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With the exception of third molar teeth, the maxillary canine is the most frequently impacted tooth, with the majority of these being palatally ectopic. When patients present with impacted canines there can often be several treatment options available to them. These could include interceptive treatment, exposure and alignment of the canine, extraction of the impacted tooth or acceptance of the deciduous canine. It is important that treatment decisions determining the ‘fate’ of palatally impacted canines should be taken on a case-by-case basis.
CPD/Clinical Relevance: The clinician should understand that several options might be available to the patient presenting with a palatally ectopic maxillary canine, in order to allow an informed choice of treatment.
Article
The maxillary canine tooth is usually one of the last teeth of the permanent dentition to erupt, normally between the age of 11 and 12 years.1 With the exception of third molar teeth, the maxillary canine is the most frequently impacted tooth, with a prevalence between 0.2%−2.8%, affecting female subjects 2.3−3 times more frequently than males.2
The majority of maxillary impacted canines are also ectopic, with literature showing 61% to be palatal and 35% buccal to the line of the arch.3
The exact aetiology of palatal maxillary canine ectopia is unknown, although four distinct groupings of causation have been described:2
It is thought that the strongest influence for palatal canine impaction relates to local factors. The ‘guidance theory’ suggests that the lateral incisor is an important contributor to canine ectopia owing to a loss in guidance for the eruption path of the canine, which is the longest in the dentition, at a distance of 22 mm. This theory is supported by a significantly increased incidence of maxillary canine impactions in patients with missing, peg-shaped or microdont lateral incisors.2
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