Diagnosis

It is easy to miss non-eruption of the permanent canines, but there are some markers which should increase suspicion of possible impaction. Any case with a deep bite, missing lateral incisors or peg-shaped upper lateral incisors needs a detailed examination. Figure 1 shows such a case and in this instance both canines were significantly impacted on the palatal aspect. The retained deciduous canine is self evident. Other clues include root and crown positions. Figure 2 shows a lateral incisor which is proclined. There

Fig. 1 Typical features which should arouse suspicion of impacted canines. There is a deep bite and a small peg-shaped lateral incisor. The retained deciduous canine is obvious. In this patient both upper permanent canines were palatally positioned

Fig. 2 There are clues as to the whereabouts of the upper right permanent canine in this patient. The upper right lateral crown is proclined because the upper right permanent canine is buccally positioned and therefore places pressure on the root moving the crown of the lateral incisor labially and the root of the lateral incisor palatally

Fig. 2 There are clues as to the whereabouts of the upper right permanent canine in this patient. The upper right lateral crown is proclined because the upper right permanent canine is buccally positioned and therefore places pressure on the root moving the crown of the lateral incisor labially and the root of the lateral incisor palatally

Fig. 3 Consequences of failure to diagnose impacted canines. This radiograph shows the roots of the upper lateral incisor to be resorbing
Fig. 4 The patient shown in Figure 3 had both lateral incisors removed because of the severe root resorption caused by the unerupted permanent canines

is a retained deciduous canine and the permanent canine lies buccal which moves the root of the lateral incisor palatally and the crown labially.

Any general dental examination of a patient from the age of 10 years should include palpation for the permanent canine on the buccal aspect. It is possible to locate the canines with palpation, but this will lead to some false observations. For instance, the buccal root of a decidous canine, if it is not resorbing, can feel like the crown of the permanent tooth. It is therefore important to back up clinical examination with radiographs. Failure to make these observations will eventually result in patients complaining of loose incisors; inevitably some permanent canines will resorb adjacent teeth with devastating efficiency as shown in Figures 3 and 4.

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