From Volume 10, Issue 1, January 2017 | Pages 28-30
This case report describes a surgical approach for the orthodontic treatment of deep infra-osseous impacted canines. This technique allows for orthodontic traction of the impacted tooth to the centre of the alveolar ridge, which results in a better periodontal outcome.
The maxillary canine is commonly displaced or impacted. Labial impaction of a maxillary canine is due either to ectopic migration of the canine crown over the root of the lateral incisor or shifting of the maxillary dental midline, giving rise to insufficient space for the canine to erupt.1
The surgical orthodontic treatment of impacted canines is aimed at bringing the tooth into its correct position in the dental arch without causing periodontal damage. To achieve this goal, a variety of surgical and orthodontic techniques have been proposed. There are three techniques for uncovering a labially impacted maxillary canine:
According to Crescini et al, one of the fundamental indicators of the success of treatment of impacted maxillary canines is the final periodontal outcome.2
The literature shows that the most severe periodontal damage occurring in the treatment of impacted canines is the loss of supporting bone and it is associated with more radical surgical procedures involving exposure of the tooth underneath the cemento-enamel junction.3,4 Therefore, a part of the keratinized gingiva must be preserved or an apically positioned flap should be used. In deep infra-osseous impaction cases, although the removal of a significant portion of cortical bone favours eruption of the tooth, removing tissue may result in the loss of bone support. In the case of deep infra-osseous impaction, these techniques cannot always be used safely and other steps are required to achieve a satisfactory periodontal outcome.
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