Impacted Canines

A canine that is prevented from erupting into a normal position, either by bone, tooth or fibrous tissue, can be described as impacted. Impacted maxillary canines are seen in about 3% of the population. The majority of impacted canines are palatal (85%), the remaining 15% are usually buccal. There is sex bias, 70% occur in females. One of the biggest dangers is that they can cause resorption of the roots of the lateral or central incisors and this is seen in about 12% of the cases.

The cause of impaction is not known, but these teeth develop at the orbital rims and have a long path of eruption before they find their way into the line of the arch. Consequently in crowded cases there may be insufficient room for them in the arch and they may be deflected. It seems that the root of the lateral incisor is important in the guidance of upper permanent canines to their final position. There is also some evidence that there may be genetic input into the aetiology of the impaction.

Late referral or misdiagnosis of impacted canines places a significant burden on the patient in relation to how much treatment they will subsequently need. If the canines are in poor positions it will require a considerable amount of treatment and effort in order to get them into the line of the arch and a judgement must be made as to whether it is worth it. Sacrificing the canine is unsatisfactory since this presents a challenge to the restorative dentist, an aesthetic problem and by definition, cannot be used to guide the occlusion. There are times when it might be sensible to consider its loss, but early diagnosis can make a significant difference to how much treatment is needed by the patient.

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