canine-impaction In dentistry oral health part 2

canine-impaction In dentistry oral health

1. Canine
Impaction
By: Dr. Saya Mustafa
BDS, M.Sc., PhDc

2. Canine Impaction
•Impactionofmaxillaryand
mandibularcaninesisafrequently
encounteredclinicalproblem.
•Caninedisplacementisgenerally
classifiedintobuccalorpalatal
displacement.
•Maxillarycaninesarethemost
impactedteeth,secondonlytothird
molars.

3. Incidence
•Twiceascommoninfemalesasitisinmales.
•Theincidenceofcanineimpactioninthemaxillaismorethan
twicethatinthemandible.
•Itisfoundpalataltothearchin85%ofcases,whilethelabial
impactionis15%

4. Etiology
*
•LOCALIZED
*
•SYSTEMIC
*
•GENETIC

5. Etiology: Localized factors
•Tooth size-arch length discrepancies
•Failure of the primary canine root to resorb
•Early loss of primary canine
•Ankylosis of permanent canine

6. Etiology : Localized factors
•Short-rooted or absent upper lateral incisor.
•Long path of eruption.
•Displacement of the crypt.
•Local obstruction anomaly : like supernumerary teeth, odontomas
•cyst
->
sometimesthe
caninelossit's
everytimeforce
causing
impaction
buccally
or
lingually-
missinglaterals

7. Etiology
SYSTEMIC
Endocrine deficiencies:
Hypothyroidism, growth hormone deficiency
Febrile diseases:
High Fever can lead to affecting Gubernacular canal
Irradiation:
Causing ankylosis, osteoradionecrosis

8. 1. Endocrine Deficiencies
•Conditions such as hypothyroidism and hypopituitarismcan delay or impair tooth eruption
due to their effects on bone metabolism and overall growth.
•Thyroid hormones are essential for bone and dental development; a deficiency can lead to
delayed eruption, abnormal root formation, and impaction.
•Growth hormone deficiency (as in hypopituitarism) results in underdeveloped jaws,
reducing space for the canine to erupt properly.
2. Febrile Diseases
•High fevers, especially during childhood, can disrupt enamel and dentin formation, leading
to hypoplastic teethand abnormal eruption patterns.
•Febrile diseases may also affect the formation of the gubernacular canal, a pathway that
guides the canine's eruption.
•If the fever coincides with the critical period of canine development, it can alter root
formation, causing misdirection or impaction.
3. Irradiation (Radiation Therapy)
•Radiation exposure to the head and neck region, especially in childhood, can cause
hypoplasia or destruction of the dental follicle, affecting the eruptive force of the canine.
•It can also lead to osteoradionecrosis, reducing the ability of the bone to remodel and
accommodate erupting teeth.
•High doses of radiation may result in damage to the periodontal ligament, preventing the
canine from moving into its correct position.
↑guides
the
toothtoerryt
"¥
Itis
a
canal
extendingfrom
follicle
tothealveolarcrest
->
deadbone
,
lissof
bloodsudy
:

9. Etiology
GENETIC
Heredity
Malposed tooth germ
Presence of alveolar cleft

11. Assessing the canine position
1-Clinically
2-Radiographically

12. Clinically
1-Palpation
2-Inclination of the lateral incisor
3-Mobility of adjacent tooth -> Root resorption
4-Study model analysis -> Amount of space available in
dental arch for impacted canine is assessed in model.

13. Suspicion of canine impaction is made when:
▪Thecanineisnotpalpableinthebuccalsulcusbytheageof10-11years
▪Ifthereisabulge(palatalorlabial)suggestiveofectopiceruption
▪Lossoftoothvitalityorincreasemobilityofpermanentmaxillarylateral
incisors
▪Inpatientsolderthan10years,anobviouspalpablebilateralasymmetry
couldindicatethatoneofthepermanentcanineisimpactedorerupting
ectopically

14. Radiographic evaluation
This is done to aid in the localization
of the unerupted tooth as well as to
assess adjacent structure
It also aid to determine the
angulation, height and mesiodistal
position of canine
It aids to see pathology around the
root and root resorption if any

15. Radiographic
techniques
•Dental panoramic tomogram (OPG)
•Periapical (Parallax technique): {SLOB}
•Upper anterior occlusal
•Lateral cephalometric
•Cone beam computed tomography (CBCT)

16. The prognostic factors have been investigated by
McSherry and Pitt to estimate treatment difficulty are:
1-Overlap of incisor 2-Vertical height

17. The prognostic factors have been investigated by
McSherry and Pitt to estimate treatment difficulty are:
3-Angulation 4-Position of apex

18. Guideline
to assess
the
prognosis
of canine
impaction

19. Management of Impacted Canine
Interceptive treatment
Treatment of Buccal impaction
Treatment of palatal impaction
Methods of applying traction
Retention consideration

20. Interception of displaced canine
•Early Detection of Ectopic Canines
•Routine palpation recommended for children aged 10+ years.
•Prognosis of Canine Eruption
•Good Prognosis:
•Palpable canines in normal position (buccal and slightly distal to lateral
incisor root).
•Signs Requiring Investigation:
•Hollow areas or asymmetry during palpation.
•Panoramic radiographs may reveal positional abnormalities.

21. Interceptive Measures
•Deciduous Canine Extraction:
•Clinical Experience:
•Best outcomes between ages 10–13 years.
•Space maintenance or creation critical in crowded dentitions.
•Risks & Commitments:
•Extraction and possible need for surgical exposure or orthodontic
alignment.

22. A patient whose displaced maxillary permanent canines
improved following the extraction of the upper deciduous canines

23. Management of buccal
displacement

24. Buccal Displacement Characteristics
•Commonly associated with crowding.
•Relief of crowding (Space creation) before eruption often leads to spontaneous improvement.
•Buccal displacements are more likely to erupt than palatal ones due to thinner buccal
mucosa and bone.
dr
.
say
as
experience
,
when
we
treat
the
crowdingwait
for
↓months
,
mostly
itwill
come
down
·
but
itis
onlypossible
incaseofbuccaldisplacementbatofthis
bareandmsa
Tart

25. Surgical Exposure
•Indicated when tooth does not erupt spontaneously after creating
space in the arch
•Attempted 6 months after the root formation
•Flap designs should preserve the band of attached gingiva

26. When Buccally Displaced Canines Don’t Erupt
Labial
impaction
Initial orthodontic treatment was
aimed at creating space in the
maxillary arch with fixed appliance
therapy.
Surgical exposure and orthodontic
traction.

27. Surgical Exposure Techniques for buccally displaced canine
•Crown Below Mucogingival Junction:
•Open procedure to expose the crown (Excisional approach).
•Crown Above Mucogingival Junction:
•Use apically repositioned flaps to preserve attached gingiva.
•Bond an attachment during surgery for traction (e.g., gold
chain or stainless-steel ligature).

28. Excisional approach: Open technique

29. Closed eruption technique
Flap is elevated
Attachment placed on impacted
tooth
Ligature or chain placed over the
attachment to activate after a week
Raised flap is repositioned in its
original location
Permit eruption of impacted canine
in normal direction

30. Case 1: Closed eruption technique

32. Case 2 (Before treatment)

33. Progress

34. After treatment

35. Periodontal
consideration
•Excisional technique must
be performed only when
sufficient gingiva is present,
to provide at least 2-3mm of
attached gingiva over the
canine crown after it has
erupted.

36. Management of palatal
displacement
Next week