So there is a confirmed impacted canine in a child, what do you do? There are some different theories.
Extracting baby canines
It is standard procedure* to extract the baby (=deciduous) canines, if the permanent canines are slow in responding.
There are other procedures that can be added to this, in hope of making it easier for the permanent teeth to erupt:
- cervical pull headgear
- double extraction of the primary canine and the first molar
- a transpalatal arch (TPA)
- TPA combined with rapid maxillary expansion
(*'Standard procedure', but not actually scientifically proven, see page on 'Evidence-based science'.)
Surgery and traction
Two main strategies:
1. Start braces, create space, then surgery to uncover the impacted canine after 6 months. Let heal "for a few
weeks" then start traction;or start immediate traction according to DR Becker and Chaushu.
2. Start with surgery. Hope that the canine will erupt autonomously (by itself) within 6 to 9 months. After the
canine is out in the palate, start braces and traction.= Preorthodontic uncovering and autonomous
eruption (palatally impacted) (1)
Make space for canine with braces
Surgery & traction, the 'expose & bond'
Look under 'Basic surgery'.
Orthopedic rapid maxillary expansion (RME)
A Brazilian paper (1) holds that, if you catch it early enough, you should start by creating space by doing a orthopedic maxillary expansion. This will, according to the paper, promote bone mass, and the canine might just erupt by itself. They claim that it is standard for treating impacted canines in young patients. (Regrettfully, the
US just seems to lack a lot of standards when it comes to impacted canines.)
Sounds like just a local practice: Enamel drilling for canine traction, according to Brazilian technique (1)
The article describes a technique whereby you avoid bonding brackets by directly drilling a hole through the enamel of the tooth and putting a 0.3 mm ligature wire through the hole. A procedure started in the 1980s by
Professor Reinaldo Mazottini. It is described as superior to the traditional 'accessory bonding for canine traction'.
Its advantage lies in the 'decreased risk of surgical procedure', 'less tissue manipulation', 'shorter surgery time', 'direction of force in the long axis of the tooth', 'no acid action on tooth'. 'While the negatives are: 'risk of enamel fracture', 'may cause pulp damage', 'future need for esthetic restoration' (= fixing the hole in the tooth) and demands a more experienced surgeon.
this technique has been used for thirty years of orthodontic practice and now boasts a caseload with 100%
successful cases, which justifies its disclosure to the scientific community. In addition to this outstanding
accomplishment, it should be emphasized that not a single canine ever required further treatment,
which was the main reason for always choosing this option
Extracting baby canines
It is standard procedure* to extract the baby (=deciduous) canines, if the permanent canines are slow in responding.
There are other procedures that can be added to this, in hope of making it easier for the permanent teeth to erupt:
- cervical pull headgear
- double extraction of the primary canine and the first molar
- a transpalatal arch (TPA)
- TPA combined with rapid maxillary expansion
(*'Standard procedure', but not actually scientifically proven, see page on 'Evidence-based science'.)
Surgery and traction
Two main strategies:
1. Start braces, create space, then surgery to uncover the impacted canine after 6 months. Let heal "for a few
weeks" then start traction;or start immediate traction according to DR Becker and Chaushu.
2. Start with surgery. Hope that the canine will erupt autonomously (by itself) within 6 to 9 months. After the
canine is out in the palate, start braces and traction.= Preorthodontic uncovering and autonomous
eruption (palatally impacted) (1)
Make space for canine with braces
Surgery & traction, the 'expose & bond'
Look under 'Basic surgery'.
Orthopedic rapid maxillary expansion (RME)
A Brazilian paper (1) holds that, if you catch it early enough, you should start by creating space by doing a orthopedic maxillary expansion. This will, according to the paper, promote bone mass, and the canine might just erupt by itself. They claim that it is standard for treating impacted canines in young patients. (Regrettfully, the
US just seems to lack a lot of standards when it comes to impacted canines.)
Sounds like just a local practice: Enamel drilling for canine traction, according to Brazilian technique (1)
The article describes a technique whereby you avoid bonding brackets by directly drilling a hole through the enamel of the tooth and putting a 0.3 mm ligature wire through the hole. A procedure started in the 1980s by
Professor Reinaldo Mazottini. It is described as superior to the traditional 'accessory bonding for canine traction'.
Its advantage lies in the 'decreased risk of surgical procedure', 'less tissue manipulation', 'shorter surgery time', 'direction of force in the long axis of the tooth', 'no acid action on tooth'. 'While the negatives are: 'risk of enamel fracture', 'may cause pulp damage', 'future need for esthetic restoration' (= fixing the hole in the tooth) and demands a more experienced surgeon.
this technique has been used for thirty years of orthodontic practice and now boasts a caseload with 100%
successful cases, which justifies its disclosure to the scientific community. In addition to this outstanding
accomplishment, it should be emphasized that not a single canine ever required further treatment,
which was the main reason for always choosing this option
(1) Capelozza Filho L, Consolaro A, Cardoso MA, Siqueira DF. Enamel drilling for canine traction: advantages,
disadvantages, description of surgical technique and biomechanics.Dental Press Journalk of Orthodontics. vol
16 no 5 Maringá Sept./Oct. 2011.
disadvantages, description of surgical technique and biomechanics.Dental Press Journalk of Orthodontics. vol
16 no 5 Maringá Sept./Oct. 2011.