Maxillary canine impaction is a common orthodontic issue, occurring in 1-3% of the population, with palatal impactions being more frequent than buccal ones (Peck et al., 1994). Impacted canines can cause aesthetic and functional concerns, necessitating a combined surgical and orthodontic approach for proper alignment (Becker, 2012). The selection of a surgical exposure technique and orthodontic mechanics depends on the impaction’s depth, angulation, and soft tissue coverage (Ericson & Kurol, 1987).
This blog explores various surgical exposure techniques.
1. Surgical Exposure Techniques for Impacted Canines
The choice of surgical technique depends on the position, depth, and tissue coverage of the impacted canine.
A. Open Surgical Exposure
1. Open Eruption Technique (Window Approach)
• Overlying soft tissue and bone is removed if necessary allowing for natural or guided eruption.
✅ Indications:
• Buccally impacted canines with minimal tissue coverage (Becker et al., 1984).
❌ Disadvantages:
• Risk of keratinised tissue loss, leading to gingival recession (Fried et al., 1996).
• Less effective for deep impactions.
2. Apical Repositioning Flap Technique
The apical repositioning flap technique aims to expose a buccally impacted canine while preserving keratinised gingiva by relocating it apically.
Procedure:
1. A full-thickness mucoperiosteal flap is raised to expose the impacted canine.
2. A section of gingival tissue covering the canine is apically repositioned and sutured.
3. This maintains keratinised gingiva, reducing gingival recession risk (Cousley, 2000).
4. The canine is either left for passive eruption or guided with orthodontic traction.
✅ Indications:
• Buccally impacted canines requiring exposure while maintaining soft tissue.
❌ Disadvantages:
• Not ideal for deep impactions.
• Requires precise surgical execution to avoid flap necrosis.
B. Closed Eruption Technique
• A mucoperiosteal flap is raised to access the canine.
• A bonded orthodontic attachment with a gold chain is bonded onto the canine crown.
• The flap is then sutured back, keeping the canine within attached gingiva.
• Gradual orthodontic traction guides the canine into position.
✅ Indications:
• Palatally impacted canines requiring controlled alignment (Stewart et al., 2001).
• Preserves keratinised gingiva, reducing recession risk (Vichi & Franchi, 1997).
❌ Disadvantages:
• Requires precise bonding to prevent detachment.
• Longer treatment time than open exposure (Vargas et al., 2011).
C. Tunnel Technique
The tunnel technique is a minimally invasive closed eruption approach that preserves soft tissue attachment while allowing for gradual canine alignment.
Procedure:
1. Extraction of the primary canine creating a natural pathway for the eruption of the impacted permanent canine.
2. Canine exposure & Attachment Placement
3. Guiding the Chain Through the Primary Canine Socket: the gold chain is passed through the socket of the extracted primary canine. This minimises trauma, preserves the gingival structure, and maintains keratinised tissue.
4. Orthodontic Force Application
✅ Indications:
• Palatal impactions with a retained primary canine (Zuccati & Doldo, 2010).
• Cases where soft tissue aesthetics are a priority.
❌ Disadvantages:
• More technically demanding for severely displaced canines.
• Longer treatment duration compared to open exposure.
Post-Treatment Considerations
A. Soft Tissue and Periodontal Health: Gingival grafting may be required in cases of gingival recession (Fried et al., 1996).
B. Retention Protocols
• Fixed retainers ensure long-term stability.
• Hawley retainers can be used in non-severe cases.
Possible Complications Secondary to Canine Exposure
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