Impacted Canines and Their Management for Orthodontic Therapy

The canines, or cuspids, are typically some of the last teeth to fully develop. They are crucial components of a healthy bite and should be monitored for normalcy throughout their development. One or more impacted canines can lead to a number of potentially complex issues and abnormalities in the dental arch, affecting all teeth adjacent to the unerupted tooth.

Canine impaction can be defined in more than one way and its specific definition varies from patient to patient. The tooth may be prevented from erupting by adjacent teeth that have grown too close together or may be embedded in the bone of the jaw. The tooth may simply fail to emerge after the root has formed completely. Approximately one to two percent of the general population suffers from impaction of one or more permanent canines.

Complications of Impacted Canines

In most cases of impacted canine teeth, the problem is first discovered during a routine visit to the dentist. Impaction of these vital teeth can be detected by a dentist or oral surgeon as early as the age of eight using a combination of physical and radiographic examination. If, however, the patient is not seen by a dental professional regularly and the impaction is not detected in a timely manner, there is an increased likelihood that the patient will experience some undesirable complications. These include:

• Pain and pressure in the gum at the expected eruption site
• Uneven spacing and malocclusion of adjacent teeth
• Gum recession and periodontal disease
• Dull ache or sharp pain in the teeth surrounding the affected area
• Decay of partially erupted or impacted tooth due to inability to clean properly
• Spread of decay from affected canine to healthy adjacent teeth
• Tumor or cyst formation potentially leading to alveolar bone and pathologic fracture

The age of the patient in question is an important factor to consider when evaluating an impacted canine. An older individual who has lived for many years with a simple impaction typically requires more specialized care than, for example, a child with a seemingly more complex impaction. This is due to the many consequences of utilizing an incomplete set of teeth for many years.

Canine Impaction Management for Orthodontic Therapy

Having Impacted Canine Surgery from AAOMS.org on Vimeo.

Proper management of impacted canines must involve the work and cooperation of both an oral surgeon and an orthodontist. Though each individual and each case will prove unique, treatment typically consists of the placement of orthodontic braces first and then a referral to the oral surgeon. The oral surgeon will make an incision along the gum above the empty cuspid’s space and lift a flap of tissue to reveal the impacted tooth beneath. When a primary tooth is present and impacted as well, it is removed to make room for the permanent tooth.

The oral surgeon then places an orthodontic bracket to the tooth, attaching the bonded and bracketed tooth with a small chain to the arch wire of the braces. In some cases, the gum tissue is repositioned over the impacted canine, leaving the chain visible. In others, the surgeon sutures the gum tissue higher up above the once hidden tooth. The oral surgeon and orthodontist will continue to work together as necessary throughout the full development and proper growth of the canine tooth or teeth treated. The ultimate result of this type of therapy is a complete set of teeth that function properly and are aesthetically pleasing.

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