Pacific Coast Society of Orthodontists Bulletin Summer 2017 - 19

Editorial

Maxillary Canine Impaction

Dr. Jae Hyun Park
PCSO Bulletin Editor

Maxillary canine impaction is a dental anomaly
that affects 1% to 2% of the population.1 It is critical to detect impacted canines early and to provide patients timely care in order to ensure their
canines erupt into the proper positions. It is
essential to inform patients that impaction can
not only affect adjacent teeth and surrounding
structures; it can also drastically affect a patient's
esthetics, occlusion, and arch development.2
Before delving into the variety of diagnostic
and treatment options for maxillary canine
impaction, it is important to first discuss a few
characteristics of canine impaction.
Under normal circumstances, maxillary canines
erupt around the age of 11; however, impacted
canines can be detected when a child is eight
years old. Unfortunately, impacted canines are
usually asymptomatic, so patients are unaware
of their existence. This makes it absolutely critical
that a thorough examination be conducted by a
well-trained clinician if there is any suspicion of
impaction. Conditions that might indicate the
palatal impaction of the permanent canines are
over-retention of the primary canines, absence of
labial bulges, presence of palatal bulges, distal
crown tipping of the lateral incisors, or a history
of aberrant eruption pattern.1,2
Many patients with ectopic canines are referred
late for orthodontic treatment, which results
in lengthy, more complicated treatments and
expensive surgeries to correct the impaction.

According to Ericson and Kurol,
after early extraction of primary
canines, if the maxillary canines
are located mesially to the
midline of the lateral incisor, 64%
are normalized, whereas if the
displaced maxillary canines are
located distally, 91% are
normalized.2

Summer 2017  PCSO Bulletin

Early referral is recommended when there is no
palpable buccal canine bulge in a child of 10 to
12 years, as this suggests palatal impaction of
canines. Maxillary canines that erupt past 13.1
years in boys and 12.3 years in girls are considered
late eruptions.3 Ideally, patients with impacted
canines should be referred to an orthodontist by
the time they are 12 years old.3 While the rates of
timely referrals have improved over the years, the

literature has shown that the mean age of referrals for impaction cases is 14.1 years.3 While many
factors may be behind this delay in referrals, it is
important for both general dentists and orthodontists to be able to correctly identify impacted
canines as early as possible.
The Importance of Early Diagnosis
With regards to treatment options, the best is
prevention. Prevention falls in line with interceptive treatment when the primary canine is
extracted at the appropriate time.1 Once again,
the importance of early diagnosis cannot be
overstated, as it may eliminate the need for interceptive treatment. It is important to closely follow the exfoliation of a child's primary tooth, and
to provide aid if needed, in order to make sure the
permanent canine erupts without any interference. In fact, for children who still have their primary canines as they approach 11 years of age, it
has been proposed that extracting the canines
can help to stabilize the eruption of the permanent canines in 91% of the cases in which the
crowns were distal to the midline of the lateral
incisor roots.2 Detection of maxillary impaction is
absolutely critical, as there are numerous associated risks involving ectopic canines. Canines with
cusp tips medial to the midline of the lateral incisor have an increased chance of developing lateral incisor root resorption, along with cystic
activity or pathology.2,3
Fortunately, many predictive measurements are
available to clinicians. For instance, the deeper
the cusp tip is from the occlusal plane, and the
more perpendicular and closer it is to the midline, the greater the chance that tooth impaction
will be present.1
As with many dental treatments, before a treatment plan can be created, a good radiographic
diagnosis is needed. Cone-beam computed
tomography (CBCT) provides a three-dimensional

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