Course Title: Canine Impactions

Name: Vincent O. Kokich, Jr., DMD, MSD

3 Locations of Canine Impactions:
1. palatal
2. mid-alveolar
3. labial

Why is cone beam technology so helpful today?
It helps the surgeon locate the impacted canine more
specifically so access can be designed most ideally
It helps the orthodontist determine which direction the tooth
needs to be moved so not to damage adjacent teeth



PALATAL:
What are 2 orthodontic techniques used to treat palatally
impacted canines? Which is used primarily today?
Closed eruption
Open eruption (used primarily today)


Whats involved in the exposure process?
1. Lay a flap to expose the tooth
2. Remove bone covering crown up to height of contour
3. Bond orthodontic attachment to the canine crown
4. Replace flap
5. Cut hole in palatal gingiva to expose the canine crown
6. Place dressing on the tooth to maintain exposure
7. Remove dressing in 3-4 weeks
8. Allow for natural eruption if possible

What is the technique for adults or other patients where you
cant wait for natural eruption?
After healing from the exposure surgery, place a fixed
appliance (possibly a mousetrap appliance) that will allow
for controlled eruption of the canine


MID-ALVEOLAR and LABIAL:
What are the 3 technique used to uncover mid-alveolarly or
labially impacted canines?
1. gingival excision
2. closed eruption
3. apically positioned flap

What determines which technique is chosen to uncover these
impacted canines?
Location of the canine bucco-lingually, mesio-distally, and
vertically relative to the adjacent teeth and the mucogingival
junction
The key is to have enough keratinized, attached gingiva
present above the free gingival margin following the exposure
surgery

1. Gingival Excision:
1. cusp tip of the canine is very close to erupting or near the
normal position on the alveolar ridge
2. the amount of attached gingiva above the new free gingival
margin following the gingival excision will be 2mm or greater
3. the canine can then be left to erupt on its own or an
attachment can be placed for orthodontic eruption


2. Closed Eruption:
1. canine is located mid-alveolarly, but higher on the ridge to the
point that an excisional technique would not leave a sufficient
band of attached gingiva above the free gingival margin
2. a flap is reflected, the bone covering the canine crown is
removed to the height of contour
3. a gold chain is bonded to the crown
4. the flap is replaced and sutured leaving the gold chain
emerging through the gingiva in at the crest of the ridge
5. a ballista spring can be used to erupt the canine through the
crest of the ridge in a controlled manner

3. Apically Positioned Flap:
1. the canine is positioned mesially or distally and typically much
more apical
2. this requires a flap to be reflected making sure that some of the
attached gingiva is taken with the flap and sutured above the
crown of the canine following normal crown exposure and
adequate bone removal
3. an orthodontic attachment is bonded to the canine crown
4. a dressing is placed over the crown to maintain exposure
5. remove the dressing in 3-4 weeks
6. start orthodontic eruption
7. a ballista spring can be used to make sure that the direction of
eruption is appropriately controlled