Palatally impacted canines: The case for preorthodontic uncovering and autonomous eruption

Abstract

4 Impacted teeth are often encountered during the diagnosis and treatment of malocclusions in adolescent orthodontic patients. After the third molars, the most commonly impacted tooth is the maxillary canine with an incidence of 1% to 3%, which varies depending on the ethnicity of the sample population. Although the canine crown can be impacted either labially or palatally, it is more frequently positioned in the palate. Although most palatally displaced canines can be positioned orthodontically in the alveolus, several problems might accompany the management of these ectopically positioned teeth. First, the overall length of orthodontic treatment is increased when the patient has a palatal impaction. Second, there are often problems of alveolar bone loss around the adjacent lateral incisor andpremolar aswell as the canine.Third, root resorption of the adjacent lateral incisor is a common aftermath of treating a palatally impacted canine. Finally, gingival recession on the labial or palatal surfaces can accompany the treatment of these teeth. All of these potential problems can result in an increased risk of litigation between the orthodontist and an unhappy patient. In the United States, lawsuits for mismanagement of palatally impacted canines rank second in frequency, just behind periodontal problems developing during the orthodontic treatment of adults. Why do these problems exist? Is it because of the orthodontic mechanics? Is it because of the surgical technique of uncovering these teeth? Or is it a combination of factors?