Most frequently, upper canine impactions, specially if they are displace towards the palate, will require adjunctive surgical procedure and subsequent orthodontic traction to successfully redirect these teeth into the dental arch. The pediatric dentist as well as the general dentist are in a unique position to identify ectopic upper canine development in the early mixed dentition, when the child is only 6 years old. At that point, they usually refer the patient to an orthodontist for early treatment. American Associaton of Orthodontics recommends that all children have an orthodontic consultation by a certified orthodontist, no later than age 7. It is not necessary to have a referral from the child’s pediatric dentist/ general dentist to visit the orthodontist.
Most impacted permanent canines are symptomless and most patients and parents of young patients are unaware of such impactions until they are informed of this clinical circumstance by a dentist. Frequently the deciduous (baby) canine will still be present, as such, poses for less of an esthetic issue than if the deciduous canine had exfoliated leaving an obvious space. Ectopic development of these permanent canines can lead to resorption of the roots of adjacent permanent teeth and future impactions of the canines, without early orthodontic therapy.
The prevalence of impacted upper permanent canines in the United States is 0.92% with females being at a higher risk than males (2:1). Genetics as well as other factors such as missing permanent lateral incision, and displaced lateral incisions one reasons that can contribute to impaction of upper canines.
The key to clinical success in treating maxillary canines that are ectopically positioned is early detection and early orthodontic treatment. At Saba Orthodontics we have been very successful with early treatment using palatal expanders, with or without extraction of primary (baby) canines at 6-7 years of age. This treatment typically takes approximately 6 months and can help avoid resorption of roots of lateral incisors, as well as future surgical exposure of the permanent canine.
Ectopic upper canine eruptive development can be unpredictable, and “cook book” approaches should be avoided for individual patients. For more information visit our website (www.sabaortho.com) or call 703-404-7222.
Definitions:
Ectopic Eruption: malposition of a permanent tooth within the arch.
Impaction: wrong positions of a tooth or teeth within the jaw bone which leads into its/their inability to erupt into the dental arch.
