Back to the blog

Impacted cuspid

Pre-orthodontic Cuspid Exposure

A different approach but not a new one. You evaluate a new case and you find that the upper canines are palatally impacted. You look at your treatment options : development of the maxillary arch over many months, open the cuspid space to finally expose and tract the cuspids. Then you have this thought, why not expose the cuspids right at the beginning of treatment since you can feel them with your finger on the palatal side which means that they are probably not too deep. If you choose this option you will have to expose the canines and cover them up with a periodontal pack during the time you are preparing and regaining the space in the arch ( a few weeks for superficial impactions to a few months for deeper ones). This procedure demands that you carefully remove the bone around the cuspid in the path of eruption. Many authors (Kokich et al. 2014) recommend this technique to save months and reduce the treatment time since during alignment of the arch the probabilities of spontanuous eruption of the cuspid are very high. When you will be ready to align, the cuspids will have improved their positions and this will save you a lot of work. My opinion : I have done this many times over the years and it works very well. Be careful : it is preferable to bond a button or eyelet on the cuspid to help maintain the perio pak in place (from a few weeks for superficial ones to a few months for deeper positions), also advise the patient that with an open flap technique, they me be inconfortable from the surgery and the pack. These are small inconvenients compared to the advantages. This technique is detailed in the book published by Quintessence in 2014, from Vincent et al., ’’Orthodontic and Surgical Management of Impacted Teeth’’.