Pacific Coast Society of Orthodontists Bulletin Summer 2017 - 23
Impacted Maxillary Canines: Survey Responses
University of California,
Los Angeles
University of California,
San Francisco
Arizona School of
Dentistry & Oral Health
University of the Pacific
Approximately how many cases
with impacted canines does each
resident treat?
5 to 10
6
About 4
2 to 3
When potential impaction of a
maxillary canine is recognized in
the mixed dentition, what course
of action is recommended?
Extraction of primary canines, extraction of primary
canines and first molars, expansion, distalization,
observation, extraction of permanent canines, surgical exposure
Extraction of primary canines, extraction Extraction of primary canines,
of primary canines and first molars,
extraction of primary canines and
expansion, distalization
first molars, expansion, distalization, observation
Extraction of primary canines, expansion
For each course of action you
recommended in Question #2,
outline the indications or patient
characteristics that would lead
you to choose that approach.
Extraction of primary canines if delayed and ectopic
eruption of permanent canine; extraction of primary
canines and first molars if delayed and ectopic eruption of permanent canine with severe crowding;
expansion if maxilla is narrow; distalization if Class II
with anterior crowding; observation if delayed but
relatively normal path of eruption; extraction of permanent canines if poor prognosis; surgical exposure
when the natural eruption will not likely allow the
canine to erupt
Extraction of primary canines if canine
tip is past midline of lateral root; angle
>25 degrees; extraction of primary
canines and first molars if moderate to
high impaction risk; more horizontal
position; expansion if moderate or moderate to high impaction risk; distalization
only if the maxillary molars/buccal sections needed distalizing
Extraction of primary canines
depending on the eruption path
of the permanent canine; extraction of primary canines and first
molars when there is an arch
length issue in addition to
unfavorable canine eruption;
expansion with narrow maxilla,
posterior crossbite; distalization if
Class II
Extraction of primary canines if
there is mesial angulation of
canines, root development not completed, canine still above apical 1/2 of
lateral, and less than 60% cross over
the lateral; typically the higher the
canine, the better chance to erupt
normally; expansion if the maxilla is
constricted
To whom is the patient referred
Resident or periodontist for gingivectomy; periodonfor each of the following maxillary tist for apically repositioned flap; oral surgeon for
open and closed exposure, tunnel technique, apicanine exposure techniques?
cotomy, and transalveolar transplantation
Periodontist for gingivectomy, apically
repositioned flap, open exposure, closed
exposure, tunnel technique; endodontist
for apicotomy; oral surgeon for
transalveolar transplantation
Periodontist for gingivectomy
and apically repositioned flap; oral
surgeon for open and closed
exposures and tunnel technique
Resident for gingivectomy; periodontist for apically repositioned flap;
oral surgeon for open exposure, apicotomy, and transalveolar transplantation; periodontist or oral surgeon
for closed exposure and tunnel
technique
Approximately how many of each
of the following techniques does
a resident encounter?
1 to 3 gingivectomies, apically repositioned flaps, open 2 gingivectomies and closed exposures,
and closed exposures, and tunnel techniques
1 open exposure, tunnel technique, and
transalveolar transplantation
2 to 4 gingivectomies, 2 open and 1 to 3 gingivectomies, 1 apically
closed exposures, rarely encounter repositioned flap, open and closed
apically repositioned flap
exposure
Are residents required to be present at exposure appointments?
No
No, but encouraged
Yes
Yes
Which diagnostic tests are routinely used to identify and locate
impacted canines?
Periapicals, panoramic film, CBCT, lateral and PA ceph
images
CBCT
CBCT
CBCT
How is the severity of the
impaction determined?
Angle of impaction, position of canine crown, apex
closure
Angle of impaction and position of
canine crown
Angle of impaction, position of
canine crown, and relationship to
adjacent tooth
Angle of impaction and position
of canine crown, anatomage
manipulation
Is a CBCT image taken on all
patients with canine impactions?
If not, what is the criteria for
choosing to take a CBCT?
It is up to the instructor, but CBCT is encouraged
Yes
Yes
Yes
What techniques are routinely
used for traction of a maxillary
canine displaced palatally?
Each instructor decides the technique most beneficial for the individual case
TPA; TAD, elastic thread; archwire; cantilever arms
Ballista spring, modified TPA,
Nance with spring & elastic
thread, Auxillary cantilever extrusion spring, overlay NiTi wire
Modified TPA w/ elastic thread/PC,
Ballista spring, TADs, tie directly to
the wire, TMA arms from secondary
tube, piggyback NiTi AW
What techniques are routinely
used for traction of a maxillary
canine displaced labially?
Each instructor decides the technique most beneficial for the individual case
Aux. wire; cantilever spring; elastic
thread; archwire
Auxillary cantilever extrusion
spring, overlay NiTi wire
Elastic thread, cantilever TMA arm,
piggyback NiTi AW
How soon after surgery is orthodontic traction initiated?
It depends on the circumstances
Immediately if possible; otherwise,
within 2 weeks
1 to 2 weeks
Immediately if possible; otherwise,
2 weeks
If mild root resorption is detected
on the maxillary lateral incisor,
what is the next step? How does
this change if the root resorption
is severe?
Find a path that will not further damage the root;
if severe, consider extracting the damaged lateral
incisor
Direct traction of the cuspid away from
the lateral root; if severe, consider a
change in Tx plan, possibly to extract
lateral
Depends on crowding status;
if the root resorption is severe
and crowded, extract the lateral
incisor and substitute with the
canine
Make sure to remove the bracket, or
don't place a bracket on the lateral
until the canine moves out of the
way; if severe resorption is present,
may consider extraction and canine
substitution as one of the options
What is the protocol for ankylosed Extraction, surgical positioning, maintaining, working Extraction
around it, all depending on the circumstances
canines?
Very rare situation
Luxation, propel, eval for possible
apicotomy, extraction as last resort
What is the retention protocol
after correction of an impacted
maxillary canine? Does retention
design vary based on severity /
location of impaction? If so, how?
Depends on severity of impaction
and location and degree of
rotation
Due to the possibility of relapse, we
recommend fixed retainer 3-3 and/or
an Essix retainer
No difference in retention
Summer 2017 PCSO Bulletin
Essix retention may be favored
23
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