Impacted canines

Permanent canines play a fundamental role: they are key pieces of the smile aesthetically, but above all they have a vital function in the bite. By guiding jaw movements during sideways motion, they protect the whole dentition.

Yet, after wisdom teeth, canines are the teeth most often trapped (impacted) in the jaw bone or under the gum, unable to erupt naturally. This most often affects the upper jaw, frequently on the palate side, and may be on one or both sides.

The protocol, step by step.

1. Step 1

   Pre-operative assessment (3D imaging)

   Three-dimensional imaging (CBCT / cone beam) analyses to the millimetre the exact position of the canine and its proximity to key structures and neighbouring roots, to choose the gentlest and safest approach.

2. Step 2

   Surgery (exposure and bonding)

   Through a small incision the tooth is reached gently, the bone covering the crown is carefully removed, then a bracket or traction chain is bonded to the canine; the gum is repositioned and sutured, often with dissolvable stitches, leaving the chain or bracket visible.

3. Step 3

   Orthodontic traction

   A few days after surgery, the orthodontist starts applying very light traction forces to guide the canine gradually along its ideal path to its natural place.

Why does a canine remain impacted?

A canine usually becomes impacted when it cannot find the ideal eruption path.

• A lack of space in the dental arch.

• An abnormal eruption path (wrong initial orientation of the tooth).

• A baby tooth that did not fall out at the right time.

• An anatomical obstacle or tissue in the eruption path.

The risks of an untreated impacted canine

• Damage to neighbouring roots: pressure from the trapped canine can damage the roots of the adjacent incisors.

• Resorption or abnormal retention of the baby tooth.

• Cysts: rare but possible around the impacted crown.

• Misalignment and loss of harmony of the dental arch.

A multidisciplinary approach: surgery and orthodontics

Treating impacted canines almost always relies on close collaboration between the maxillofacial surgeon and the orthodontist. The main aim is to save the natural tooth, free it and bring it to its ideal place in the arch.

Careful planning is essential: using three-dimensional imaging (CBCT / cone beam), Dr Yousefpour analyses with millimetre precision the exact position of the canine and its proximity to key structures and neighbouring roots, to choose the gentlest and safest surgical approach.

What is the recovery like?

• Anaesthesia: the procedure can be done under simple local anaesthesia, or with sedation or even general anaesthesia depending on the case and the comfort wanted.

• Discomfort: mild pain or moderate swelling may occur for a few days; suitable painkillers are always prescribed.

• Recommendations: careful oral hygiene, antiseptic mouthwashes and lukewarm or cold food for the first days promote optimal healing.

Potential risks and side effects

• Usual risks: swelling of the operated area, pain or bruising, which usually settle within a few days.

• Specific risks: although rare, accidental damage to the roots of neighbouring teeth (particularly the incisors) due to their anatomical proximity, or scar discomfort of the gum, may occur.

• Failure to erupt: despite precise surgical technique and suitable traction, the canine may be fused to the bone (ankylosis), preventing it from moving into place; extraction is then indicated.

Informed consent and pre-operative information

Exposing an impacted canine is a common procedure, but like any medical act it requires a full understanding of what is at stake, the benefits and the potential risks.

A mutual commitment: your decision to go ahead results from a discussion based on your clinical file and the analysis of your 3D imaging. As a specialist, my role is to give you everything you need to make an informed decision, taking into account your specific anatomy and the goals of your orthodontic treatment.

Your questions come first

Before any procedure, Dr Yousefpour takes the time to go through the following points at your consultation:

• The treatment plan: confirmation of the position of the tooth on your 3D imaging.

• The alternatives: discussion of the treatment options, including the risk of not treating the impacted canine.

• The post-operative protocol: detailed explanation of the hygiene and follow-up measures after the procedure.

Your role is essential

The success of the traction depends on attending your orthodontic appointments regularly and strictly following the post-operative instructions.