#DEN4001
#D4/S1/W10
#ORTHO

Impacted Canines

• canine that is prevented from erupting into its normal position, delay in 6mo after contralateral tooth has erupted
• prevalence
  • maxillary canine 1-3% impacted
  • 1.5% have palatally impacted maxilalry canine
  • F>M 3:1
  • 80% palatal, 20% buccal
  • unilateral > bilateral
  • increased prevalence class II div 2
  • 40% have anomalous lateral incisor
  • strong inheritance factor
• aetiology
  • lateral guidance theory, distal surface of its eruption and agenesis of lateral incisors
  • autosomal dominant with incomplete penetrance
  • buccally impacted canines are more commonly associated with crowding
• diagnosis
  • maxillary permanent canines erupt around 11-12
  • mandibular permanent canines erupt 9-11
  • asymmetry on palpation, delay in lateral or canine eruption
  • flaring/tipping/migration of laterals
  • loss of vitality / increased mobility of upper 2s or 1s
  • should be able to palpate the maxillary canines by the age of 10, if you cant must refer for OPG
  • OPG or PA
  • PALATAL IMPACTION = LARGER ON OPG
  • BUCCAL IMPACTION = SMALLER ON OPG
• early management
  • exo the primary canine
  • avoiding impaction is best to avoid surgical
  • expansion or headgear
• classification
• 
• 
• 

difficulty

• position relative to distance from occlusal plane - midline
• distance from lateral and central incisor - sectors
• early treatment

  • 30 degrees less chance of deciduous canine removal will improve impaction

  • <1/2 root of lateral incisors gives 87% chance of improvement if deciduous exo
• average tx time
  • uni 24mo
  • bilateral 30mo
• with surgical exposure, difficulty increases if
  • closer to midline
  • greater distance from occlusal plane
  • greater the angle

Complications

• periodontal problems
  • especially on lateral,
• root resorption
  • central, lateral, 1st premolar
• ankylosis
• loss of tooth
  • lateral, canine, central
• pathology
  • cyst formation

Treatment for impacted canines

Exo of deciduous canine

• if low impaction severity, but potential to erupt into arch with guidance

Surgical exposure and bracketing

• severe impaction without eruption on its own
• expose impacted tooth, bracket attachment then use chains to pull into position
• consideration factors:
  • position and severity of impaction
  • health of adjacent teeth

Open vs closed exposure

• open
  • really close to occlusal plane or
  • palatal surface (greater keratin in that mucosa)
• closed exposure
  • buccal (doesn't have keratin)
  • very high
• if open exposure in contraindicated area, will result in great amount of recession

Methods of traction

• URA
  • 
  • removable appliance not very good as very finicky and challenging
• piggyback
  • 
  • solid arch wire for other teeth, flexible wire piggybacking to move the canine
• elastic thread
  • 
  • 
  • best for more impacted teeth, or for rotation
• TPA + auxilliary arm (transpalatal appliance)
  • 
  • for more distalisation cases
• ballista spring
  • 
  • spring under force
• TAD traction
  • 

Woven canine

• palatal to upper CI and buccal to upper LI
• 
• TPA + auxilliary arm

Undesirable side effects

• root resorption
• aesthetics
• pain
• other
  • 21% chance of pulp canal obliteration of paltal impacted canine
  • vertical relapse
  • differential torque between contralateral maxillary canine
  • gingival recession
  • ankylosis
  • post op infection

Periodontal problems