Impacted Maxillary Canines: Management

Introduction:

Roughly one-third of impacted maxillary canines in individuals are found either labially or palatally in the oral cavity. Canine impaction is commonly caused by a variety of factors with differing etiologic roots. Though current dental research cannot exactly elicit the etiology behind these occurrences of impacted maxillary or upper canines. A consensus from the dental reports studied across the globe indicates the given below factors responsible for impacted canines:

1. Genetic factors or inheritance.

2. Local factors during a child's tooth eruption.

3. Systemic factors that can delay tooth eruption.

Amongst these three factors that would be primarily responsible for canine impaction in children or young adults. The common underlying clinical observation in most patients is the arch length discrepancies. For labially impacted canines especially, arch length discrepancies or even constricted maxillary arches that may not allow for enough space for the permanent canine eruption would be the reasons, according to the research hypothesis. According to the research results of a major study that showed almost 85 percent of palatally impacted canines were because of lack of sufficient space for eruption, and only 17 percent of labially impacted canines tended to still have sufficient space in terms of the dental arch length of the patient.

What Are the Complications Associated with Impacted Canine?

The etiologic factors for canine impactions that have been proposed are either localized, systemic, or genetic factors with the following complications after canine impaction:

1. Migration of the neighboring teeth due to the impacted canines can be a common dental observation firing routine dental checkups.

2. Pre-existing or subsequent loss of dental arch length when impacted canines are left untreated.

3. Internal resorption of the tooth.

4. Labial or lingual malpositioning of the impacted tooth or canine.

5. Cyst formations due to the infection of impacted teeth.

6. External root resorption of the impacted tooth. Root resorption can occur even in the neighboring teeth.

7. Infections that are associated with the partial eruption of the impacted canine tooth.

8. Referred pain from the impacted canine.

Frequently, patients may report experiencing a mix of the aforementioned consequences or elements outlined. The clinical manifestations observed in children and young adults typically lead the dentist to suspect a canine impaction during the clinical assessment. It is imperative for the dentist or maxillofacial surgeon to accurately diagnose impacted canines using 2D or 3D imaging radiographic techniques to confirm their presence and address them effectively to avoid the potential pain or infection consequences mentioned earlier.

What Are the Symptoms of Impacted Canine?

These signs listed below can prompt the dental surgeon a suspicion of canine impaction:

1. Absence of a labial canine bulge that exists usually.

2. Presence of a palatal bulge without a permanent canine.

3. Delayed eruption of permanent teeth.

4. Distal tipping or migration (splaying) of the lateral incisors.

5. Delayed eruption of several permanent teeth.

6. Prolonged retention of the deciduous canine even past 14 to 15 years of age.

The assessment of impacted canines can be significantly enhanced through the use of various radiographic techniques, including occlusal films, panoramic images, and lateral cephalometric radiographs, which facilitate a precise determination of the impacted canine's location. Typically, periapical two-dimensional radiographs are particularly effective in identifying impacted canines. Timely diagnosis and intervention can alleviate the financial burden on dental patients, as it reduces the need for extensive surgical procedures and orthodontic treatments that may involve collaboration among orthodontists, general dentists, and maxillofacial surgeons to achieve proper alignment of permanent dentition in children and young adults. Tooth impaction of a canine would be defined primarily in dental literature as the intraosseous position of the tooth past the expected time of its eruption, while any intraosseous position of the canine before the expected time of eruption can be defined as a displaced canine instead.

How to Manage Impacted Canine?

Clinicians use the CBCT (cone-beam computed tomography) technology or 3d radiographic imaging to mainly localize canines, for identification of the accurate position of impacted canines, and also for assessing any possible damage to the roots of adjacent teeth or the amount of bone surrounding the next tooth. Proper visualization via CBCT can ensure that the dentist can plan the feasibility of proper access needed to surgically approach and align the impacted tooth through the proper application of orthodontic forces. The treatment of this complex clinical entity involves mainly the surgical exposure of the impacted tooth that can be subsequently followed up by orthodontic traction. Orthodontic traction forces can help guide and align the permanent canine tooth back into the dental arch. The dental surgeon or the orthodontist needs to prevent bone loss, root resorption, or gingival recession complications that may recur even after the alignment of the impacted canine in the dental arch. Preventing these undue complications around the treated teeth would be prioritized by regular dental follow-ups such as a three to six-month follow-up post-operative treatment and alignment.

Interceptive treatment that is performed by many general dental surgeons commonly when the clinician possibly detects early signs of ectopic eruption of canines (during routine dental checkups) is usually by the selective extraction of the deciduous or primary canines at the age of eight or nine years itself in children. pediatric dentist or pedodontist. The new age approach is the removal of the deciduous canine before the age of eleven years when an impacted or ectopic permanent canine is detected.

The normalization of the position of the impacted or ectopically erupting canine tooth would not only be achieved, but this approach may also facilitate the acquisition of adequate space for its alignment. In numerous cases, the orthodontist, maxillofacial surgeon, or general dentist may recommend the extraction of the ectopic or impacted canine, particularly when the permanent teeth are experiencing external or internal root resorption, when the root of the impacted canine is significantly dilacerated, or in instances of severe impaction.

Conclusion:

The management of impacted canines holds significant importance in the field of pediatric dentistry, as well as in general dentistry, for the restoration of both aesthetics and functionality in affected individuals. Timely detection and accurate diagnosis using 2D or 3D imaging techniques in dentistry are crucial for enabling dental practitioners to effectively plan the treatment of impacted canines in children or young adults, thereby promoting proper alignment and long-term aesthetic success rates.