2025 Catalog: General Courses

Impacted canines
•   Impacted canines are the second most impacted tooth behind the third molars. Disturbances in their development are common because they originate high in the maxilla and must travel further for eruption compared to any other tooth.
•   The prevalence of maxillary canine impaction is less than 5, and less than 0.5 for mandibular impaction.
•   Impacted canines are twice as likely to occur in females.
•   Canines are three times more likely to be palatally impacted.

Why is prevention of impacted canines important?
•   Increases the risk of root resorption of adjacent teeth      • Increases treatment costs
•   Impaction lengthens orthodontic treatment         • Complicates orthodontic mechanics

What are some causes of maxillary canine impaction?
Causes of maxillary canine impaction can be contributed to:
1]   Tooth size / arch length discrepancies.
2]   Local obstructions such as over retained primary canines or the failure of resorption of the primary canine root, supernumerary teeth, odontomas, and cysts.
3]   Genetic causes such as a developmental disturbance of the dental lamina, which can be repeated in families.
4]   A disturbance of the normal development which is also known as the guidance theory.

The Guidance theory of eruption is that the erupting canines use the lateral incisors as guides. So, when peg shaped or missing laterals are present, the canine is more likely to erupt palatally. The midline diastema does not close until permanent canines are fully erupted. Therefore, congenitally missing or peg laterals are not able to ‘guide’ in the canine eruption and can result in palatally displaced canines.

How do you detect ectopically erupting canines?
Early diagnosis is essential and should be completed by the general dentist by age 9 or 10, approximately 2 years before the expected canine eruption.

Inspect to see if any of the following conditions exist:
• Delayed eruption of the permanent canine      • Absence of labial bulge
• Persisting deciduous canine            • Presence of palatal bulge
• Asymmetry in eruption            • Buccal tipping of lateral incisors

Palpation is an easy diagnostic method that should not be overlooked. Canines are palpable in the buccal vestibule approximately 18 months prior to eruption. 95 of canines are palpable by age 11. If you cannot palpate a canine at that time, a radiograph is recommended.

Radiographs:
An early sign of canine impaction is overlapping with the lateral incisor in panoramic radiographs if the development of the lateral is already complete.
If a panoramic radiograph is obtained and there is a concern regarding impaction and possible resorption of the lateral, then a CBCT would be warranted. Root resorption can be difficult to diagnose with traditional radiographs due to limitations such as magnification, loss of information, overlapping and distortion. A CBCT can provide more accurate imaging.


What are some complications from canine impactions?
Root resorption is the most common and the most severe side effect associated with an impacted canine. Other complications that can arise from canine impactions include pain, infections, cyst development, and ankylosis.

Studies have shown the prevalence of root resorption in lateral incisors to be rather common with 50 showing signs of resorption, the majority being mild resorption.

What can be done to help with the redirection of the canine?
•   Extraction of the deciduous canine allows the palatally displaced canines to spontaneously correct in the majority of cases.
•   Root development of first premolars is usually ahead of the canines, so extraction of primary molars can accelerate their eruption, thereby facilitating the eruption of the canines as it provides more space for the uprighting movement of the canine in a distal direction.
•   Extraction of a peg lateral.
•   Increasing space in the arch with orthodontic treatment, such as through use of an expander.

What are some possible predictors on influencing the eruption of the palatally displaced canine?
•   Younger patients. The earlier a possible canine impaction is identified, the better.
•   A smaller mesioangular angle.
•   Shorter palatal displacement or shorter distance of the canine cusp tip to the dental arch.
•   Farther distance of the canine cusp tip to the dental midline.

Permanent canines are typically monitored by the general dentist. If it is determined to be displaced, early interceptive treatment is desirable to
prevent palatally displaced canines and their potential risks. A missed
diagnosis may pose a risk of damage to adjacent teeth and can result in prolonged and expensive treatment for the patient.


Reading Resources:
https://medicaljournalssweden.se/actaodontologica/article/view/35830

https://pubmed.ncbi.nlm.nih.gov/35883990/

https://pubmed.ncbi.nlm.nih.gov/25700993/

https://pubmed.ncbi.nlm.nih.gov/25246604/

https://scholarworks.indianapolis.iu.edu/server/api/core/bitstreams/ed4dd7d3-cb26-41d3-ad80-5d0ab27fae29/content

1]   Know why impacted canines are the second most impacted tooth
2]   Learn who are most likely to have impacted Canines
3]   Know what causes impacted Canines.

The speaker has no conflicts of interest to report.

It is the policy of the Indian Health Service, Division of Oral Health, that faculty/planners disclose any financial or other relationships with commercial companies whose products may be discussed in the educational activity. The Indian Health Service, Division of Oral Health, also requires that faculty disclose any unlabeled or investigative use of pharmaceutical products and medical devices. Images that have been falsified or manipulated to misrepresent treatment outcomes are prohibited.

None of the faculty/planners for this activity has a conflict of interest, and there is no use of unlabeled or investigative pharmaceutical products or medical devices. No images have been falsified or manipulated to misrepresent treatment outcomes.The educational objectives, content, and selection of educational methods and instructors are conducted independent of any commercial entity.

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