ORTHODONTICS
Cite this article:
Mew J, Mew M.
Canine impaction:
how effective is
early prevention?
An audit of treated
cases. Stoma Edu J.
2015;2(2):114-119.
CANINE IMPACTION: HOW EFFECTIVE
IS EARLY PREVENTION?
AN AUDIT OF TREATED CASES
John Mew1a*
Michael Mew1b
1
The London School of Facial Orthotropics
16-18 Pampisford Rd, Croydon, London
CR8 2NE, UK
BDS, Lond; LDS, RCS, Eng; MFGDP, (UK)
M.Orth, RCS, Edin; Visiting Professor
b
BDS Lond; M Orth Aarhus
a
Abstract
Introduction: Impacted maxillary canines are a major problem and expense
in orthodontic practice. It seems as though their incidence has risen in recent
years. It had been noticed that fewer canines appeared to be impacted amongst
patients who had been treated by Orthotropics®, a form of treatment which
involves proclining the incisors and expanding the maxilla. The objective was
to compare the influence of Orthotropics on the ratio of impacted canines with
matched averages from other populations.
Methodology: Records over a five year period were taken from a practice
specialising in Orthotropics. An audit of the incidence of impacted canines was
taken and compared with average frequencies.
Results: There appeared to be a zero incidence of impacted canines amongst
patients from this practice who started treatment before the age of ten. This
compares with an incidence of 3½ % in the wider range of older patients from
comparative populations.
Conclusion: Expansion coupled with proclination of the incisors in children
under nine years old, may reduce or eliminate the impaction of maxillary canines.
Keywords: canine impaction, incidence, early treatment, incisor proclination,
expansion
Introduction
Patients whose canines fail to erupt are
at risk for a range of problems. Not only
may dental aesthetics be prejudiced but
correction can prove both expensive
and traumatic. Healthy incisors may be
lost through pathologic root resorption1
and other teeth may need extracting to
provide room. Surgery may be required to
expose a canine buried in the palate and
this can be a complex procedure involving
the removal of a considerable volume of
bone. Additional orthodontic treatment
may be required, either to pull the canine
into position and/or to align the dentition
subsequently.
There is also the risk of damaging the
periodontum and devitalising the canine
Received: July 15th, 2015
during the traction procedure2, in addition
Accepted: August 26th ,2015
the force vectors sometimes result in root
resorption.1 Recent costings including,
surgery, orthodontics and after care,
* Corresponding author: suggests that a single impacted canine can
Professor John Mew
3
Braylsham Castle easily exceed £8000.
Broad Oak, Heathfield, Sussex TN21 8TY, UK Consensus
supports a multi-factorial
Tel / Fax: +44 435 862045
origin for this condition. Possible factors
e-mail: [email protected]
114
include: 1/Small or missing lateral incisors,
2/Retruded incisors 3/Lack of maxillary
development. 4/Genetic Predisposition. 5/
Shortened Arch Length. 6/ Tooth size - arch
size discrepancy. However evidence to
confirm any of these possibilities is weak.
For example canine impaction has been
attributed to both narrow maxillae4 and
wide maxillae.5 Other papers have noted a
link with a range of dental anomalies6 such
as distally inclined mandibular second premolars7 suggesting a genetic syndrome
but this begs the question of the genetic
and environmental contribution to jaw
development in the first place.
The percentage of children in industrialised
societies, who develop canine impaction
is second only in frequency to impacted
third molars.8 This percentage is probably
higher in orthodontic offices where such
cases are likely to be concentrated. An
additional percentage of canines are
either buccally or palatally displaced
because of a lack of space. In ѡ