The surgical removal of an impacted canine: diagnosis, investigations and technique

The surgical removal of impacted maxillary canines is a commonly performed procedure in oral surgery. Indications for this procedure include impacted canines causing root resorption or hindrance of eruption of other teeth and canines undergoing cystic change.^1,2 During this process, diagnosis and investigation are achieved through clinical examination, palpation and radiographic imaging. Clinicians routinely use the horizontal or vertical parallax technique which involves using radiographic images taken at different angulations. This is usually performed to help determine the location of the impacted tooth. High quality radiographic imaging in the maxillary incisal region may also help identify local anatomical features, such as the nasopalatine foramen. It is important to identify such features during the surgical treatment planning stages.

A 19-year-old female was referred to the oral surgery department for the orthodontic extractions of her retained URC and ULC to aid management of her impacted canines.³ Upon clinical and radiographic investigations, it was determined that the maxillary canines were positioned unfavourably and would not be suitable for orthodontic extrusion; thus needing to be surgically removed.⁴ The patient had an underlying skeletal malocclusion that required a bimaxillary osteotomy. However, the patient was not keen on orthognathic surgery. Thus it was agreed by the orthodontist and patient to mask her bimaxillary proclination with orthodontic camouflage, by removing her impacted canines and bringing her maxillary first premolars anteriorly to mimic canines.