CANINE IMPACTION

INTRODUCTION:
The word IMPACTION is derived from latin word “impactus”.

DEFINITION:
Impacted tooth is the tooth that has failed to erupt completely or partially to its
correct position in the dental arch and its eruption potential has been lost.
Maxillary canines are usually more commonly impacted than mandibular canines.

FACTORS RESPONSIBLE FOR CANINE IMPACTION:

1. Delayed resorption of the primary canines may lead to impaction of permanent
canine.
2. As canines erupt between the teeth already in occlusion,these have to compete for
space in the oral cavity, moreover mesio-distal diameter of the primary canine is
much less than that of permanent canine.
3. The bone of the hard palate offers more resistance than the alveolar bone on the
ridge for a lingually erupting canine.
4. The muco-periosteal tissue covering the anterior 1/3rd of the palate is very thick,
dense and firmly adherent to the bone and as such offers resistance to eruption of
canine.
5. The greater the distance a tooth is supposed to travel from the point of
development to its place of normal occlusion, greater will be the possibility of its
misdirection and impaction. Canines have a greater distance of all the teeth to
travel , so are more prone to be impacted.

INDICATIONS FOR REMOVAL OF IMPACTED CANINE:

1. Change in position of the adjacent teeth because of pressure exerted due to the
attempt for eruption of the canine.
2. Resorption of the roots of adjacent teeth because of pressure exerted by the
impacted canine.
3. Cyst formation from the follicle around the canine. Attempt should be made to
remove the cyst and facilitate the eruption of impacted canine.
4. Repair of cleft palate may cause scarring and narrowing of the arch leaving no
place for canine to erupt.
5. In edentulous jaw, an impacted canine can be left unnoticed. It starts erupting
with denture irritation and needs to be removed.
6. Pain in eye, ear, side of the head, entire face and back of neck can be attributed to
impacted canine and calls for its removal.
 7. Canines lying in unusual positions like naso-antral wall or floor of the orbit are
indicated to be extracted as they may not start erupting in the nasal cavity or on
the face.

CLASSIFICATION:
Class 1: Maxillary canine in palatal position. This can be horizontal, vertical, and
angulated.
Class 2: Labially impacted canine. It may be horizontal, vertical or angulated.
Class 3: Impacted canine with crown on the palatal side and root on the buccal side
or vice versa.
Class 4: Vertically impacted canine between lateral incisor and first premolar.
Class 5: Canine impacted in the edentulous maxilla.
Class 6: Maxillary canines in unusual positions. Eg: in naso-antral wall or
infraorbital margin.

TECHNIQUE: (FOR LABIAL POSITION)

Two types of incisions are designed:
1. Semilunar incision
2. Angulated flap incision

1.Semilunar incision:
It is designed on the alveolar mucosa.
It starts from the frenum keeping the bulge of the tooth in the centre and extend in the
premolar region.
The lower margin of the incision should be 5mm away from the gingival margin.

2.Angulated flap incision:

It is given in the gingival crevice of incisors and premolars with vertical arm
going into the muco-buccal fold.
Even two vertical incisions can be made on each side of the impacted canine.

OPERATIVE PROCEDURE:
Raise muco-periosteal flap.
Drill holes in the bone covering the tooth.
Join these holes to remove the bone in the bulge area exposing the crown fully.
Make a deep cut on mesial side of the crown elevate the tooth with crier or straight
elevator.
If tooth can’t be luxated and there are chance of damage to the adjoining tooth, the bone
from the root should also be removed, alternately the tooth can be removed by sectioning.
After removing the tooth, the socket should be examined.
Remove the tooth follicle, loose piece of bone and tooth etc.
Smoothen the sharp edges of bone.
Irrigate the socket with normal saline.
Replace the flap after obtaining the hemostasis.
Suture by interrupted sutures.
Stitches should be removed on seventh post operative day.

Note: When canine is lying below the apices of the roots of the lower teeth on the buccal
side , it is approached intraorally.

TECHNIQUE : (FOR PALATAL POSITION)

PALATAL INCISION:
Incision is started from first molar region around the neck of the teeth upon the central
incisor.
COMPLETE PALATAL INCISION:
If both the maxillary canines are impacted and plan to be removed in a single sitting , the
incision is extended across the midline upto the first molar region of opposite side. In this
case the naso-palatine vessels are caught with hemostats and ligated/cauterised.

OPERATIVE PROCEDURE:
Raise the mucoperiosteal flap with periosteal elevator.
A stay suture is passed through the flap for retraction.
Most of the time the bulge bone is present.
Make holes in the bone covering the canine.
Join these holes to cut the bone, thereby exposing crown and part of the root of the tooth.
Make a deep cut on the exposed crown, try to elevate the tooth taking bone as a fulcrum.
Examine the socket, remove the tooth follicle and bone chips.
Wash the cavity with normal saline, replace the flap by suturing with interrupted sutures
after obtaining complete hemostasis.

Note: If there is danger of luxating the adjoining teeth, the impacted tooth should be
removed by sectioning.

PROCEDURE FOR REMOVAL OF IMPACTED CANINE IN AN

UNUSUAL POSITION:
Canine lying at the infraorbital margin is removed intraorally by exposing the infraorbital
margin through an incision given in the vestibule.
Canine in nasoantral wall, if erupting in the maxillary antrum has to be removed by going
into the antrum through Coldwell Luc approach. If the tooth is erupting in the nasal
cavity the same can be approached through an intra-nasal approach.
The impacted maxillary canines in class 3 position can be removed by approaching from
the buccal side as well as palatal side conveniently exposing crown from one side and the
root from the other.

When the canine is impacted in the mental protuberance it can be removed by intraoral
approach.
A canine impacted at the inferior border of mandible is best removed by extra oral
approach.