Pacific Coast Society of Orthodontists Bulletin Summer 2017 - 22

Program Talk

CBCT is the most commonly used diagnostic
method (N=8), although several programs report
that CBCT is not required; diagnosis may depend
on faculty and ability to localize the canine using
two-dimensional (2-D) radiographic techniques.
The 2-D techniques reported to be in use are periapical radiographs (N=4), panorex (N=4), lateral
cephalograms (N=2), and posteroanterior (PA)
cephalograms (N=1).
The severity of the impaction is determined by
the angle of impaction (N=8), position of the
canine crown (N=7), relationship to adjacent
teeth (N=1), and apex closure (N=1).
Many techniques are used for traction of a maxillary canine that is palatally displaced, including a
modified TPA (N=5), TADs (N=2), elastic thread
(N=5), cantilever arms (N=3), Ballista spring (N=5),
and overlay NiTi archwire (N=3). Similar techniques are used for labially displaced canines,
including overlay archwires (N=5), cantilever
springs (N=4), and elastic thread (N=5). Traction
is typically initiated within two weeks of the
surgical procedure.
If mild root resorption is detected on the maxillary lateral incisor, it is advised to direct the
canine away from the lateral. In some cases, the
lateral will not be bracketed until clearance is

22

achieved. If severe root resorption is detected, the
lateral incisor may need extraction with canine
substitution.
If a canine is ankylosed, indications include
extraction (N=6), leaving it as is (N=2), luxation
(N=1), or decoronation (N=1).
The retention protocol after correction of an
impacted canine does not seem to differ from
traditional retention protocols. Occasionally, a
fixed retainer may be recommended.
Overall, the techniques and diagnostics for
impacted canines seem to be consistent among
programs, with minor expected variability. There
are differences in the amount of exposure the
residents obtain in treating these cases and the
techniques they are likely to perform. 
References
1. Bedoya MM, Park JH. A review of the diagnosis and
management of impacted maxillary canines. J Am Dent
Assoc 2009;140:1485-1493.
2. Bass T. Observation on the misplaced upper canine
tooth. Dent Pract Dent Rec 1967;18:25-33.
3. Becker A, Zogakis I, Luchian I, Chaushu S. Surgical
exposure of impacted canines: Open or closed surgery?
Semin Orthod 2016;22:27-33.

PCSO Bulletin  Summer 2017



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