Thilander B, Jakobsson SO Local factors in impaction of maxillary canines. Acta Odontol Scand. 1968; 26:145-168
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Open or closed exposure for palatally impacted maxillary canines? A review Orthodontic Update 2025 10:3, 102-110.
Abstract
Palatally impacted canines (PICs) can be surgically exposed using one of the two exposure methods: open or closed. There is generally lack of consensus with regards to the preferred exposure method, hence the choice of operative technique remains open to discussion. The two techniques are compared and the choice of surgical technique is assessed in terms of patient factors, orthodontic/surgical and radiographic factors. Taking all possible determinant factors into account, a flowchart for the selection of the surgical exposure technique is presented.
CPD/Clinical Relevance: As there are no clinical guidelines currently in the literature for the selection of surgical exposure method of PICs, carrying out this review article might help orthodontists and oral surgeons (especially juniors) in the selection process by following the proposed flowchart presented in this article, based on the available evidence in the literature.
Article
An impacted tooth can be defined as ‘a tooth whose eruption is considerably delayed and for which there is clinical or radiographic evidence that further eruption may not take place’.1 It has been shown that the incidence of canine impaction is 1.7%.2 Impacted canines are palatally positioned in 85% of the cases.3
Displacement of the maxillary canine palatally might be due to the thick mucosa and dense bone palatally, making it difficult for it to erupt. Surgically assisted orthodontic intervention is often required to guide the canine into occlusion.4,5,6 Surgical exposure and orthodontic alignment is indicated in patients beyond the age of interceptive treatment, in which the PIC is not severely ectopic, and the adjacent tooth shows no or mild resorption.7 Accommodation of the canine within the arch can involve procedures of varying degrees of complexity, ranging from the simple interceptive treatment (removal of retained deciduous canine) or any impediments to exposure, up to surgical re-implantation. A strategy which is commonly adopted is surgical exposure followed by orthodontic alignment. The treatment of impacted canines should follow a multidisciplinary assessment involving orthodontist, oral surgeon, periodontist, paediatric dentist and general dental practitioner. With PICs, two surgical methods for exposure are commonly used: open and closed. Currently, there is no general consensus about the choice of operative technique. Various considerations might influence the choice of surgical exposure method, including patient factors, orthodontic/surgical and radiographic factors.
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