orthodontic management of impacted canine.

Presented by,
Dr. MUHAMMAD SHAFAD
MANAGEMENT
OF
IMPACTED CANINE
MANAGEMENT OF IMPACTED CANINE

CONTENTS
1.Introduction
2.Commonly impacted tooth
3.Incidence of canine impaction
4.Classification of impacted canine
5.Etiology of impacted canine
6.Theories of canine impaction
7.Localization of impacted canine.
8.Prognosis of impacted canine
9.Management of impacted canine
10.Retension consideration
11.Conclusion
12.REferences

Introduction
 IMPACTUS (latin origin) = pushed against
 Impacted tooth is one that fails to erupt and will not
attain its anatomical position beyond the chronological
eruption date even after its root completion
 Archer (1975) defines impacted tooth as one
which is completely or partially unerupted and is
positioned against another tooth or bone or soft
tissue so that its further eruption is unlikely.
Archer William H. Oral and Maxillofacial Surgery, Vol. I,ed. 5, Philadelphia, WB Saunders Co. 1975

COMMONLY IMPACTED
TEETH
◦ Mandibular third molar
◦ Maxillary third molar
◦ Maxillary canine
◦ Mandibular premolars
◦ Maxillary premolars
◦ Mandibular canine
◦ Maxillary central incisor
◦ Maxillary lateral incisor

Calcification and eruption of
maxillary canines
◦ Calcification begins 4 months
◦ Enamel complete 6-7 years
◦ Eruption 11-12 years’
◦ Root completed 13-15 years
◦ Important anatomical risks are
◦ Longest course of development
◦ Deepest area of development
◦ Most circuitous path of eruption

Incidence
Dachi and Howell
reported that the
incidence of
maxillary canine
impaction is
0.92%(Dachi SF, Howell FV. A
survey of 3,874 routine full mouth
radiographs. Oral Surg Oral Med Oral
Path 1961;14:1165-9.)
Thilander and Myrberg
estimated the cumulative
prevalence of canine
impaction in 7 to 13-
year-old children to be
2.2%(Thilander B, Myrberg N.
The prevalence of malocclusion in
Swedish school children. Scand J
Dent Res 1973;81:12-20.)
Ericson and Kurol
estimated the incidence
at 1.7% Impactions are
twice as common in
females (1.17%) as in
males (0.51%).(Ericson S,
Kurol J. Radiographic assessment of
maxillary canine eruption in children
with clinical signs of eruption
disturbances. Eur J Orthod
1986;8:133-40.)
Of all patients
with maxillary
impacted
canines, it is
estimated that 8%
have bilateral
impactions

The incidence of
permanent canine
impactions was 20 times
higher in the maxilla
than in the mandible.
(Johnston WD. Treatment of palatally
impacted canine teeth. Am J Orthod
1969;56:589-96.)
Becker et al. reported
that the palatally
displaced canines
occurred three times
more frequently than
those found buccally.
(Becker A, Smith P, Behar R.
Theincidence of anomalous maxillary
lateral incisors in relation to
palatally-displaced cuspids.
AngleOrthod 1981;51:24-9.)
Johnston reported that
the palatal impactions
were twice as common
as the labial impactions.

CLASSIFICATION OF IMPACTED CANINE
Impacted canine
Maxillary canine Mandibular canine
Buccal Palatal LingualBuccal

Classification of impacted maxillary
canine:
ARCHER”S CLASSIFICATION
1) Class I
Palatally Impacted canine
a) Horizontal
b) Vertical
c) semivertical
2)Class II
Buccally impacted canine
a) Horizontal
b) Vertical
c) Semivertical
3)Class III
Impacted canine located in both the palatal and labial surfaces.
4)Class IV
Impacted canine located in the alveolar process.
5)Class V
Impacted canine located in an edentulous maxilla.
6)Class VI in aberrant position.
•

Classification by ACKERMAN and FIELDS in 1935.
IMPACTED CANINE
Horizontally vertically
Palatal
Above
Labial
Mid- alveolar
Below
( With respect to the arch)
(With respect to the apex)
(J CO 1979 DEC)

Etiology of impacted canine
Becker Concepts :
◦ Becker (1984) hypothesized two processes in the palatal impaction of the
maxillary canine:
1. Absence of initial early guidance from an anomalous lateral incisor
2. Failure of buccal movement of the canine at an unspecified age .
MC Bridge Concept
Canine formed at high level in the anterior wall of antrum, below the floor of
orbit, having long tortous path of eruption.

Etiology of impacted canine
• LOCALIZED
• SYSTEMIC
• GENETIC

LOCALIZED
Tooth size- arch length discrepancies
Failure of the primary canine root to resorb
Prolonged retention or early loss of primary
canine
Ankylosis of permanent canine
Cyst or neoplasm

LOCALIZED
Dilaceration of the root
Absence of maxillary lateral
incisor
Variation in timing of lateral
incisor root formation
Iatrogenic factors
Idiopathic factors

SYSTEMIC
Endocrine deficiencies
Febrile diseases
Irradiation

GENETIC
Heredity
Malposed tooth germ
Presence of alveolar cleft

Theories of canine impaction
GUIDANCE
THEORY
GENETIC
THEORY

• Canine erupts along the root
of lateral incisors, which serve
as a guide, and if the lateral
incisor is absent or malformed,
the canine will not erupt.
GUIDANCE
THEORY

• Genetic factors are primary
origin of palatally displaced
maxillary canine and include
other possibly associated
dental anomalies, such as
missing or small lateral incisor.
GENETIC
THEORY

SEQUELAE OF IMPACTED CANINE
Labial or lingual
malpositioning
of impacted
tooth
Migration of
neighbouring teeth
and loss of arch
length
Internal resorption or
external root
resorption of impacted
or neighbouring tooth
Dentigerous cyst
formation
Infection particularly
with partial eruption
Referred pain

CLINICAL EVALUATION
• Amount of space available in dental arch
for impacted canine is assessed in model.
Study model
analysis
• Gives clue of position of impacted tooth.
Morphology of
adjacent tooth
• Canine bulge present buccally or palatally.
Contours of
adjacent alveolar
bone
• Root resorption.
Mobility of adjacent
tooth

RADIOGRAPHIC METHOD FOR DIAGNOSIS
In Orthodontic treatment planning, the exact localization of
the position of an impacted canine is necessary.
Periapical
Mandibular arch
Max. ant. occlusal True vertex/occlusal
OPG Lateral ceph
Extraoral
I. Qualitative radiographs
Maxillary arch Occlusal
PA view

Parallax method
Radiographic views at different angle
angle
II. 3-D diagnosis of the position
C T scanning

Periapical Radiography-
•Are the simplest and the most informative X-ray films.
• As this view passes through minimum of surrounding
tissues, it gives accuracy & quality of resolution.
•

The periapical film gives the following information:
[1] Presence or absence of impacted tooth.
[2] Stage of development.
[3] Presence & size of follicle.
[4] Indicates crown or root resorption, resorption pattern
& integrity.
[5] Indicates presence or absence of supernumerary tooth.
[6] Indicates soft tissue lesions like cysts.

1.Maxillary anterior occlusal
• In the maxillary arch, the nose and forehead interfere with
the positioning of x-ray tube close to the area to be viewed.
• The best that can be achieved by positioning the tube
close to the face, so that it becomes high and steeply angled
view.

2. Ture vertex / occlusal
• A true vertex view is one which passes parallel to the long
axis of central incisors.This is possible if the cone is placed
over the vertex of the skull to produce vertex occlusal film.
• Since the beam has to travel a great distance there is loss of
clarity.

Extraoral Radiography:
• OPG has the advantage of simplicity & quickly
offering a good scan of the teeth & jaws from
Temporomandibular joint to Temporomandibular joint.

Ericson and Kurol in 1988 defined number of sectors to
denote different types of impaction
i. Sector 1: if the cusp tip of the canine is between the
interincisor median line and the long axis of the central
incisor;
ii. Sector 2: if the peak of the cuspid of the canine is
between the major axes of the lateral and central;
iii. Sector 3: if the peak of the cuspid of the canine is
between the major axis of the lateral and the first premolar.

 Parallax method:
- By Clark & Richards
• Principle:
• 2 periapical views of the same object are taken from
slightly different angles which can provide depth to
the flat 2-D picture depicted by each of the films
individually.
• Useful in distinguishing the buccal or lingual
displacement of the canine.

 Procedure:
1. In the periapical film, the
X-ray is taken in the area of
interest with the X-ray beam
passing perpendicular to a
tangent to the line of arch at
this point & at an appropriate
angle to horizontal plane.

2. In the second film, the X-ray tube is shifted mesially or
distally round the arch but held at the same angle to the
horizontal plane. The X-ray tube should describe between
30-450 of an arc of circle whose centre is somewhere in
the middle of the palate.

 Result:
• It is based on the SLOB principle.
• If the object has moved on the same side as that
of the X-ray tube it is lingually placed & if it has
moved on the opposite side it is on the buccal
side

Radiographic views at right angles:
1. A true lateral view {e.g. Lateral
cephalograph} gives information
regarding the antero-posterior &
ventral location of an object . However,
it gives no information regarding
bucco-lingual {transverse} plane of an
object.

Readings under 10° are considered to be
within the norm;
1. between 15 and 25°, the possibility of
the necessity of treatment are increased;
2. between 25 and 45°, spontaneous
growth is an exception and the difficulties
involved in treatment increase;
3. Over 45°, reservations as to the
possibilities of treatment success arise.

2. A true occlusal view will provide information in the
transverse & antero-posterior direction of an object .

3. True postero-anterior view defines the
ventral plane & buccolingual
relationship of an object.
• These views provide complete information regarding
3 planes of space of any impacted teeth .

CT Scanning:
By Ericson & Kurol
• Used to diagnose the exact
position of an impacted
tooth.
• Clear serial radiographs
may be taken at graduated
depth in any part of
human body in this
method.

• This technique allows the
elimination of
superimposition of other
structures.
• It is however rarely used in
the diagnosis of impacted teeth
because of
(1) Large radiation
dosage.
(2) High cost.

CBCT
Because of superimposition of structure on the film it become difficult to
distingusish the details which makes the diagnosis and treatment planning
difficult with conventional radiographic methods.
◦ 1. The exact position of the crown and root apex of the impacted tooth and
orientation of the long axis.
◦ 2. The proximity of the impacted tooth to the roots of the adjacent teeth.
◦ 3. The presence of pathology, such as supernumerary teeth, apical granulomas,
or cysts, and their relationship with the impacted tooth.
◦ 4. The presence of adverse conditions affecting adjacent teeth, including root
resorption.
◦ 5. The anatomy and position of crown and root

DETERMINING THE PROGNOSIS
◦ FACTORS INFLUENCING THE TREATMENT
DECISION OF AN IMPACTED CANINE
Position of canine –
Favorable or Unfavorable
Age of patient
Availability of space
Presence of adequate
width of attached gingiva
VERTICA
L RULE
OF
THIRDS
HORIZONT
AL RULE
OF THIRDS

MANAGEMENT OF
IMPACTED CANINE
Interceptive treatment.
Treatment of labial impaction.
Treatment of palatal impaction
Methods of applying traction.
Retention consideration.

INTERCEPTIVE TREATMENT
◦ When the clinician detects early signs of
ectopic eruption of canines, an attempt should
be made to prevent their impaction and its
potential sequelae.
◦ Selective extraction of the deciduous canines
as early as 8 0r 9 years of age.
◦ Normalize the eruption of ectopicaly erupting
permanent canine.

Labial impaction of upper canine
◦ Due to ectopic migration of canine crown over
the root of lateral incisor or insufficient space in
the arch caused by midline shift of dental origin.
◦ Arch length- tooth material discrepancy is the
most common cause.
◦ Extraction of deciduous canine at early age of 8
or 9 years will enhance eruption and self
correction of labial impaction.

Labial
impaction
Initial orthodontic treatment was aimed
at creating space in the maxillary arch
with fixed appliance therapy.
Surgical exposure and orthodontic
traction.

SURGICAL EXPOSURE
◦ Indicated when tooth does not erupt
spontaneously after creating space in the arch.
◦ Attempted 6 months after the root formation
◦ Flap designs should preserve the band of
attached gingiva and should guide tooth to
erupt through its natural path of eruption.

Open technique
• Excisional approach
Canine crown
coronal to
mucogingival
junction
• Apically positioned flap
Canine crown
apical to
mucogingival
junction

Closed eruption technique
◦ Indicated if tooth is impacted in the centre of
the alveolus.
Flap is elevated
Attachment placed on impacted
tooth
Ligature or chain placed over the
attachment to activate after a week
Raised flap is repositioned in its
original location
Permit eruption of impacted canine
in normal direction

PALATAL impaction of upper canine
• Crown is surgically exposed, an attachment
is bonded during the exposure, flap is
sutured back, leaving a twisted ligature wire
passing through the mucosa to apply
orthodontic traction.
CLOSED
ERUPTION
• A flap is raised, bone covering crown is
removed, small window or fenestration is
made, orthodontic attachment is bonded
and flap is sutured in to place.
OPEN
WINDOW
ERUPTION
TECHNIQUE

Surgical Exposure of impacted
tooth:
 Circular incision or
open approach :
 Advantages:
a) Easy to perform
b) Suitable access can be
provided for bonding of the
attachment
c) Reduction of impaction is
rapid.
A simple palatal impaction (cusp tip
of the canine at the same level of the
cemento-enamel junction of lateral
incisor or central incisor) usually
requires open surgical exposure.

 Disadvantages:
a) Tooth will be invested on labial side with thin oral mucosa
rather than attached gingiva.
b)Typical soft tissue contour aggravates Plaque acclumation
which leads to gingivitis. Inflammation will prevent
regeneration of the Periodontal ligament which leads to
apical movement of the epithelial attachment

PERIODONTAL CONSIDERATION
◦ Excisional technique must be parformed only when
sufficient gingiva is present, to provide atleast 2-3mm of
attached gingiva over the canine crown after it has
erupted.
◦ If crown is positioned mesially and over the root of the
lateral incisor, the crown should be exposed completely
with an apically positioned flap.

 Apically Repositioned Flap:
◦ This method was proposed by Vanarsdall and corn in 1977.
 procedure:
◦ In cases without deciduous canine, Mucoperiosteal flap is elevated from the
crest of the ridge that includes attached gingiva.
◦ In cases with deciduous canine, tooth was extracted and the flap was
designed to include the entire area of buccal gingival that invest it.
◦ In either cases, Split thickness Flap is elevated by incision made vertically
into the vestibule someway up into the sulcus,to expose the canine.
◦ 2/3rd of bone covering the crown was removed.
◦ Connective tissue follicle was curreted from periphery of the exposed
portion of the crown.

◦ Flap is then sutured to the labial side of the crown of the permanent canine, to
cover the denuded periosteum and overlying cervical portion of the crown; while
remainder portion of the crown is exposed.
◦ Surgical dressing was placed on enamel to prevent overgrowth of adjacent tissue.
Dressing was removed 1 week post operatively. After 2
weeks, orthodontic traction was started.

 Advantages:
a) Maintain the width of attached gingiva
b) Easy access for bonding of the attachment
c) Tooth can be visualized from the time of exposure
still it come to occlusion
 Disadvantages: Vermette , 1995
a) Uneven and unesthetic gingival margin
b) Increased Clinical crown length
c) Some degree of attachment and bone loss on the labial
surface,which was considered as possibly related to an
increased potential for plaque accumulation.
d) Vertical orthodontic relapse : After apical repositioning the
gingival tissue heals to the adjacent mucosa, producing soft
tissue band of gingival scarring. As the tooth is pulled incisally
this mucosa get stretched down with it,toward the alveolar
crest.Thus it tend to relapse once the force is released .

Full Flap Exposure:
◦ This method was proposed by MCBride in 1979.This method is more
effective for buccal and palatally impacted tooth.
 Procedure:
◦ A full buccal surgical flap is raised to expose the canine.An attachment is
bonded to the tooth and the flap is sutured back to its former place itself.
◦ Then a Twisted thread is tied to the bonded tooth and then drawn inferiorly
and through the sutured ends of the replaced flap, or through the crest of
the ridge or through the socket vacated by the extracted deciduous canine.
Advantages:
a) Tooth can be erupted towards and through the attached gingiva
which maintains the width of the attached gingiva
b) No gingival scarring and good periodontal attachment is established
c) No vertical relapse
d) Conservative bone removal
e) Immediate traction possible
f) Less discomfort and good post operative Haemostasis

 Disadvantage:
a) Placement of the bonding attachment is necessary at the time
of exposure
b) If there is a bond failure it needs re-exposure
c) Difficulty in gaining dry field
d) Buttonholing: This occurs because of the buccal
prominence of the tooth, lack of buccal
bone and relative tightness of the
replaced flap. The damage to the
mucogingival tissue is due to the bulk
of wide and high profile conventional
bracket, which may leads to a breakdown of
the overlying tissue to cause a dehiscence.

LASER FOR IMPACTED CANINE EXPOSURE
Light Amplification by Stimulated Emission of Radiation
LASER exposure gives bloodless are for attachement bonding.
Both soft tissue and hard tissue lasers are available
Painless procedure with minimum post operative discomfort
Procedure can be done under sufrace local anaesthetics.

Attachments: –
 Lasso wires
 Threaded pins
 Orthodontic bands
 Standard orthodontic bracket
 A simple eyelet
 Elastic ties and modules
 Magnets

{a} Lasso wires:
It is twisted lightly around the neck of the canine.
Disadvantages:
 This results in irritation of the gingiva
 Prevents reattachments of the healing tissues in area of
CEJ (cemento-enamel junction).
 May produce areas of external resorption & ankylosis in
areas of CEJ.
So, it is rarely used now.

(b) Threaded Pins:
Provide the attachment for
an impacted tooth.
Disadvantages:
- Dentally invasive.
- Requires a subsequent restoration.
- Difficult to place along the long axis of the tooth because of
smaller surgical exposure.
- The drilled hole may inadvertently enter the pulp(unerupted
teeth may have large pulp chambers).
So it is rarely used.

{c} Orthodontic bands:
They largely replace the
Lasso wires & threaded pins.
Advantage:
They are compatible with the health of periodontal
tissues.
Disadvantage:
- Large surgical field required.
- Inadequate moisture control may hamper with the
cement-band bond.

{d}Standard orthodontic brackets:
• Any edge-wise , Begg’s , PAE brackets can be used.
• They are routinely used as direct attachments along
with the composites.

Disadvantages:
- As the bracket base is wide, it is difficult to adapt to
any other tooth surface except for the buccal surface.
- The bracket’s shear bulk creates irritation as the tooth
is drawn the soft tissues.
- Ligature wire or elastic thread tied to bring the
impacted tooth into arch.

{e} A simple eyelet:
Advantages:
- An eyelet welded to band material with a mesh backing is soft
& easy to contour making its adaptation to bonding surface more
accurate which makes for superior retentive properties.
- Because of small size they can be placed in more awkwardly
placed teeth.
- It is less irritating to the surrounding tissues.

(f) Elastic ties and modules
Advantages
- Application of light forces
- Good range of action
- Easier to tie
Disadvantages
- Tends to loosen
- High degree of force decay

{f} Magnets:
It is made up of rare earth lanthanide alloys .
• It is rarely used.
Disadvantage:
- corrosion.

 Ballista Spring (Jacoby 1979)
◦ A ballista loop is a simple, convenient, unobtrusive method
of applying a vertical vector of force to a palatally impacted
tooth to erupt the crown into the center of the alveolus.

• It is made of rectangular wires.
• It proceeds forward until it is opposite to canine space and bent vertically
downwards and terminate into a small loop.
• With slight finger pressure ,spring is tied to pigtail ligature, by this it provide an
extrusive force for the canine to erupt.
• If the impacted tooth is resistant to movement or if the distance for the tooth to
move is more it will leads to lingual molar root torque leads to loss of
anchorage. To overcome this feature TPA is used.

Guiding tooth to oral enviroment :
I) Active palatal arch (Becker1978)
• It consist of fine 0.020 inch removable palatal arch wire carrying an omega loop
on each side.
• End of the wire is doubled for Frictionless fit in lingual sheath.
• It is activated by elevating downward activated palatal arch wire and hooking the
pigtail ligature around it

3) Light Auxiliary Labial Arch (Kornhauser1996)
It is made up of 0.014 inch round SS wire with vertical loops in the
• This loop has a small helix.
• Wire is tied with the basal arch wire in piggyback fashion.
• If basal arch wire is not used it will leads to extrusion of adjacent tooth and
cause alteration of occlusal plane .

Kilroy spring:
• The Kilroy Spring is a constant force module
that is slid onto a rectangular archwire over
the site of an impacted tooth.
• In the passive state, the vertical loop of the
Kilroy Spring extends perpendicularly
from the occlusal plane (Fig. 2).
• To activate the spring, a stainless steel
ligature is guided through the helix at the
apex of the vertical loop, and the loop is
directed toward the impacted tooth. The
ligature is then tied to an attachment that has
been direct-bonded to the surgically exposed
tooth. (Fig. 3)

Kilroy II Spring
• The Kilroy II Spring was designed to
produce more vertical than lateral eruptive
forces for eruption of buccally impacted
teeth.
• Its multiple helices increase its flexibility, but
also increase the likelihood of impingement
on the adjacent soft tissue.
• Consequently, more frequent progress
checks are recommended with the Kilroy II.

THE K- 9 SPRING
•Varun Kalra (2000)
• Made in 0.017”X 0.025”TMA wire
 Advantages:
• Simple in design
• Low cost
• No patient compliance
• Light continuous eruptive and distalizing
forces
JCO Oct 2000

CANTILEVER SPRING
 Lindauer and Isaacson
(1995)
• TMA .017 X .025 wire used
• Force generated was measured
by dontrix guage.
• It should not exceed 70gms.
JCO Feb 1999

TMA BOX LOOP
• TMA .017 X .025 wire
used.
• Produce sagittal and
horizontal corrections while
continuing vertical eruption.
Surendra Patel J C O 1999

THE MONKEY HOOK
S.Jay Bowman (2002)
• It is a simple auxiliary with an open loop on each
end for the attachment of intra oral elastic or
elastomeric chain or for connecting to a bondable
loop button. JCO July 2002

A combination of monkey hooks and bondable loop-
buttons allows the production of a variety of different
direction force such as:
I. Vertical intermaxillay eruptive forces
JCO July 2002

MANDIBULAR ACHORAGE
• Pramod K.Sinha (1999)
• Lingual arch is fabricated with 0.036 inch SS wire
• Vertical hooks (5-6mm in length)
• Elastic force should not exceed 40-60 gm
AJO March 1999

Advantages
• Simplicity in appliance
design and application
• Reduced overall treatment
time

AUSTRALIAN HELICALARCHWIRE
• Christine Hauser (2000)
• Made in special plus .016”
arch wire
• Force should not exceed
200 gm
• Activation by twisting the
steel ligature wire every two
weeks

◦ This technique consist of double
wires (auxiliary and base wire) , the
auxiliary wire can be segmented or
continuous.
◦ The applied forces to the malposed
tooth create undesired tooth
movements in the abutment teeth, a
sequence of wires is usually required
to realign all of the teeth. The
Piggyback technique helps to avoid
this waste of time and resources

◦ Advantages :
◦ NiTi wires are considered ideal as they provide a relatively
constant, light force with high flexibility and range
allowing engagement of significantly displaced teeth.

 CRESCINI approached a method called as TUNNEL TRACTION.
Procedure:
a) Extract deciduous canine
b) Full thickness mucoperiosteal flap is elevated to expose the
cortical plate.
c) Drill with bur until exposing crown of canine
d) Tooth was bonded and ligature wire tied
e) Traction force given after 1week of surgery
Advantage:
a) No buccal or palatal access
b) No loss of supporting tissue
Disadvantage:
a) Post operative discomfort will be more.

MIINI IMPLANT SUPPORTED
DISSIMPACTION SPRING

•Spring is made up of 17*25 TMA wire or 17*25 SS wire.
•Rectangular wire is preferred over round wire.
•It is designed in such a way that length of wire increases ,so
tht range of action of spring increases.
•It is giving a force of 100gm to 120 gm when it is activated
,and force can vary according to the amount of activation of
spring.
•Occlusal slieve will be placed on horizontal arms to prevent
soft tissue disturbance

DISSIMPACTION SPRING-PARTS
U loop to engage the attachment from impacted
canine
(Position of u loop has planned 2 mm mesial to
the 34 to give a verical aswellas a distalizing force
to dissimpact mesially impacted canine)
Horizontal
arm(occlusal)
Helix where spring is activating
Horizontal arm(gingival)
Vertical arm
Occlusalslieves on horizontal
arms
Activated helix

Non activated spring
Activated spring by opening the helix
Checking on patient
cast
Spring delivers 100 gm of force on forcful
engagement

CBCT at the begnning of
dissimpaction
LASER
exposure
Miniimplant placement
PRE TREATMENT
RADIOGRAPH
MID TREATMENT
RADIOGRAPH

Springis acivated in such a
way tht it delivers 100 gmof
force .
Force delivery was confirmed
by using dontrix guage.
Spring is secured on implant
head by using 0.010steel
ligature wire .

Patient has recalled in every 30 days for activation of spring
Activation is done by tightening the ligature wire engaged to U loop
of spring
Force delivery was confirmed in every appointments by using dontrix
guage
Afer 2 months canine position has confirmed by using IOPA

references
1.Modified dissimpaction spring for impacted canine:Syed Omar Aziz,Arun Nayak et
al:APOS trend in Orthodontics,2015
2.Effect of canine dissimpaction performed with temporary anchorage devices(TAD)
before comprehensive orthodontic treatment to avoid root resorption of adjacent
tooth:Farzin Heravi,Hooman Shafaee, et al:Dental Press Journal Of
Orthodontics,2016
3.Skeletal anchorage in the treatment of impacted teeth:Stella Chaushu,Cavriel
Chaushu:Semin Orthod ,2010
Extrusion of impacted teeth using mini-implant mechanics:Nienkemper M, Wilmes
B,etal: J Clin Orthod, 2012

RETENTION CONSIDERATION
Relapse of rotations and spacing may occur after completion
of the orthodontic treatment of an impacted canine.
SUPRACRESTALFIBROTOMY
FIXED RETAINERS
REMOVAL OF HALF MOON SHAPED WEDGE OF TISSUE
( To prevent lingual drift of palatally impacted canine)

To minimize rotational relapse, options available are
1. Fiberotomy
2. Bonded fixed retainer
This can be done during or after the treatment.
Clark’s suggestion for palatally impacted canine: Lingual
drifting can be prevented by removal of halfmoon- shaped
wedge of tissue from lingual aspect of canine.

CONCLUSION:
◦ Various surgical and orthodontics techniques may be used to recover
impacted maxillary canines.
◦ Proper management of these teeth requires appropriate surgical
techniques to apply forces in a favourable direction and to have
complete control for efficient correction, thereby avoiding damage to the
adjacent teeth.
◦ The management of impacted canine is a complex procedure requiring
a multidisciplinary approach.
◦ The clinician should communicate with each other to provide the patient
with an optimal treatment plan based on scientific rationale.

REFERENCES
◦ Impacted mandibular canine:Muhammet Selim Yavuz,Mutan Hamedi,et al:The Journal Of Contemporary Dental
Practice,volume 8,2007
◦ Prevalence of impacted canine in population of western part of india:Santhosh Patil,Sneha Maheswari:Universal
Research Journal Of Dentistry:volume 4,2014
◦ The monkey hook,An auxillary for impacted,roatated and displaced teeth:S.J Bowman,Aldo Carano:JCO ,2002
◦ Kilroy Spring for impacted teeth: S.J Bowman,Aldo Carano:JCO ,2003
◦ Ballista spring system for impacted teeth:Harry Jacoby:Am J Ortho,1979
◦ Modified dissimpaction spring for impacted canine:Syed Omar Aziz,Arun Nayak et al:APOS trend in Orthodontics,2015
◦ Effect of canine dissimpaction performed with temporary anchorage devices(TAD) before comprehensive orthodontic
treatment to avoid root resorption of adjacent tooth:Farzin Heravi,Hooman Shafaee, et al:Dental Press Journal Of
Orthodontics,2016
◦ Skeletal anchorage in the treatment of impacted teeth:Stella Chaushu,Cavriel Chaushu:Semin Orthod ,2010
◦ Extrusion of impacted teeth using mini-implant mechanics:Nienkemper M, Wilmes B,etal: J Clin Orthod, 2012
◦ The Orthodontic Treatment of Impacted Teeth: 3.Becker A: 2 nd ed. London Informa Healthcare, 2007
◦ Mah J, Enciso R, Jorgensen M. Management of impacted cuspids using 3-D volumetric imaging. J Calif Dent Assoc
2003; 31(11): 835−841.
◦ .

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