Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct 7;29(5):e24spe5.
doi: 10.1590/2177-6709.29.5.e24spe5. eCollection 2024.

Focus on leveling the hidden: managing impacted maxillary canines

Orlando Motohiro Tanaka  1 , André Weissheimer  2 , Matheus Melo Pithon  3 , Gil Guilherme Gasparello  1 , Eustáquio Afonso Araújo  4
Affiliations

Focus on leveling the hidden: managing impacted maxillary canines

Orlando Motohiro Tanaka et al. Dental Press J Orthod. .

Abstract
in English, Portuguese

Introduction: The long pathway that the canines take as they emerge into the maxillary arch makes them vulnerable to disruption during their natural emergence time. The process of planning treatment for impacted maxillary canine (IMC) presents significant challenges, underscoring the need for careful consideration and expertise.

Objective: The aim of this article was to shed light on these complexities by discussing clinical case studies involving IMC, providing insights into the intricacies of their management.

Conclusions: The management of IMC within orthodontics presents a multifaceted challenge that include the necessity for precise diagnostic processes, prudent use of cone beam computed tomography (CBCT), the strategic selection between open and closed exposure techniques, a in-depth understanding of the specific orthodontic biomechanics involved, and a keen awareness of potential adverse outcomes such as ankylosis, prolonged treatment times, root resorption, and additional complications.

Introdução:: O longo caminho que os caninos percorrem até irromper na arcada superior os torna vulneráveis a interrupções durante a erupção fisiológica. A etapa de planejamento do tratamento para caninos superiores impactados (CSI) apresenta desafios significativos, destacando a necessidade de consideração cuidadosa e expertise.

Objetivo:: O objetivo do presente artigo é esclarecer esses aspectos, discutindo relatos de casos clínicos envolvendo CSI, fornecendo percepções sobre a complexidade de seu manejo.

Conclusões:: O manejo do CSI na Ortodontia apresenta um desafio multifacetado, que inclui a necessidade de um diagnóstico preciso, o uso prudente de tomografia computadorizada de feixe cônico (TCFC), a seleção estratégica entre as técnicas de exposição aberta ou fechada, uma compreensão aprofundada da biomecânica ortodôntica específica envolvida, e uma consciência ampla dos possíveis resultados adversos, como anquilose, tempo de tratamento prolongado, reabsorção radicular e complicações adicionais.

PubMed Disclaimer

Conflict of interest statement

The authors report no commercial, proprietary or financial interest in the products or companies described in this article.

Figures

Figure 1:
Figure 1:. Frontal clinical photographs, panoramic and periapical radiographs, and CBCT for the diagnosis of the position of the impacted maxillary canine. A) Distal inclination of the laterals, and the canines positioned palatally. B) Distal inclination of the laterals, and canines without deviation. C) Distal inclination of the left lateral, and the canine positioned labially.
Figure 2:
Figure 2:. Open exposure of palatally impacted maxillary canine.
Figure 3:
Figure 3:. After attaching the hook, the wire is positioned to direct the tooth to its correct position in the occlusion line.
Figure 4:
Figure 4:. Closed exposure of palatally impacted maxillary canine, with a light-cure periodontal surgical dressing.
Figure 5:
Figure 5:. Open exposure, whereas it should be a closed exposure of palatally impacted maxillary canine.
Figure 6:
Figure 6:. Extraction of the deciduous canines, and exposure of the permanent canines. It could have been an open exposure, and no sutures would be necessary.
Figure 7:
Figure 7:. Closed exposure, whereas it should be used an open exposure of palatally impacted maxillary canine.
Figure 8:
Figure 8:. Both impacted maxillary canines were extracted and the deciduous were maintained.
Figure 9:
Figure 9:. The rapid maxillary expansion facilitated the eruption of both maxillary canines.
Figure 10:
Figure 10:. Three first premolars and the right impacted maxillary canine were extracted, and the space was closed by retracting the incisors, to improve the facial profile.
Figure 11:
Figure 11:. In an adult patient with all four canines impacted, both mandibular canines were brought into alignment, while both impacted maxillary canines were extracted, and the deciduous canines remained in place for the 12-year follow-up.
Figure 12:
Figure 12:. A TAD was used to achieve distal inclination of the left maxillary canine. Significant torque was applied to the lateral incisor, which might have resulted in mild root resorption.
Figure 13:
Figure 13:. The 0.016-in stainless steel multiloop wire enables the impacted maxillary canine to move labially without the need for a bite block.
Figure 14:
Figure 14:. Intrusion of the adjacent teeth during leveling. The apicotomy was a contributing factor to the successful alignment of the teeth to the occlusion line.
Figure 15:
Figure 15:. The maxillary canines in the positions of the lateral incisors. The use of Class III intermaxillary elastics favored the loss of maxillary anchorage and the maintenance of the mandibular incisors on the bone base. However, poor oral hygiene led to the formation of white spots.
Figure 16:
Figure 16:. Gingival recession observed after a 12-year follow-up period.
Figure 17:
Figure 17:. A multidisciplinary approach involving orthodontics for alignment, surgical intervention for tooth exposure, periodontics for crown lengthening, and esthetic dentistry for the final restoration.
See this image and copyright information in PMC

References

    1. Kim Y, Hyun HK, Jang KT. Interrelationship between the position of impacted maxillary canines and the morphology of the maxilla. Am J Orthod Dentofacial Orthop. 2012;141(5):556–562. - PubMed
    1. Koç A, Kaya S, Abdulsalam WA. Three-dimensional analysis of impacted maxillary and mandibular canines and evaluation of factors associated with transmigration on cone-beam computed tomography images. J Oral Maxillofac Surg. 2021;79(3):538.e1–538.11. - PubMed
    1. Litsas G, Acar A. A review of early displaced maxillary canines etiology, diagnosis and interceptive treatment. Open Dent J. 2011;5:39–47. - PMC - PubMed
    1. Ucar FI, Celebi AA, Tan E, Topcuoglu T, Sekerci AE. Effects of impacted maxillary canines on root resorption of lateral incisors a cone beam computed tomography study. J Orofac Orthop. 2017;78(3):233–240. - PubMed
    1. Bedoya MM, Park JH. A review of the diagnosis and management of impacted maxillary canines. J Am Dent Assoc. 2009;140(12):1485–1493. - PubMed

LinkOut - more resources