Treatment for Impacted Teeth – Upper Canines

Impacted upper canines and self-correction
It's important to choose effective treatment for impacted teeth.

We often hear about impacted teeth, but most patients are not sure what it really means. We will discuss what an impacted upper canine is, why treatment is important, and treatment options available to correct it.

What’s an impacted upper canine?

Impacted and normal maxillary caninesAn impacted canine is essentially one that is oriented so that it cannot erupt into the mouth. These impacted canines are most common in the upper jaw.

They can be positioned to the outside of the jaw, or more commonly aimed toward the middle of the palate. The latter is known as a palatally-impacted canine, and we shall focus on this situation.

(The red arrow indicates a palatally-impacted upper canine, and the green arrow indicates a normally-erupting canine.)

What are the treatment options for impacted upper canines?

Primary canine to be extracted to allow eruption of impacted permanent canine.The standard treatment is to place braces on the other teeth and having an oral surgeon or gum specialist expose the canine by removing the “soft tissue” covering the tooth.

A bracket with a gold chain (I know, how early 80’s!) is typically attached so that the orthodontist can gently move the canine into its proper position in the dental arch. This usually adds about 6 months to standard orthodontic treatment.

However, there is a “hack” that can be done to raise the odds of an impacted canine self-correcting. That is to remove the primary or baby canine (yellow arrow to the left) that is holding space for the permanent one.

By how much are the odds of self-correction improved?

Two recent systematic reviews of previously published research indicate that there is a 25-30% better chance of self-correction, or the canine erupting into the mouth if the primary canine is extracted. The second review is linked here.

In my opinion, this is a low-risk potentially high yield option that should be considered in patients aged 9-12. Some factors include how out of position the permanent canine is, and how far along the dental development is in general.

The bottom line:

If your child is diagnosed with a palatally-impacted canine or is at risk of one developing, then extraction of the corresponding primary canine is a discussion you should have with your orthodontist. Feel free to contact us if you have questions about this blog post.

*Acknowledgement to Dr. Kevin O’Brien for evaluating the two referenced systematic reviews in his blog.


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