Surgical considerations and management of bilateral labially impacted canines

Abstract

Canines are among the most commonly impacted teeth. When a canine is positioned labially, the untoward soft-tissue responses following surgical exposure may cause unfavorable esthetic outcomes. Therefore, decision making as to the choice of a proper surgical technique to uncover labially impacted teeth is critical. This case presentation describes two different surgical approaches for two maxillary impacted canines in a 12-year-old girl. A sequential approach included a first stage of surgical exposure using apically positioned flaps and orthodontic extrusion of both impacted teeth. A successive laterally positioned flap was used for the left maxillary canine to achieve a harmonious soft-tissue contour. In this case, close monitoring and cooperation during the various treatment phases led to proper canine positioning and a successful esthetic result, with good periodontal health and functional occlusion.

Keywords: canine impaction; mucogingival surgery; surgical exposure.

Figure 1

Pretreatment view showing that the bilateral maxillary canines have not erupted.

Figure 2

Periapical radiographs indicating two impacted canines at different levels and angulations. (A) The maxillary right canine crown is positioned in the middle of the edentulous ridge. (B) The left canine crown is located near the apex of the maxillary left central incisor.

Figure 3

Surgical exposure of both impacted canines. (A, B) Horizontal incisions on the keratinized gingiva with two vertical incisions were designed. (C) The flap was elevated, and the right maxillary canine was exposed. (D) The left canine crown was exposed following removal of the labial bone. (E, F) After bonding with an orthodontic button on the labial surface of the left canine, the flaps were positioned apically and sutured bilaterally. (G, H) The stitches were removed 1 week postoperatively.

Figure 4

Mucogingival surgery over the left canine area. (A) Preoperative view indicating minimal keratinized tissue with an irregular appearance over the left lateral incisor and canine region. (B) A partial-thickness flap was dissected from the labial surface of the left incisors. (C) The flap was laterally positioned to the lateral incisor and canine area following preparation of the recipient bed. (D) The pedicle flap was sutured with 4-0 Vicryl.

Figure 5

One year after orthodontic debonding, the canines were both positioned properly. Harmonious soft tissue and an adequate zone of keratinized gingiva were present.