What to Do with Impacted Canines

Nearly everyone has heard about impacted wisdom teeth, but what about impacted canines? It is a finding, usually first detected on an x-ray that dentists often see and must properly manage.

An impacted canine is an eye tooth that, instead of erupting normally into the mouth, remains embedded in the jaw bone. Why this happens is something of a mystery, but the existence of an impacted canine, though uncommon, is not rare.

When patients are informed of this condition, they justifiably want to know what it means, if it is a problem, and whether it needs to be treated. The answers to these questions can be complicated, but a few basic facts can shed some light on the subject and make decisions easier for the patient.

The Cornerstone Tooth

The canine is the cornerstone tooth of the human dentition. Some call it an eye tooth, but it is properly called a canine because, as the longest tooth in the mouth, it resembles the long tooth of a dog. Because of its strength and position, as well as the fact that it is near the front of the mouth and highly visible, it is one of the most important teeth. It therefore follows that if one or both of a patient's canine teeth remain impacted and fail to properly erupt into the mouth, it is a matter of concern to both the dentist and the patient.

Impacted Canines Happen

Next to wisdom teeth, upper canines are the most commonly impacted teeth. They occur in about 1 out of 50 people, and twice as often in females as in males. They occur about half as often in the lower jaw as the upper. Of those who have impacted canines, about 1 out of 10 have them bilaterally—on both the left and right side.

Patients must be aware, however, that any retained impacted tooth should be regularly monitored in the future with periodic radiographs to make sure they don't develop cysts or other pathology.

The cause of impacted canines is not clear. Researchers have proposed numerous possible local, systemic, and genetic factors, but it is usually not possible to determine the causative factor in any given case.

Impacted canines are usually asymptomatic, so patients are nearly always unaware of their presence until their dentist informs them of it. Dentists can sometimes detect them clinically by a bulging in the jaw bone that these teeth can create. However, the definitive diagnosis is usually made by their appearance in radiographs.

Managing Impacted Canines

Often, adult patients will have a space or a baby tooth where the impacted canine should be. Even if a baby tooth is still present, it likely will eventually resorb and fall out, leaving a space. Thus, the dentist will—perhaps after consulting with an orthodontist and an oral surgeon—want to sit down with these patients and help them make some important clinical decisions. There are several different ways to treat an impacted canine, any one of which can be the right one for a given patient. These include:

  • Do nothing. This is usually an alternative that dentists should offer their patients. If they elect this option, they will be no worse off than they were before. However, they must still contend with the space in the mouth where the impacted tooth should be. If this is not a concern to the patient, then perhaps doing nothing is the best option. Patients must be aware, however, that any retained impacted tooth should be regularly monitored in the future with periodic radiographs to make sure they don't develop cysts or other pathology.
  • Leave the impacted canine in place and fabricate a prosthesis to fill the space. This option would fill the space but leave an impacted tooth in place. It is unlikely that an implant could be placed in this case, since the impacted tooth would interfere with implant placement. Again, the impacted tooth should be radiographically monitored in the future for possible pathological changes.
  • Surgically extract the impacted canine but nothing else. This option eliminates the risk of keeping an impacted tooth which can become involved pathologically. However, the patient must endure an oral surgery procedure, with the attendant risks, and it also fails to address the open space.
  • Extract the impacted canine and place a prosthesis to fill the space. This option eliminates the risk of leaving an impacted tooth in the mouth and it solves the open space problem. It could be filled with a fixed or removable partial denture, but the best option would, in most cases, be an implant. This is a titanium cylinder that is surgically imbedded into the bone, just like the impacted canine would have been, and a false tooth is attached to it. Many dentists would favor this option.
  • Surgically expose the canine and orthodontically move it into its proper position. Many would favor this treatment plan. It eliminates the risk of retaining an impacted tooth, and it fills the open space with a natural tooth. It involves the surgical uncovering of the impacted canine so that an orthodontic bracket could be bonded to the tooth. Then, the orthodontist places tension on the impacted tooth to slowly move it down and into place. It is a lengthy process, but one that could give the best possible result.

An impacted canine can present many clinical challenges, but there are several viable ways in which dental professionals can manage them. Patients who have been told that they have impacted canines are encouraged to discuss their options with their dentist and decide which one is best for them.

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