine
Mandibular canine
 Conclusion

3. INTRODUCTION
 An impacted maxillary canine is usually diagnosed
during a routine dental examination.
 Disturbance in the eruption of permanent maxillary
canines can cause problems in the dental arch and
adjacent teeth, which require special care and attention.
Therefore, clinicians should be capable of dealing with
this clinical situation to deliver optimal treatment.
 Canines are the most common impacted tooth,
following the third molars.

4. Developmental considerations

5. Etiologic factors

6. Two major theories associated with palatally
displaced maxillary canines
1. The guidance theory
2. Genetic theory

7. >
>
EPIDEMIOLOGY

8. Sequelae of Canine Impaction
Shafer et al. suggested the following sequelae for
canine impaction:

9. Classifcation of Impacted Maxillary Canines
Classifcation Suggested by Archer (1975)
Class I: Impacted canines in the palate.
1. Horizontal 2. Vertical 3. Semivertical
Class II: Impacted canines located on the labial surface.
1. Horizontal 2. Vertical 3. Semivertical
Class III: Impacted canine located labially and palatally—crown
on one side and the root on the other side.
Class IV: Impacted canine located within the alveolar process—
usually vertically between the incisor and first premolar.
Class V: Impacted canine in edentulous maxilla— Impacted
canine can be in unusual positions like inverted position.

10. Ericson and Kurol in 1988.
• Sector 1: If the cusp tip of the canine is
between the inter incisor median line and the
long axis of the central incisor
• Sector 2: If the cusp tip of the cuspid is
between the major axis of the lateral and
central
• Sector 3: If the cusp tip of the cuspid is
between the major axis of the lateral and the
first premolar.

11. Modification of Ericson and Kurol’s
classification by Lindauer
• Sector I: Located distal to a tangent to the distal
crown and root of the lateral incisor
• Sector II: The area from the tangent on the distal
surface to a midline bisector of the lateral incisor
tooth
• Sector III: The area from the midline bisector to a
tangent to the mesial surface of the lateral incisor
crown and root
• Sector IV: All areas mesial to sector III

14. The Yamamoto et al. [9] seven subtypes
classification

15. Field and Ackerman (1935) Classifcation
Maxillary Canines 1. Labial position •
Crown in intimate relation with incisors. •
Crown well above apices of incisors. 2.
Palatal position • Crown near surface. •
Crown deeply embedded in close
relation to apices of incisors. 3.
Intermediate position • Crown between
lateral incisor and first premolar roots. •
Crown above these teeth with crown
labially placed and root palatally placed
or vice versa. 4. Unusual position • In
nasal or antral wall. • In infraorbital
region.

16. MANDIBULAR CANINE a. Labial
position: Vertical, oblique, and horizontal
b. Unusual position: At inferior border, •
In mental protuberance, • Migrated to the
opposite side along with the original
nerve supply.

18. DIAGNOSIS i. Clinical assessments ii.
Radiographic assessments.

19. Clinical assessments Impacted canine
teeth can be detected as early as the
age of 8 years. It is done with two
methods: Clinical inspection and
palpation [Figure 2].[2,3] Inspection
Clinical examination includes overall arch
inspection. Mobility or the absence of
primary canines past its eruption age.
Persistent median diastema, abnormality
or missing lateral incisor, ectopic
deviation of lateral incisor from its
position may all be signs of canine
impaction. Clinical examination for the
presence of bulge in the canine region
deep in the vestibule should be done
buccally as well as palatally

20. Palpation In the absence of canine,
palpation by finger deep in the vestibule
above the deciduous canine should be
done palatally/buccally above the
deciduous canine 2–3 years before its
eruption. It should be palpated deep
above attached gingiva in the sulcus
where mucosa reflects. Deciduous
canine should be checked for mobility.
The presence of bulge provides a
positive sign of impacted canine.
However, it should be noted that the
absence of bulge does not prove the
absence of impacted canine. When there
is a clinical presence of any of these
signs, radiographic examination should
be performed to confirm the diagnosis

22. Radiographic Localization of Impacted
Canine
Radiographic examinations may include
periapical X-ray, occlusal radiography,
anteroposterior and lateral radiographic
views of maxilla, OPG, CBCT, CT scan.

23. Periapical films A single periapical film
provides the clinician with a
twodimensional representation of the
dentition. In other words, it would relate
the canine to the neighboring teeth both
mesiodistally and superoinferiorly. To
evaluate the position of the canine
buccolingually, a second periapical film
should be obtained by one of the
following methods. Tube-shift technique
or Clark’s rule or (SLOB) rule
Buccal-object rule

24. Occlusal Films Also help to determine
the buccolingual position of the impacted
canine in conjunction with the periapical
films, provided that the image of the
impacted canine is not superimposed on
the other teeth.

25. Extraoral films Frontal and lateral
cephalograms These can sometimes aid
in the determination of the position of the
impacted canine, particularly its
relationship to other facial structures
(e.g., the maxillary sinus and the floor of
the nose).

26. Panoramic films These are also used to
localize impacted teeth in all three planes
of space, as much the same as with two
periapical films in the tube-shift method,
with the understanding that the source of
radiation comes from behind the patient;
thus, the movements are reversed for
position.

27. CT/CBCT Clinicians can localize canines
by using advanced threedimensional
imaging techniques. Cone beam
computed tomography (CBCT) can
identify and locate the position of
impacted canines accurately. By using
this imaging technique, dentists also can
assess any damage to the roots of
adjacent teeth and the amount of bone
surrounding each tooth. However,
increased cost, time, radiation exposure,
and medicolegal issues associated with
using CBCT limit its routine use. The
proper localization of the impacted tooth
plays a crucial role in determining the
feasibility of as well as the proper access
for the surgical approach and the proper
direction for the application of orthodontic
forces.

28. Treatment options
1. No treatment
2. Interceptive treatment
3. Extraction of the impacted canine
4. Auto transplantation of the canine
5. Surgical exposure and orthodontic
alignment