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References

Moyers RE., 4th edn. Chicago: Yearbook Medical Publishers Inc; 1988
Bishara SE. Impacted maxillary canines: a review. Am J Orthod Dentofacial Orthoped. 1992; 101:159-171
Johnston WD. Treatment of palatally impacted canine teeth. Am J Orthod. 1969; 56:(6)589-596
Dewel BF. The upper cuspid: its development and impaction. Angle Orthod. 1949; 19:79-90
McSherry PF. The ectopic maxillary canine: a review. Br J Orthod. 1998; 25:209-216
Hägg U, Taranger J. Timing of tooth emergence. A prospective longitudinal study of Swedish urban children from birth to 18 years. Swed Dent J. 1986; 10:(5)195-206
Ericson S, Kurol J. Longitudinal study and analysis of clinical supervision of maxillary canine eruption. Community Dent Oral Epidemiol. 1986; 14:172-176
The management of the palatally ectopic maxillary canine. The Royal College of Surgeons of England, Faculty of Dental Surgery Clinical Guidelines. 2004. http://www.rcseng.ac.uk
Becker A, Smith P, Behar R. The incidence of anomalous lateral incisors in relation to palatally displaced cuspids. Angle Orthod. 1981; 51:24-29
Peck S, Peck L, Kataja M. The palatally displaced canine as a dental anomaly of genetic origin. Angle Orthod. 1994; 64:(4)249-256
Jacoby H. The etiology of maxillary canine impaction. Am J Orthod. 1983; 84:125-132
Becker A, Chaushu S. Dental age in maxillary canine ectopia. Am J Orthod Dentofacial Orthop. 2000; 117:(6)657-662
Ericson S, Kurol J. Radiographic examination of ectopically erupting maxillary canines. Am J Orthod Dentofacial Orthop. 1987; 91:483-492
Ericson S, Kurol J. Resorption of incisors after ectopic eruption of maxillary canines: a CT study. Angle Orthod. 2000; 70:415-423
Houston WJB, Stephens CD, Tulley WJ.Bristol: Wright; 1992
Ericson S, Kurol J. Resorption of maxillary lateral incisors caused by ectopic eruption of the canines. Am J Orthod Dentofacial Orthop. 1988; 94:503-513
Becker A, Chaushu S. Success rate and duration of orthodontic treatment for adult patients with palatally impacted maxillary canines. Am J Orthod Dentofacial Orthop. 2003; 124:(5)509-514
Ericson S, Kurol J. Radiographic assessment of maxillary canine eruption in children with clinical signs of eruption disturbance. Eur J Orthod. 1986; 8:(3)133-140
Jacobs SG. Radiographic localization of unerupted maxillary anterior teeth using the vertical tube shift technique: the history and application of the method with some case reports. Am J Orthod Dentofacial Orthop. 1999; 116:(4)415-423
Preda L, La Fianza A, Di Maggio EM, Dore R, Schifino MR, Campani R, Segù C, Sfondrini MF. The use of spiral computed tomography in the localization of impacted maxillary canines. Dentomaxillofac Radiol. 1997; 26:(4)236-241
Becker A, Shpack N, Shteyer A. Attachment bonding to impacted teeth at the time of surgical exposure. Eur J Orthod. 1996; 18:457-463
Pearson MH, Robinson SN, Reed R, Birnie DJ, Zaki GA. Management of palatally impacted canines: the findings of a collaborative study. Eur J Orthod. 1997; 19:511-515
Van Noort R., 3rd edn. Oxford: Mosby Elsevier; 2007
Parkin N, Benson PE, Thind B, Shah A. Open versus closed surgical exposure of canine teeth that are displaced in the roof of the mouth. Cochrane Database of Systematic Reviews. 2008; (4) https://doi.org/10.1002/14651858.CD006966.pub2
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Impacted maxillary canines – a perennial problem

From Volume 39, Issue 7, September 2012 | Pages 487-497

Authors

Mohit Mittal

BDS, MFDS RCSEd, MClinDent

Specialist Registrar in Orthodontics, Charles Clifford Dental Hospital, Sheffield and Royal Derby Hospital, Derby

Articles by Mohit Mittal

Alison Murray

BDS, MSc, MOrth RCS(Eng), FDS RCPS(Glasg)

Consultant Orthodontist, Royal Derby Hospital, Derby

Articles by Alison Murray

Jonathan Sandler

BDS (Hons), MSc, PhD, MOrth RCS, FDS RCPS

Consultant Orthodontist, Chesterfield Royal Hospital, Chesterfield, UK

Articles by Jonathan Sandler

Abstract

Ectopic eruption with impaction of maxillary permanent canine teeth is a frequently encountered clinical problem. Surgical exposure and attachment of a gold chain to impacted maxillary canines is often required in order to bring them into the dental arch and to allow good alignment. The principle of radiographic parallax is employed to determine whether the impacted canine is placed buccal or palatal to adjacent teeth. Good flap design allows adequate access to the impacted tooth. Bone removal should be adequate to free the impacted crown to its greatest circumference. An orthodontic eyelet with a gold chain is then bonded to the crown of the impacted tooth. Use of a good bonding technique will minimize chances of bond failure necessitating a second surgical procedure. Atraumatic surgical procedure will allow minimal postoperative complications and a rapid recovery.

Clinical Relevance: This article describes a surgical technique to expose impacted maxillary canines and attach gold chains, to facilitate orthodontic alignment into the dental arch. The principle of radiographic parallax to determine the bucco-palatal position of impacted canines is also discussed.

Article

Ectopic eruption and impaction of maxillary permanent canine teeth is a frequently encountered clinical problem. The maxillary canine is second only to the lower third molar in frequency of impaction.1 The prevalence of impaction or ectopic eruption of the permanent maxillary canine has been reported to range from 0.92% to 2.2%, of which 8% are bilateral impactions. Maxillary canine impactions are twice as common in females (1.17%) as in males (0.51%).2 About one-third of impacted maxillary canines are positioned labially or within the alveolus, and two-thirds are located palatally. A palatally impacted maxillary canine is the most common impaction encountered by orthodontists.3

Development of upper and lower canines commences between 4 and 5 months of age. Maxillary canines have the longest period of development, as well as the longest and most tortuous path of eruption.4 These are the last teeth with a deciduous predecessor in the upper arch to erupt and therefore the most susceptible to environmental influences, such as crowding.5 On average, the maxillary canines erupt at 11–12 years of age and mandibular canines erupt at 9–10 years of age.6

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