impacted maxillary canine impacted mandibular canine impacted mandibular premolars

1. Principles of management of
impacted teeth
- Chapter Two -
DR. HAYDAR MUNIR SALIH ALNAMER
BDS, PHD (BOARD CERTIFIED)

2. Impacted maxillary canine
 The canine is not only a critical tooth in determining facial
esthetics and dental occlusion, but it also affects the course of
orthodontic treatment when there is a disturbance in its
eruption and alignment the maxillary canine is usually
expected to erupt before 13.9 years of age for girls and before
14.6 years for boys
 In maxillary canine impaction, the position of the tooth is most
often palatal, with a ratio of 2 : 1 The maxillary canine travels
almost 22 mm during the time of eruption, and it moves in a
palatal direction before it begins its buccal descent

3. Archer classification of impacted
canine
Class I: Impacted canines in the palate
1: Horizontal
2: Vertical
3: Semi-vertical
Class II: Impacted canines located on the labial surface
1: Horizontal
2: Vertical
3: Semi-vertical

4. Archer classification of impacted
canine
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

5. Archer classification of impacted
canine

6. Clinical Examination
The position of the tooth may be obvious by the presence
of a bulge either palatally or buccally

7. Radiographic examination
Buccal object rule (parallax method, tube shift technique) a
rule called SLOB (Same Lingual Opposite Buccal)

8. Radiographic examination
Vertex occlusal projection; which produces an axial
view of the incisors, will demonstrate the
buccopalatal localization of the canine

9. Radiographic examination
OPG; can be used to localize impacted canine on the
basis that palatally impacted canine appear magnified. It
can also demonstrate the vertical angulation and its
height.

10. Radiographic examination: CBCT

11. Radiographic examination: CBCT

12. Options of treatment
1.Retention or leave in situ; indicated when:
1. The canine is asymptomatic and its extraction may
lead to damage to the adjacent teeth.
2. There is absence of infection, abnormal widening
of the follicle, resorption of the adjacent roots or
any other associated pathology.
3. Aesthetically acceptable.

13. Options of treatment
2. Surgical exposure and orthodontic traction
 Certain criteria must be fulfilled:
1. There should be adequate space in the arch to
accommodate the tooth.
2. There should be an unobstructed path of
eruption.
3. After eruption the tooth should be in near to
normal position in all planes.
4. The timing of the procedure should be as close
as possible to the normal eruption time.

14. Surgical exposure and orthodontic traction:
buccally

15. Surgical exposure and orthodontic traction:
palatally

16. Options of treatment
 3. Transplantation; in this procedure the canine is
carefully extracted and transferred to a surgically
prepared socket in the dental arch with minimum delay.
The transplanted tooth should be splinted in its new
position for about a month with an orthodontic
appliance.
 Success rate is increased when the un-erupted teeth
still have open apex
 Endodontic treatment should be performed as soon as
possible after surgery (about 6-8 weeks),

17. 3. Transplantation

18. Options of treatment
4.Removal; surgical extraction maybe performed when
the other options are unavailable.
 The main indications include:
1. Before construction of a dental prosthesis.
2. To permit orthodontic alignment of other anterior
teeth.
3. When there is resorption of the roots of adjacent
teeth.
4. When a follicular cyst has developed.
5. Infection although uncommon.

19. Options of treatment: 4. Removal

20. Options of treatment: 4. Removal

21. Options of treatment: 4. Removal

22. Options of treatment: 4. Removal

23. Options of treatment: 4. Removal

24. Options of treatment: 4. Removal

25. Impacted mandibular canines
 These are less frequently impacted than
maxillary canines (about 0.3% of population)
and are mostly buccally located
 Localization of the unerupted teeth is by
periapical film, OPG or occlusal view that is
taken with the X-ray directed along the long
axis of the teeth.

26. Impacted mandibular
canines: Removal
Dr. Haydar Munir Salih

27. Impacted mandibular canines:
Removal
Dr. Haydar Munir Salih
Dr. Haydar Munir Salih
Dr. Haydar Munir Salih

28. Impacted mandibular canines:
Removal
Dr. Haydar Munir Salih
Dr. Haydar Munir Salih

29. Impacted mandibular canines:
Removal
Dr. Haydar Munir Salih
Dr. Haydar Munir Salih

30. Impacted mandibular canines:
Removal
Dr. Haydar Munir Salih

31. Impacted lower premolars
 It occurs mostly due to loss of space by drifting
forward of the first permanent molar after early
extraction of the second deciduous molar
 Localization is by periapical film or OPG with
occlusal view to demonstrate the buccolingual
position.

32. Impacted lower premolars
Dr. Haydar Munir Salih
Dr. Haydar Munir Salih

33. Impacted lower premolars: Removal

34. Impacted lower premolars: Removal

35. Impacted lower premolars: Removal

36. Impacted lower premolars: Removal

37. Impacted lower premolars: Removal

38. Impacted lower premolars: Removal