Canine impaction is a relatively frequent clinical
presentation in dentistry, with challenges that should be resolved.
A good understanding by the clinician of the situation and treatment
options can have a significant impact, on the treatment outcome.
Therefore, clinicians should be competent to perform proper investigation,
provide a correct diagnosis, develop an optimum treatment plan,
and render appropriate treatment for each individual patient
so each patient realizes the best outcome possible.(1)
This website was started by me, Sam's mom, in 2012, when Sam was 14 years old. I am continuously updating and rewriting as needed, and my son 'Sam's story' is ongoing...I apologize, I'm way behind on editing, this is a work in progress.
Initially I had the subtitle 'a parent to parent perspective', but I have been contacted by parents as well as dental professionals, and have been assured that posting my son's experience together with my research is valuable both to patients and dental practitioners, so given how long this has been going on for my son, the subtitle is now 'impacted life'.
Initial disclaimer:
Everything written here by me, or assembled from different sources, is done by me as a parent, not claiming to be a professional expert in any way. All facts, conclusions, and recommendations have to be judged accordingly. I am stating my own personal opinions, making my own conclusions, but I am also relating the science behind it and referring you to the source. Use my site as a starting point and a help when you pose questions to dental professionals.
Why a website?
The purpose of this website is firstmost to shed light on the problem of impacted canines. I have an ambitious goal to change how the subject of impacted canines are taught in dental schools, and how impacted canines are treated generally. I have tried writing letters and contacting institutions and I realize change is hard to come by, but I feel I have to try. I want to empower parents who are trawling the internet, and give them a headstart. The website is also a way for me to gather and try to organize information for myself, and as such, it feels empowering and therapeutic.
The important thing is for parents to arm themselves with information, before heading out into the yet unexplored and not fully settled territory of 'impacted canines'. Knowing about CBCT is absolutely necessary!
Sam's story
My son started out as a 12-year-old with impacted canines (both upper and lower on the right side, as you can see on the pano above) in 2010. He had braces for 5 years. The lower canine emerged after 3 1/2 years (thanks to Dr Becker*). Sam had 4 surgeries trying to get the upper canine to emerge, but, in the end, had it extracted in December 2017. We were all set for him to get the implant and be done with this, when further complications, like dehiscence of the neighboring teeth, left us in limbo again.
Impacted canines that don't resolve easily may set you off on a long, time consuming, painful and expensive journey. We live in the San Francisco Bay Area, US, and you would expect state-of-the-art treatment when you end up at the University. If the handling of impacted canines does not work here, I think my concerns may apply elsewhere. I hope this site, can, at least, illustrate the problems. There are specialists out there in the world trying to advance clinical orthodontics, but I think informed parents, as discerning consumers, can do their part in pushing for a better standard of practice everywhere.
A case like Sam should have been dealt with by a dedicated, collaboraing team of specialists in the fields of orthodontia, oral surgery, periodontia and prosthodontia. Instead we have had this very painful journey leaving us at loose ends.
Each specialty has its own quirks that the other specialties will consider detrimental. An orthodontist, like Dr Becker, is very wary of having oral surgeons do luxations of teeth in the process of deciding the question of ankylosed or not when they do the 'expose&bond, because they might damage the ligament that is needed to get the tooth down; and then, when you get to the surgeon they will state that the orthodontia and previous surgeries have cause scar tissue, damaged vascularisation, and dehiscence, and now an implant might not work.
If there had been an 'impaction' department within the Orthodontist Department here (like the University in Jerusalem), this website would not exist, my 3 am worries would not have kept me up, and we could have been confident that Sam was getting the best of care.
So what is the problem?
1. Lack of knowledge, skill and careful consideration
As a dentist or orthodontist you have to first ask the question 'Why is the tooth impacted?' To answer the question it is probably wise to invest in a CBCT. But, this also implies that you, the dentist, have to be able to understand the CBCT.
Sounds like obvious statements, but not in reality. In Sam's story you will find that the dental professionals involved either forgot to look at the CBCT they ordered, didn't even see the resorption - PEIR- going on in the crown, or saw it and didn't bother reflecting on it.
2. Lack of cooperation
Any paper put out on the subject of impacted canines will stress that success depends on a team effort between
dentist, orthodontist, oral surgeon and if needed, endodontist, prosthodontist.
In reality, the team work consists of a referral on a paper for 'expose & bond' or 'extract'.
Dr Adrian Becker**, one of the few specialists of impacted teeth in the world, has what he calls a 'cri de cœur', an appeal to fellow orthodontists: To ensure the success of surgical interventions such as the 'expose and bond' for impacted canines, the orthodontist should be present at surgery and actively bonding brackets and make sure that everything is set up in the proper way for traction. When the orthodontist doesn't feel that degree of responsibility for surgery and the surgeon no responsibility for traction, you loose teeth. More on this under 'the most important thing'.
The importance of an impacted canine to a family
Thousands of dollars, hundreds of miles in travel to and fro appointments, hundreds of hours. But the main thing, is the devastating realization that someone you put trust in didn't bother looking at a CBCT, didn't bother considering factors involved (like resorption in Sam's case), didn't bother consulting with experts, didn't bother talking to or communicate with the oral surgeon or the orthodontist that was part of the 'team'. Compared to the effort and emotional investment you put in as a parent/patient, negligence like that is heartbreaking.
1. Lack of knowledge, skill and careful consideration
As a dentist or orthodontist you have to first ask the question 'Why is the tooth impacted?' To answer the question it is probably wise to invest in a CBCT. But, this also implies that you, the dentist, have to be able to understand the CBCT.
Sounds like obvious statements, but not in reality. In Sam's story you will find that the dental professionals involved either forgot to look at the CBCT they ordered, didn't even see the resorption - PEIR- going on in the crown, or saw it and didn't bother reflecting on it.
2. Lack of cooperation
Any paper put out on the subject of impacted canines will stress that success depends on a team effort between
dentist, orthodontist, oral surgeon and if needed, endodontist, prosthodontist.
In reality, the team work consists of a referral on a paper for 'expose & bond' or 'extract'.
Dr Adrian Becker**, one of the few specialists of impacted teeth in the world, has what he calls a 'cri de cœur', an appeal to fellow orthodontists: To ensure the success of surgical interventions such as the 'expose and bond' for impacted canines, the orthodontist should be present at surgery and actively bonding brackets and make sure that everything is set up in the proper way for traction. When the orthodontist doesn't feel that degree of responsibility for surgery and the surgeon no responsibility for traction, you loose teeth. More on this under 'the most important thing'.
The importance of an impacted canine to a family
Thousands of dollars, hundreds of miles in travel to and fro appointments, hundreds of hours. But the main thing, is the devastating realization that someone you put trust in didn't bother looking at a CBCT, didn't bother considering factors involved (like resorption in Sam's case), didn't bother consulting with experts, didn't bother talking to or communicate with the oral surgeon or the orthodontist that was part of the 'team'. Compared to the effort and emotional investment you put in as a parent/patient, negligence like that is heartbreaking.
The importance of an impacted canine to a child/young adult
A Romanian paper (3) from last year with mainly patients who were diagnosed late, at 22 years old mean age, (and most of them diagnosing themselves because of an acquaintance with the same problem, a circumstance that probably says something about dental care in Romania) made a survey on the discomfort, feeding problems, speech problems, feeling around facial appearance, limitations to social life, feelings of inferiority etc. The paper mainly deals with the importance of good looks, having a good smile, etc. 'A great smile' is what everyday orthodontics is all about. Conclusion of the paper: impacted canines impact one's life very much, especially aesthetically, especially for women.
To spend years in braces, to go through oral surgeries, to end up with a gap, or to go through more surgeries for
grafts and implant, takes it's toll!
A Romanian paper (3) from last year with mainly patients who were diagnosed late, at 22 years old mean age, (and most of them diagnosing themselves because of an acquaintance with the same problem, a circumstance that probably says something about dental care in Romania) made a survey on the discomfort, feeding problems, speech problems, feeling around facial appearance, limitations to social life, feelings of inferiority etc. The paper mainly deals with the importance of good looks, having a good smile, etc. 'A great smile' is what everyday orthodontics is all about. Conclusion of the paper: impacted canines impact one's life very much, especially aesthetically, especially for women.
To spend years in braces, to go through oral surgeries, to end up with a gap, or to go through more surgeries for
grafts and implant, takes it's toll!
How to fix the lack of care:
There are fundamental flaws in the handling of impacted teeth today. I see concern expressed in the scientific journals and papers between colleagues. To the common orthodontists it might pose 'a dilemma', but to patients/parents spending years and thousands of dollars, maybe with unfavorable outcomes in the end, status quo today, is a potential TRAGEDY. As such a parent, I want to convey this sense of TRAGEDY to the dental community and to parents alike. A thorough reformation of the handling of impacted canines is overdue.
- Main problem: Ignorance. There is no required reading, as far as I can tell, no set courses, no test,
to ensure that someone is competent to treat impacted canines. It's lumped in with the general orthodontia.
- In Europe, South Korea, Australia and other places, oral surgeon's are developing skills to transplant impacted
canines in some cases. In the US this doesn't happen at all, there is no alternative between 'expose & bond'
and dental implant. Implants can only be placed after facial growth is done so it is not a solution for children.
- The American Association of Orthodontics (AAO) has not established a protocol, or 'standard of
care', for how impacted canines have to be treated, so it is pretty much 'the wild west' out there.
All orthodontists are willing to give a 'virgin' impacted canines a go, collecting thousands of dollars and putting parents and patients through years of appointments, but all are not qualified to handle it. And an impaction that has proven itself to be difficult is not an attractive prospect for the next orthodontist (we don't do 'transfer',
'too much liability', we are suddenly 'not taking new clients').
- Without a standard, orthodontists and oral surgeons still think they can treat impacted canines
without CBCT (cone beam computer tomography), even to the point where they can have a canine
extracted without a CBCT, or trying to analyze the reason for failure of traction, at least 6 years ago.
(Sounds like if it came to it, this would be considered malpractise though).
- You need a curious, analytical and biomechanical mindset when dealing with impacted canines. You need to
ask 'Why is the tooth impacted?' Are there complicating factors? Resorption? Dilaceration? How does it
affect the attempts of pulling on the tooth? Orthodontics is art, science and experience combined; impacted
canines requires a higher dose of all those ingredients.
To attack an impacted tooth with a I'll-have-a-go-at-it attitude, might work by sheer luck in many
cases, but will fail when the complicated case comes along. What recourse does the orthodontist
have then. How 'OK' is it for the orthodontist to make a referral. Who can he/she refer to? Is it easier to
extract rather than have a loss of face? Will the orthodontist have a CBCT done, that they don't know how to
use, but just as a legal precaution?
- To be able to use the information of a CBCT to best effect, you have to be able to read it. There is no
quality control on this either. It seems up to the individual orthodontist to decide if he/she feels competent or
not. (If you read through this website, you'll see that even the experts disagree on the finds). You can find
this quote on my CBCT page: "after reviewing a few dozen of them [radiologist reports], one becomes quite
comfortable evaluating the image on one's own." On the other hand, there are radiology services encouraging
orthodontists to rely on them, so orthodontists can save time, see more patients...This would take a valuable
instrument away from the orthodontist who is the one who has to understand what he is actually doing when
he is pulling on teeth.
Until CBCTs can be more reliably evaluated by qualified clinicians, there should be a system where each CBCT
is looked at by several people who then compare notes and get consensus. Training and evaluation of
competence is lagging.
The AAO has only since Sep 2012 decided that the CBCT should be read by an oral radiologist,
mostly in case there are pathologies outside an orthodontic field of expertise. So far they don't
seem to know how to handle the orthodontic part. Is the orthodontist/ oral surgeon CBCT literate? They
caution about the radiation, but fail to address the fact that an ALARA (as low as reasonably achieveable)
dose CBCT now is equivalent to a panorama image. (See details under 'CBCT-3D')
- The optimal situation for the treatment of impacted canines would be an 'impactologist', someone
who could embody all the skills necessary when it comes to biomechanics and traction, radiology,
and surgery. As it is, it's a complicated network of dentist, orthodontist, perio- and endodontist, radiologist,
surgeon that has to run smoothly, and at least in the Bay Area, it doesn't, in my experience. If at least there
could be a team of professionals in every region, that could take a special interest in impacted canines, and
where difficult cases could be referred to for a review, teeth could be saved, and the need for implants
in youth reduced.
Dr. Becker* writes that the orthodontist should be active and present at surgery (See
'The most important thing...'). The orthodontist should do the bonding and apply immediate
traction. That makes sense even to a layman, and sounds like optimal patient care, but it doesn't even work
where it is geographically easy, within a building such as UCSF. Is it worth the logistics of setting this
up? From a patient point of view, definitely. Surgery needs to be optimal, because every surgery is
trauma, and for impacted canines optimal care is the difference between success or dental implants.
To make 'impactology' a speciality would be the ultimate fix. Failing that, you need a functional
orthodontist-surgical Team. In the end, as Dr. Becker states it, the responsibility of the
whole endeavor, including surgery, 'rests firmly on the shoulders of the orthodontist', so the orthodontist has
to be at least an equal player and able to stand up to the surgeon, so the patient isn't suffering from some
internal power struggle between different dental specialities.
- At the Hebrew University Hadassah in Jerusalem there is a Impacted Teeth Clinic within the orthodontic
department with three orthodontists. It would be a good start if American Universities could identify
complicated 'impacted teeth' as a subspeciality within orthodontics. When complicated cases turn up they
should not be given to a junior resident.
I sense a worrying trend that it is OK to fail with impacted canines, because there are always implants.
Implants are relatively new, but no doubt a profitable industry. It has done a lot of good for people
with severe tooth problems. When we are considering children and youth however, I can't see that it is an
easy solution, or that good orthodontic analysis and strategies should be replaced by it. Admittedly I haven't
read up on it fully, but it seems like a reasonable assumption that in a growing person, you want to preserve
a tooth, the alveolar ridge and the gum, rather than extract and wait for a fully grown mouth where the
bone has resorbed and you need bone grafts, and periodontal restorations, as well as implants. Implants
should not substitute skill.
In the 2014 spring edition of the orthodontists' magazine 'PSCO Bulletin' (2), an article entitled "Managing
Patients with Impacted or Ectopically Positioned Teeth" (with rudimentary information on impacted
canines) asks the question: 'Why is the topic of impactions important' ["considering the very low
occurrence rate"]? The article answers the question:
The most common litigation against orthodontists is the claim that they have not managed a
patient periodontally. The second most common reason for litigation is impacted canines.(2)
Notice that you have the juxtaposition of a 'rare' condition with a 'common' reason for failure/ litigation, it
speaks for itself. I think I have justified my frustration and my website!
Other sources on impacted canines put it differently, see quote at the top (1).**
Besides the 'attitude' problem, the article 'Managing Patients with Impacted or Ectopically Positioned Teeth'
information on the subject of impacted canines is quite basic, which leads you to believe that the level of
knowledge among non publishing orthodontists, is not very elevated.
As a mom, I'm very saddened by litigation being the main motivator for bothering with impacted canines. As the
quote on top of the page declares, it is ethically up to the orthodontist to 'realize the best possible outcome' for
each patient. I want an orthodontist who cares about my son and the outcome; I want an orthodontist who is
skilled and who can analyze the specific problems that each impaction poses with intelligence and professional
interest. My main advice to fellow parents/ patients is to try and find that kind of orthodontist, because that is
what it takes, and you can not assume that just being an 'orthodontist' or even a professor of orthodontics is a
qualification for handling impacted canines.
Nota Bene: I think, most impacted canines will erupt either by just getting the room they need (extract the baby tooth, make space with braces) and some more time, or with the one surgery for 'expose & bond', i.e. gluing an attachment to the tooth and then pulling by wire or chain. Out of all impacted canines, especially the younger the patient, it seems that only a few percent go on to be problems. My son is one of those. In most cases, if you have a child with an impacted canine, chances are very high that it will erupt and fit nicely into the dental arch.
However, if there has been one round of surgery and then months of traction without movement, you are in trouble. At this point chances are your orthodontist will declare the tooth 'ankylosed'. Ankylosed anatomically means that the tooth is fused to bone, but it is also used by orthodontists when they don't know how to analyze what is preventing the tooth from moving, they don't have the skill needed to solve the situation, and they don't want to refer to someone who can.
The wrong kind of procedure at surgery, and/or the wrong kind of traction, or the general time delay, might already have ruined the prospect of success, or you would need to find the right Team willing to analyze the reasons for failure and how to deal with it, but you are now a complicated case and not the easy money another orthodontist will go for. Only a rare few has the professional interest, skill and ethics to take this on, and you will be on a quest to find them., and in the end, sadly, there might not be any in your city, state, or country.
There are fundamental flaws in the handling of impacted teeth today. I see concern expressed in the scientific journals and papers between colleagues. To the common orthodontists it might pose 'a dilemma', but to patients/parents spending years and thousands of dollars, maybe with unfavorable outcomes in the end, status quo today, is a potential TRAGEDY. As such a parent, I want to convey this sense of TRAGEDY to the dental community and to parents alike. A thorough reformation of the handling of impacted canines is overdue.
- Main problem: Ignorance. There is no required reading, as far as I can tell, no set courses, no test,
to ensure that someone is competent to treat impacted canines. It's lumped in with the general orthodontia.
- In Europe, South Korea, Australia and other places, oral surgeon's are developing skills to transplant impacted
canines in some cases. In the US this doesn't happen at all, there is no alternative between 'expose & bond'
and dental implant. Implants can only be placed after facial growth is done so it is not a solution for children.
- The American Association of Orthodontics (AAO) has not established a protocol, or 'standard of
care', for how impacted canines have to be treated, so it is pretty much 'the wild west' out there.
All orthodontists are willing to give a 'virgin' impacted canines a go, collecting thousands of dollars and putting parents and patients through years of appointments, but all are not qualified to handle it. And an impaction that has proven itself to be difficult is not an attractive prospect for the next orthodontist (we don't do 'transfer',
'too much liability', we are suddenly 'not taking new clients').
- Without a standard, orthodontists and oral surgeons still think they can treat impacted canines
without CBCT (cone beam computer tomography), even to the point where they can have a canine
extracted without a CBCT, or trying to analyze the reason for failure of traction, at least 6 years ago.
(Sounds like if it came to it, this would be considered malpractise though).
- You need a curious, analytical and biomechanical mindset when dealing with impacted canines. You need to
ask 'Why is the tooth impacted?' Are there complicating factors? Resorption? Dilaceration? How does it
affect the attempts of pulling on the tooth? Orthodontics is art, science and experience combined; impacted
canines requires a higher dose of all those ingredients.
To attack an impacted tooth with a I'll-have-a-go-at-it attitude, might work by sheer luck in many
cases, but will fail when the complicated case comes along. What recourse does the orthodontist
have then. How 'OK' is it for the orthodontist to make a referral. Who can he/she refer to? Is it easier to
extract rather than have a loss of face? Will the orthodontist have a CBCT done, that they don't know how to
use, but just as a legal precaution?
- To be able to use the information of a CBCT to best effect, you have to be able to read it. There is no
quality control on this either. It seems up to the individual orthodontist to decide if he/she feels competent or
not. (If you read through this website, you'll see that even the experts disagree on the finds). You can find
this quote on my CBCT page: "after reviewing a few dozen of them [radiologist reports], one becomes quite
comfortable evaluating the image on one's own." On the other hand, there are radiology services encouraging
orthodontists to rely on them, so orthodontists can save time, see more patients...This would take a valuable
instrument away from the orthodontist who is the one who has to understand what he is actually doing when
he is pulling on teeth.
Until CBCTs can be more reliably evaluated by qualified clinicians, there should be a system where each CBCT
is looked at by several people who then compare notes and get consensus. Training and evaluation of
competence is lagging.
The AAO has only since Sep 2012 decided that the CBCT should be read by an oral radiologist,
mostly in case there are pathologies outside an orthodontic field of expertise. So far they don't
seem to know how to handle the orthodontic part. Is the orthodontist/ oral surgeon CBCT literate? They
caution about the radiation, but fail to address the fact that an ALARA (as low as reasonably achieveable)
dose CBCT now is equivalent to a panorama image. (See details under 'CBCT-3D')
- The optimal situation for the treatment of impacted canines would be an 'impactologist', someone
who could embody all the skills necessary when it comes to biomechanics and traction, radiology,
and surgery. As it is, it's a complicated network of dentist, orthodontist, perio- and endodontist, radiologist,
surgeon that has to run smoothly, and at least in the Bay Area, it doesn't, in my experience. If at least there
could be a team of professionals in every region, that could take a special interest in impacted canines, and
where difficult cases could be referred to for a review, teeth could be saved, and the need for implants
in youth reduced.
Dr. Becker* writes that the orthodontist should be active and present at surgery (See
'The most important thing...'). The orthodontist should do the bonding and apply immediate
traction. That makes sense even to a layman, and sounds like optimal patient care, but it doesn't even work
where it is geographically easy, within a building such as UCSF. Is it worth the logistics of setting this
up? From a patient point of view, definitely. Surgery needs to be optimal, because every surgery is
trauma, and for impacted canines optimal care is the difference between success or dental implants.
To make 'impactology' a speciality would be the ultimate fix. Failing that, you need a functional
orthodontist-surgical Team. In the end, as Dr. Becker states it, the responsibility of the
whole endeavor, including surgery, 'rests firmly on the shoulders of the orthodontist', so the orthodontist has
to be at least an equal player and able to stand up to the surgeon, so the patient isn't suffering from some
internal power struggle between different dental specialities.
- At the Hebrew University Hadassah in Jerusalem there is a Impacted Teeth Clinic within the orthodontic
department with three orthodontists. It would be a good start if American Universities could identify
complicated 'impacted teeth' as a subspeciality within orthodontics. When complicated cases turn up they
should not be given to a junior resident.
I sense a worrying trend that it is OK to fail with impacted canines, because there are always implants.
Implants are relatively new, but no doubt a profitable industry. It has done a lot of good for people
with severe tooth problems. When we are considering children and youth however, I can't see that it is an
easy solution, or that good orthodontic analysis and strategies should be replaced by it. Admittedly I haven't
read up on it fully, but it seems like a reasonable assumption that in a growing person, you want to preserve
a tooth, the alveolar ridge and the gum, rather than extract and wait for a fully grown mouth where the
bone has resorbed and you need bone grafts, and periodontal restorations, as well as implants. Implants
should not substitute skill.
In the 2014 spring edition of the orthodontists' magazine 'PSCO Bulletin' (2), an article entitled "Managing
Patients with Impacted or Ectopically Positioned Teeth" (with rudimentary information on impacted
canines) asks the question: 'Why is the topic of impactions important' ["considering the very low
occurrence rate"]? The article answers the question:
The most common litigation against orthodontists is the claim that they have not managed a
patient periodontally. The second most common reason for litigation is impacted canines.(2)
Notice that you have the juxtaposition of a 'rare' condition with a 'common' reason for failure/ litigation, it
speaks for itself. I think I have justified my frustration and my website!
Other sources on impacted canines put it differently, see quote at the top (1).**
Besides the 'attitude' problem, the article 'Managing Patients with Impacted or Ectopically Positioned Teeth'
information on the subject of impacted canines is quite basic, which leads you to believe that the level of
knowledge among non publishing orthodontists, is not very elevated.
As a mom, I'm very saddened by litigation being the main motivator for bothering with impacted canines. As the
quote on top of the page declares, it is ethically up to the orthodontist to 'realize the best possible outcome' for
each patient. I want an orthodontist who cares about my son and the outcome; I want an orthodontist who is
skilled and who can analyze the specific problems that each impaction poses with intelligence and professional
interest. My main advice to fellow parents/ patients is to try and find that kind of orthodontist, because that is
what it takes, and you can not assume that just being an 'orthodontist' or even a professor of orthodontics is a
qualification for handling impacted canines.
Nota Bene: I think, most impacted canines will erupt either by just getting the room they need (extract the baby tooth, make space with braces) and some more time, or with the one surgery for 'expose & bond', i.e. gluing an attachment to the tooth and then pulling by wire or chain. Out of all impacted canines, especially the younger the patient, it seems that only a few percent go on to be problems. My son is one of those. In most cases, if you have a child with an impacted canine, chances are very high that it will erupt and fit nicely into the dental arch.
However, if there has been one round of surgery and then months of traction without movement, you are in trouble. At this point chances are your orthodontist will declare the tooth 'ankylosed'. Ankylosed anatomically means that the tooth is fused to bone, but it is also used by orthodontists when they don't know how to analyze what is preventing the tooth from moving, they don't have the skill needed to solve the situation, and they don't want to refer to someone who can.
The wrong kind of procedure at surgery, and/or the wrong kind of traction, or the general time delay, might already have ruined the prospect of success, or you would need to find the right Team willing to analyze the reasons for failure and how to deal with it, but you are now a complicated case and not the easy money another orthodontist will go for. Only a rare few has the professional interest, skill and ethics to take this on, and you will be on a quest to find them., and in the end, sadly, there might not be any in your city, state, or country.
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
A heartfelt 'thank you!' to Dr. Adrian Becker**, who responded (within hours!!) from the other side of the world, when I needed a second opinion way back in 2012, and then diagnosed Sam's resorption, operated, and tried to
give his thoughtful advice in how to proceed.
I use a lot of citations from the publications of Dr. Becker. You can tell from his website
(www.dr-adrianbecker.com) and publications that he, and his colleagues, Stella and G Chau, are on a mission to raise the expertise on impacted teeth, to improve the results, and to ultimately save teeth. They are addressing the professionals. As a parent afflicted with the 'impacted teeth' problem, I am immensely grateful for their efforts.
I am of a generation which is not taking the internet for granted, and I am in constant awe of what the internet can do for people. I think it is truly 'awesome' if you can get specialist advice from the other side of the globe in an instant. You can spread information that advances science and empowers people. To that end, this site.
If you read this and have a story to tell, please submit it through my contact page, and I'll put it up on 'Case stories'
Birgitta Bower, El Granada, CA
From 2012 and ongoing...
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++
(1) Park JH, Srisurapol T, Kiyoshi T. Impacted maxillary Canines: Diagnosis and
Management.dentalcetoday.com, sep 2012.
(2) Pacific Coastal Society Bulletin, Spring 2014. Managing Patients with Impacted or Ectopically
positioned Teeth. Presented by Dr. Douglas Knight and Dr. Jim Jnakkievski at the PSCO Annual
Session, October 18, 2013. Summarized by Dr. Shahram Nabipur.
I believe they got their claim about lawsuits from 'Palatally impacted canines: The case for preorthodontic
uncovering and autonomous eruption' (by Mathews D. and Kokich V. AJO-DO 2013,;143:450-458),
but Mathews and Kokich state it as a reason to look into what goes wrong, not as a caution against the
lawsuit itself.: "Why do these problems exist? Is it because of the orthodontic mechanics? Is it because of the
surgical technique of uncovering the teeth? Or is it a combination of both?
(3) Counihan et al. Guidelines for the assessment of the impacted maxillary canine. Dent Update.
2013 Nov; 40(9):770-2,775-7. PMID 24386769.
(4) Lucaciu et al. The importance of canine impaction on the patient's quality of life. HVM Bioflux 2015;7(2):
108-113.
* Dr. Adrian Becker is Clinical Associate Professor, Department of Orthodontics, Hebrew University-Hadassah
School of Dental Medicine, Jerusalem, Israel. website: www.dr-adrianbecker.com.
The third edition of his "On the Treatment of Impacted Teeth' came out in the spring of 2012. Dr Becker also
presents monthly case studies on his website. That is how I originally read about PEIR.
** Actually no article or book I've seen talks of how 'rare' impacted canines are (the actual number quoted is
usually is 1-2% depending of ethnicity). If you are interested enough to write about it, it probably is an
oxymoron to say it is rare, obscure and somehow irrelevant. It is important enough to write about, so the
article will instead say that it is 'relatively frequent'. It should be regarded as an oddity, that in a circle of
orthodontic specialists, you would even pose a question of the importance of 'impacted canines', even odder
is the answer that the reason to care is you risk getting sued when mismanaging the condition.
A heartfelt 'thank you!' to Dr. Adrian Becker**, who responded (within hours!!) from the other side of the world, when I needed a second opinion way back in 2012, and then diagnosed Sam's resorption, operated, and tried to
give his thoughtful advice in how to proceed.
I use a lot of citations from the publications of Dr. Becker. You can tell from his website
(www.dr-adrianbecker.com) and publications that he, and his colleagues, Stella and G Chau, are on a mission to raise the expertise on impacted teeth, to improve the results, and to ultimately save teeth. They are addressing the professionals. As a parent afflicted with the 'impacted teeth' problem, I am immensely grateful for their efforts.
I am of a generation which is not taking the internet for granted, and I am in constant awe of what the internet can do for people. I think it is truly 'awesome' if you can get specialist advice from the other side of the globe in an instant. You can spread information that advances science and empowers people. To that end, this site.
If you read this and have a story to tell, please submit it through my contact page, and I'll put it up on 'Case stories'
Birgitta Bower, El Granada, CA
From 2012 and ongoing...
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++
(1) Park JH, Srisurapol T, Kiyoshi T. Impacted maxillary Canines: Diagnosis and
Management.dentalcetoday.com, sep 2012.
(2) Pacific Coastal Society Bulletin, Spring 2014. Managing Patients with Impacted or Ectopically
positioned Teeth. Presented by Dr. Douglas Knight and Dr. Jim Jnakkievski at the PSCO Annual
Session, October 18, 2013. Summarized by Dr. Shahram Nabipur.
I believe they got their claim about lawsuits from 'Palatally impacted canines: The case for preorthodontic
uncovering and autonomous eruption' (by Mathews D. and Kokich V. AJO-DO 2013,;143:450-458),
but Mathews and Kokich state it as a reason to look into what goes wrong, not as a caution against the
lawsuit itself.: "Why do these problems exist? Is it because of the orthodontic mechanics? Is it because of the
surgical technique of uncovering the teeth? Or is it a combination of both?
(3) Counihan et al. Guidelines for the assessment of the impacted maxillary canine. Dent Update.
2013 Nov; 40(9):770-2,775-7. PMID 24386769.
(4) Lucaciu et al. The importance of canine impaction on the patient's quality of life. HVM Bioflux 2015;7(2):
108-113.
* Dr. Adrian Becker is Clinical Associate Professor, Department of Orthodontics, Hebrew University-Hadassah
School of Dental Medicine, Jerusalem, Israel. website: www.dr-adrianbecker.com.
The third edition of his "On the Treatment of Impacted Teeth' came out in the spring of 2012. Dr Becker also
presents monthly case studies on his website. That is how I originally read about PEIR.
** Actually no article or book I've seen talks of how 'rare' impacted canines are (the actual number quoted is
usually is 1-2% depending of ethnicity). If you are interested enough to write about it, it probably is an
oxymoron to say it is rare, obscure and somehow irrelevant. It is important enough to write about, so the
article will instead say that it is 'relatively frequent'. It should be regarded as an oddity, that in a circle of
orthodontic specialists, you would even pose a question of the importance of 'impacted canines', even odder
is the answer that the reason to care is you risk getting sued when mismanaging the condition.