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Canine Exposure Surgery - What Causes Canine Impaction?

Dr. Livingston • Feb 07, 2022
canine exposure surgery

An Introduction to Canine Exposure Surgery

An impacted tooth is one that does not erupt or just partially emerges. Canines are the most usually impacted teeth after third molars. The impaction occurs on either the palatal or labial portion of the jaw, with palatal impactions occurring twice as frequently as labial impactions. Females are more than twice as likely as males to suffer from an impaction. The prevalence of maxillary canine impaction has been estimated to be between 0.9 and 2.2 percent.


Teeth eruption delays can be caused by a range of general and unique reasons. Common reasons include a history of irradiation, febrile diseases, and hormonal deficiencies. Inadequate dental arch space, prolonged retention or an early loss of the primary canine, abnormal tooth bud position, the presence of alveolar clefts, ankylosis, the presence of cysts or neoplasms, root dilacerations, the absence of maxillary lateral incisors, or variations in the shape and timing of maxillary lateral incisor root formation are examples of localized causes. There appears to be an inherited propensity in many cases, or the causes are idiopathic. The vast majority of canine impactions are the result of localized causes. Contact us immediately for Canine Exposure Surgery in Fort Collins.


Canine impactions, if left untreated, can cause a labial or lingual eruption of neighboring teeth, as well as loss of arch length, internal or external root resorption, dentigerous cyst development, and potential infection or transferred pain. Aside from the possible detrimental consequences on orthodontic placement and/or therapy, impacted teeth are often completely asymptomatic.


Canine impaction is caused by what?

Most canine teeth will develop into the dental arch without difficulty, however, these vital teeth can occasionally become impacted owing to a variety of factors.

  • Baby teeth that have not yet fallen out or abnormal growths that are obstructing the canine teeth
  • Too much dental crowding


The American Association of Orthodontists advises that children see a dentist by the age of seven for an examination and imaging to follow the eruption of permanent teeth and ensure that the canines are growing appropriately. If an impacted canine tooth is discovered, you will be referred to a skilled oral surgeon for treatment. Early treatment is critical since therapy is less likely to be successful if a canine tooth stays impacted into adulthood. When it is not possible to repair an impacted canine, dental implants or other tooth-replacement methods can be utilized to replace the canines with extremely good cosmetic and functional outcomes.


What exactly does 'impacted' mean?

This signifies that bone, fibrous tissue, or another tooth has blocked your tooth from properly emerging. Upper canine teeth are among the last to emerge and, as a result, are more likely to get impacted and fail to reach their proper place inside the upper jaw.


What happens if you don't treat it?

If the canine is left in its impacted position, a cystic lesion around the crown of the tooth can form, which can become infected and cause harm by placing pressure on the roots of neighboring teeth.


Treatment for an impacted canine is normally part of a course of orthodontic therapy, so you should consult with an orthodontist about your specific situation.


Treatment Alternatives

Patients with impacted canines may require the following treatment:

  • There will be no intervention, but there will be a periodic follow-up to detect any pathologic changes.
  • Following surgical exposure, orthodontics is used to move the previously affected tooth into the plane of occlusion.
  • Following auto-transplantation, orthodontics, and prosthetic replacement, no more treatment is required.


Extraction is typically not recommended unless the impacted tooth is ankylosed, dilacerated, or exhibits evidence of resorption, the impaction is severe, a cyst is detected, or the patient is unwilling to undertake orthodontic therapy. If the impacted canines are lost without following orthodontic or prosthetic treatment, there is a high risk of dentoalveolar or cosmetic difficulties such as drifting of neighboring teeth and midline deviation, which can cause aesthetic problems and occlusal discrepancies.

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Pre-Canine Exposure Surgery Examination

Before deciding on a specific surgical treatment, the following diagnostic stages must be completed:

Clinical and radiological evaluation of the impacted tooth's horizontal, vertical, and mesiodistal position. Cone-beam CT can offer useful information about the position of the impacted tooth and its closeness to the surrounding teeth in situations of difficult impactions. The width of keratinized gingiva is measured.


How long will the Canine Exposure Surgery procedure take?

This is determined by the location of the affected canine and whether the procedure is performed under local anesthetic alone or with supplemental intravenous medication.


A local anesthetic surgery appointment normally lasts 60 minutes. A visit with intravenous sedation normally lasts 90 minutes. The additional time provides for the necessary healing period before you may be sent home.


Surgical Procedure for the exposure of palatally impacted canines

When the impacted tooth has a decent axial inclination and does not need to be uprighted, surgical exposure to allow for spontaneous eruption should be employed. After allowing the canine to naturally emerge until it reaches the level of the surrounding teeth, orthodontics can be employed to shift the tooth into normal alignment.


First, local infiltration is used to anesthetize the face and palate tissues. A flap or a portion of palatal tissue is excised to get access to the bone (using a 15 or 15C scalpel blade or a tissue punch). For bone removal, rotary and/or manual devices such as chisels are employed. Only the bone surrounding the affected tooth's crown is removed. To reduce future attachment loss, the bone around the root is maintained intact. If the palatal mucosa covering the impacted canine has been fully removed before enabling unsupported eruption, a periodontal dressing should be worn to cover the surgical region for 3-8 weeks to prevent the re-growth of soft tissue around the previously exposed tooth. This dressing may need to be replaced since it becomes dislodged and is frequently lost during mastication.


If orthodontic movement and/or forced eruption of the impacted tooth is necessary, the canine crown is exposed in the same way as for unaided eruption, and an orthodontic attachment such as a bonded bracket is put on the tooth during surgery or after a period of recuperation (2-6 weeks post-op). Due to limited access to the complete facial aspect of the impacted tooth, bracket placement during surgery is frequently not appropriate. Once the canine crown has fully erupted, this can be repaired. Once the bracket has been attached to the tooth, no periodontal dressing is required.


Surgical procedure for exposing labially affected canines

Canines that are labially affected should be exposed only when enough room has been established by orthodontic movement. The impacted canine can thus be directed into the dental arch in this manner. If sufficient room cannot be made, the affected canine or the neighboring first bicuspid may need to be excised, depending on the treatment strategy.


There are three ways to expose the labially affected canine. The first technique is exposure with apical relocation of the labial flap, followed by the closed eruption technique, and finally, exposure by window construction.


The location is anesthetized with local infiltration before making an approximate 12mm broad horizontal incision (with a 15, 15C, or 12 scalpel blade) into the mid-crestal area of the ridge coronal to the affected tooth. Two vertical releasing incisions are made (with the same blade) joining the horizontal incision and reaching apically into the vestibular mucosa. The scalpel blade and periosteal elevators are used to raise a split-thickness flap. If it is present, the bone covering the canine crown's face aspect is removed. To avoid harming the enamel of the impacted canine, rotary and/or manual devices like chisels are used with caution. The flap is adjusted apically and sutured in place such that its keratinized section covers 2-3mm of the exposed tooth's enamel and CEJ (cementoenamel junction). The flap is sutured in place with horizontal sutures that are either 5-0 or 6-0 resorbable or non-resorbable (if non-resorbable sutures are used they must be removed 1-2 weeks post-operatively). An orthodontic bracket can be glued to the exposed enamel and passively fastened to the archwire with a ligature wire or chain. These are then triggered one week after surgery.


The closed eruption approach is employed when the impacted tooth is farther from the labial cortex and optimal apical placement of the soft tissue at the time of surgery is not attainable. A mucoperiosteal flap is raised just enough to expose the bone protecting the crown of the affected canine in this method. Enough bone is removed (as stated above) to enable for the installation of a bonded bracket that is passively fastened to the archwire using a ligature wire or chain. The flap is then restored and sutured back into place. Following the post-operative appointment, the bracket is activated. The final soft tissue recontouring is postponed until after the orthodontic treatment is completed.


The third exposure for exposing labially-impacted canines is to cut a window in the mucosa and overlying bone. The impacted tooth is located, and a portion of labial mucosa the size of the canine crown is removed with a scalpel and a 15 or 15C blade. If present, the underlying bone is removed as stated above, and a bracket is attached to the exposed tooth. This procedure is only performed in rare cases since it results in the canine missing keratinized free and attached gingiva, making them more prone to inflammation and eventual attachment loss. However, in situations where there is no keratinized gingiva at all, the impacted tooth can be exposed in this manner and a free tissue transplant is placed once the canine has been positioned in the dental arch.

Post-Canine Exposure Surgery Care

The patient is told to avoid chewing on the surgical site for two weeks after surgery and to rinse with 0.12 percent Chlorhexidine twice daily for two minutes until the surgical site is comfortable and normal hygiene practices may be resumed.


Will I experience any discomfort as a result of Canine Exposure Surgery?

Because the region of surgery will be numb from the local anesthetic, you should not experience any discomfort immediately following the procedure.


As the numbness wears off, the region may become unpleasant, at which point you should take pain relievers. We will provide you with them, as well as dosage information.


When will I be able to return to work following Canine Exposure Surgery?

This is determined by your work and how well you recover from your therapy. You might be able to return to work the next day. Some patients will need to take time off work, especially if the procedure was performed under intravenous sedation. We will provide you with guidance tailored to your specific situation.

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