CANINE IMPACTION: HOW EFFECTIVE IS EARLY PREVENTION? AN AUDIT OF TREATED CASES
Female
Female
Figure 5. A girl with a horizontally placed
canine. Surgical removal through her nose
was considered followed by fixed orthodontic
treatment, but she subsequently received
Orthotropics to create room for the canine which
spontaneously up-righted and erupted.
Figure 6. A girl whose upper right canine was
lying over the central incisor. Her upper incisors
were assessed as being 9 millimetres down and
back from their ideal relationship with the cranial
vault. Surgery had been planned but instead the
incisors were moved forward with Orthotropics
and she was trained to keep her mouth closed
with her tongue on her palate. The canine then
erupted without further assistance.
To some extent the reason is obvious because the
forward movement of the incisors coupled with
the expansion creates a large amount of space
in the canine region (Fig. 1). In addition, if the
incisors were distally placed to begin with (see
Fig. 4), then the canines are more likely to erupt
on top of them as suggested by Lüdicke and his
colleagues.18 As is shown in figures 3, 4, 5, and 6
older patients may also benefit from Orthotropics
although eruption can be quite slow. These four
patients were referred for second opinions after
being told that their canines would need to be
exposed by surgery. Instead they were treated by
Orthotropics and it was thought that their progress
might illustrate why impactions may not occur in
younger patients. Of interest no fixed archwires
were used for any of these patients.
forward and this provided room for the canines to
erupt spontaneously without any extractions.
Case 2 (Fig. 4) This twelve year old girl attended
for a second opinion because her canines were
palatally impacted against her right lateral and
left central. She had been advised to have her peg
laterals and first pre-molars extracted, followed
by surgery to expose the permanent canines.
She had also been warned that she might loose
the upper left central. Instead she was treated
by Orthotropics without any extractions, using
expansion to widen and move forwards her maxilla
and incisors. Enough space was created to avoid
the premolar extractions, enabling her peg laterals
to be crowned. In our experience it is wise to open
a space one and a half times the width of the
canine crown as this helps it to rotate lengthwise.
Case 3 (Fig. 5) This patient aged 12 arrived with her
right canine horizontally impacted. The possibility
of extracting it through her nose was considered,
but she was referred to the school for Orthotropics
for a second opinion and a course of treatment
encouraged the canine to erupt without either
surgery or extractions.
Case 4. (Fig. 6) Her upper incisors and maxilla were
measured to be nine millimetres down and back
from their ‘ideal’ relationship with the crani