What is an Impacted Canine? How is it Treated?

An impacted canine is a tooth that fails to emerge into the mouth cavity and remains embedded in the jawbone despite being due to erupt. After wisdom teeth, canines are the second most commonly impacted teeth. Impacted canines are observed twice as frequently in females as in males and affect about 2% of the population. These teeth are twice as likely to be impacted in the upper jaw compared to the lower jaw, with 90% being unilateral and 10% bilateral.

Harms of Impacted Canines

• Resorption of Adjacent Tooth Roots: Scientific studies show that impacted canines can cause resorption of the roots of permanent incisors in children aged 10-13.

  Reference: Ericson S, Kurol J. Longitudinal study and analysis of clinical supervision of maxillary canine eruption. Community Dent Oral Epidemiol. 1986;14:112–6.

• Dentigerous Cyst Formation: Benign lesions can form due to developmental or inflammatory reasons.

  References: Tóth M, Adrienn B, Zsuzsanna S, Szilvia M. Dentigerous cyst in the mixed dentition. Fogorv Sz 2012;105:147-51. Aher V, Chander PM, Chikkalingaiah RG, Ali FM. Dentigerous Cysts in Four Quadrants: A Rare and First Reported Case. J Surg Tech Case Rep 2013;5: 21–6.

• Pain: Impacted teeth can cause pain depending on the problem.

  Reference: Shafer WG, Hine MK, Levy BM, editors. A textbook of oral pathology. 2nd ed. Philadelphia: WB Saunders; 1963.

Symptoms of Impacted Canines

• The canine on the opposite side has erupted, but the other has not.
• Presence of unerupted primary canine roots despite the child being 12 years old.
• Lack of a bulge on the labial side of the upper jaw at 12 years of age.
• Retained primary canine at 13 years of age.
• Swelling or bulging in the palate (indicates shallow impaction).
• Absence or malformation of the upper lateral incisors.
• Spacing or tilting of the front incisors.
• Non-resorption of primary canine roots.
• Fusion of primary canines to the bone, preventing natural exfoliation.
• Individuals with cleft lip and palate are at higher risk.

Causes of Impacted Canines

If the impacted canine is in the palate, genetic factors and congenital tooth deficiencies are more influential. If the impacted canine is in the labial side, early loss of primary teeth, discrepancies in dental arch width, and crowded teeth are more impactful.

Premature extraction of primary canines can lead to space deficiency, hindering the eruption of permanent canines. If the natural exfoliation of primary canines occurs less than a year before the permanent tooth eruption, it accelerates the process. However, if more than a year remains, the hardened bone above can delay and cause the permanent canine to become impacted.

Detection of Impacted Canines

An orthodontist can easily diagnose impacted canines early using periapical X-rays, panoramic X-rays, or cone-beam computed tomography. Early diagnosis is crucial, as with any medical field. The American Association of Orthodontists recommends the first orthodontic examination at age 6, no later than age 7.

Will an Impacted Canine Erupt on Its Own?

No, impacted canines cannot erupt on their own and will remain impacted.

What Happens if Impacted Canine is Not Treated?

The canine is the tooth with the longest and strongest root in the mouth. An impacted canine will repeatedly hit the roots of adjacent teeth, leading to their resorption. If untreated, the space created by the resorption will require treatment, possibly involving implants or prosthetics, which are more complex and costly than orthodontic treatment.

How is Impacted Canine Treated?

The ideal approach to impacted canine treatment is early diagnosis and intervention. However, early diagnosis without an orthodontic examination is challenging. A common misconception is that orthodontic treatments can only be performed after 12-13 years of age.

In the early period (ages 7-11):

• We perform orthodontic space gaining to eliminate space loss. This can involve moving all teeth back (distalization) or expanding the jaw. These procedures can be done using Invisalign clear aligners or palate expanders.

In the later period (ages 12+):

1. Position Detection: X-ray imaging to identify the impacted tooth.

2. Surgery for Palatal Impacted Canines: We remove the surrounding soft tissue using a soft tissue burr or laser without pain. Depending on the clinical situation, we perform closed or open eruption techniques. In closed eruption, we attach a bracket to the tooth during surgery, while in open eruption, we cover the exposed tooth with a protective cap.

3. Tissue Healing: We allow three days for healing. If a cap is used, we remove it.

4. Tooth Eruption: We attempt to bring the tooth into the mouth using natural or orthodontic forces.

Is Impacted Canine Surgery Difficult?

No, the procedure is performed under local anesthesia, ensuring complete numbness and no pain.

How Long Does Impacted Canine Surgery Take?

The duration of the surgery depends on the position and angle of the tooth, typically ranging from 5 to 45 minutes.

What Happens if the Impacted Canine is Not Erupted?

If not treated, the consequences mentioned above, such as root resorption, cyst formation, and unexpected pain, are likely. The chance of successful eruption decreases with age. Regardless of age or severity, you should seek an orthodontic examination and be willing to undergo treatment. At DentMax Orthodontics and Aesthetic Dental Clinic, we are always ready to assist you.

How Long Does it Take to Erupt an Impacted Canine?

The time required varies depending on the position and angle of the impacted tooth. It can take from 2-3 months to 12-18 months to erupt. A tooth responsive to treatment will show signs within 3-4 months. If no movement is detected after 6 months of force application, surgical extraction should be considered.

Can Braces be Applied with an Impacted Tooth?

Yes, braces can be applied with an impacted tooth. Combining the treatment of the impacted canine with braces can save time and shorten the overall treatment duration. While creating space for the impacted tooth, orthodontic treatment for the other teeth continues.

Placement of Impacted Tooth in the Dental Arch

Although an impacted tooth can erupt without braces or clear aligners, it is not practical. The tooth's final position in the dental arch is best achieved with orthodontic treatment. The primary goal is to bring the impacted tooth into the mouth, and proper alignment in the arch is only possible with braces or clear aligners.

Cost of Impacted Tooth Orthodontic Treatment

Your impacted teeth are your original teeth that should be in your mouth. Extracting them without attempting orthodontic treatment is like committing a crime. Canine teeth support the corners of the mouth, and their extraction can result in a 5-10 year aged appearance. Therefore, the cost of utilizing your natural teeth is incomparable to the price of lifeless implants. The cost of orthodontic treatment for impacted teeth varies depending on their position and angle. We invite you to our DentMax Orthodontics and Aesthetic Dental Clinic for radiographic and 3D digital intraoral scanning to provide you with accurate pricing.

Extraction of Impacted Canines

Never have your impacted canine extracted without an orthodontic examination and approval from your orthodontist. If no orthodontic intervention has been attempted, it is recommended to do so first. Extraction is considered only in rare cases, such as deeply positioned, horizontally oriented, or inverted teeth. If you have a recent X-ray (within the last 3 months), you can send it to info@dentmax.com.tr for assistance. We are pleased to help you at our DentMax Orthodontics and Aesthetic Dental Clinic in Istanbul, Bakırköy.

What Happens After Impacted Tooth Extraction?

Follow your doctor's recommendations for the healing process after impacted tooth extraction. Avoid hot foods for a while and do not smoke to prevent alveolitis. It is normal to see slight bleeding on your pillow for the first 1-2 nights. You may notice blood in your saliva, but avoid spitting repeatedly as it can prolong bleeding. Applying cold packs for 15 minutes on and 20-30 minutes off for the first 12-18 hours helps control swelling. Carefully monitor the healing process, and if stitches were placed, they should be removed by your dentist within 7-10 days, or they may dissolve on their own in 3-5 weeks. You can start brushing your teeth 24 hours after the extraction. Proper cleaning is crucial to prevent infection.

What Happens if Impacted Canine is Not Extracted?

If the impacted canine is not extracted after being deemed necessary by your orthodontist, it can lead to:

• Resorption of adjacent tooth roots
• Unwanted cyst formation
• Unexpected and persistent pain

References

1. Power SM, Short MB. An investigation into the response of palatally displaced canines to the removal of deciduous canines and an assessment of factors contributing to a favourable eruption. Br J Orthod. 1993;20:215–23.
2. litsas G. A review of early displaced maxillary canines: Etiology, diagnosis and interceptive treatment. Open Dent J. 2011;5:39–47.
3. Bishara SE. Impacted maxillary canines: A review. Am J Orthod Dentofacial Orthop. 1992;101:159–71.
4. Ericson S, Kurol J. Early treatment of palatally erupting maxillary canines by extraction of the primary canines. Eur J Orthod. 1988;10:283–95.
5. Mitchell L, editor. An Introduction to Orthodontics. 3rd ed. New York: Oxford University Press; 2007.
6. Jacoby H. The etiology of maxillary canine impactions. Am J Orthod. 1983;84:125–32.
7. Richardson G. A review of impacted permanent maxillary cuspids — diagnosis and prevention. J Can Dent Assoc. 2000;66:497–501.
8. Becker A, editor. The orthodontic treatment of impacted teeth. 2nd ed. Abingdon, Oxon, England: Informa Healthcare; 2007.
9. Peck S, Peck L, Kataja M. The palatally displaced canine as a dental anomaly of genetic origin. Angle Orthod. 1994;64:249–56.