Forced Eruption of a Palatally Impacted Canine with a Temporary Skeletal Anchorage Device: A Case Report Forced Eruption of an Impacted Canine with TADs
Regeneration, Reconstruction & Restoration (Triple R),
Vol. 10 (2025),
1 January 2025
https://doi.org/10.22037/rrr.v10.45708
Abstract
Maxillary canines are the second most commonly impacted teeth, with palatal impactions predominating. Forced eruption supported by temporary anchorage devices (TADs) can minimize adverse effects on adjacent teeth and shorten the preparatory phase. A 17-year-old male presented with maxillary left canine impaction (#23). Extraoral examination showed mild facial asymmetry; intraorally, there was absence of #23, anterior crowding, and a Class II subdivision molar relationship on the right. CBCT revealed a horizontally impacted palatal canine in close proximity to the left incisors. Cephalometrics indicated a Class I skeletal pattern with hypodivergent growth. A canine-first approach was used. Skeletal anchorage was obtained with a 1.6 × 8 mm palatal miniscrew between the left second premolar and first molar. The canine was surgically exposed, a palatal button bonded, and immediate traction applied with elastic thread, followed by a ballista spring. Fixed appliances (0.022-in slot) were used with sequential NiTi and stainless-steel archwires. To avoid lateral incisor root contact, initial retraction was directed posteriorly from the TAD before buccal movement. Space creation with open-coil springs and later interarch Class II elastics on the right were employed. Torque control of the canine was finalized with rectangular archwires. Total active treatment time was 34 months; retention included a braided fixed lingual retainer and a removeable retainer. Posttreatment records showed Class I canine and molar relationships bilaterally, normal overjet/overbite (2 mm/2 mm), improved midline coincidence, appropriate root parallelism, and no radiographic evidence of root or bone loss. Facial profile was harmonious on lateral cephalometry. CBCT-guided, TAD-assisted forced eruption using a canine-first protocol enabled safe, controlled disimpaction of a palatally impacted canine, preserving anchorage and protecting adjacent roots while achieving stable functional and esthetic results.
- Forced Eruption
- Palataly impacted canine
- Temporary anchorage device (TAD)
- Ballista spring
- Canine-first approach
How to Cite
References
1. Litsas G, Acar A. A review of early displaced maxillary canines: etiology, diagnosis and interceptive treatment. Open Dent J. 2011;5:39-47.
2. Lövgren ML, Dahl O, Uribe P, Ransjö M, Westerlund A. Prevalence of impacted maxillary canines-an epidemiological study in a region with systematically implemented interceptive treatment. Eur J Orthod. 2019;41(5):454-9.
3. Alqerban A, Jacobs R, Lambrechts P, Loozen G, Willems G. Root resorption of the maxillary lateral incisor caused by impacted canine: a literature review. Clin Oral Investig. 2009;13(3):247-55.
4. Becker A, Chaushu S. Etiology of maxillary canine impaction: A review. American Journal of Orthodontics and Dentofacial Orthopedics. 2015;148(4):557-67.
5. Bedoya MM, Park JH. A Review of the Diagnosis and Management of Impacted Maxillary Canines. The Journal of the American Dental Association. 2009;140(12):1485-93.
6. Izadikhah I, Cao D, Zhao Z, Yan B. Different Management Approaches in Impacted Maxillary Canines: An Overview on Current Trends and Literature. J Contemp Dent Pract. 2020;21(3):326-36.
7. Sinavarat P, Anunmana C, Hossain S. The relationship of maxillary canines to the facial anatomical landmarks in a group of Thai people. J Adv Prosthodont. 2013;5(4):369-73.
8. Papadopoulos MA, Tarawneh F. The use of miniscrew implants for temporary skeletal anchorage in orthodontics: a comprehensive review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103(5):e6-15.
9. Heravi F, Bayani S, Madani AS, Radvar M, Anbiaee N. Intrusion of supra-erupted molars using miniscrews: clinical success and root resorption. Am J Orthod Dentofacial Orthop. 2011;139(4 Suppl):S170-5.
10. Becker A, Chaushu G, Chaushu S. Analysis of failure in the treatment of impacted maxillary canines. American Journal of Orthodontics and Dentofacial Orthopedics. 2010;137(6):743-54.
11. Heravi F, Shafaee H, Forouzanfar A, Zarch SH, Merati M. The effect of canine disimpaction performed with temporary anchorage devices (TADs) before comprehensive orthodontic treatment to avoid root resorption of adjacent teeth. Dental Press J Orthod. 2016;21(2):65-72.
12. Hourfar J, Ruff CJ, Wilmes B, Ludwig B, Kanavakis G. Rapid Maxillary Expansion and Upper-Molar Distalization with a Miniscrew-Supported Hybrid Appliance. J Clin Orthod. 2016;50(8):476-84.
13. McSherry PF. The assessment of and treatment options for the buried maxillary canine. Dent Update. 1996;23(1):7-10.
14. Pitt S, Hamdan A, Rock P. A treatment difficulty index for unerupted maxillary canines. Eur J Orthod. 2006;28(2):141-4.
15. Counihan K, Al-Awadhi EA, Butler J. Guidelines for the assessment of the impacted maxillary canine. Dent Update. 2013;40(9):770-2, 5-7.
16. Coulter J, Richardson A. Normal eruption of the maxillary canine quantified in three dimensions. Eur J Orthod. 1997;19(2):171-83.
17. Suri L, Gagari E, Vastardis H. Delayed tooth eruption: pathogenesis, diagnosis, and treatment. A literature review.Am J Orthod Dentofacial Orthop. 2004;126(4):432-45.
18. Alhammadi MS, Asiri HA, Almashraqi AA. Incidence, severity and orthodontic treatment difficulty index of impacted canines in Saudi population. J Clin Exp Dent. 2018;10(4):e327-e34.
19. Heravi F, Shafaee H, Forouzanfar A, Zarch SH, Merati M. Forced eruption of palatally impacted canines using bracket-head miniscrews. J Clin Orthod. 2014;48(9):576-80.
20. Capuozzo R, De Felice ME, Caruso S, Gatto R, Caruso S. Upper canine extrusion using temporary anchorage devices
and clear aligners. J Clin Orthod. 2023;57(1):63-72.
21. Weltman B, Vig KW, Fields HW, Shanker S, Kaizar EE. Root resorption associated with orthodontic tooth movement: a systematic review. Am J Orthod Dentofacial Orthop. 2010;137(4):462-76; discussion 12A.
22. Simić S, Nikolić P, Stanišić Zindović J, Jovanović R, Stošović Kalezić I, Djordjević A, Popov V. Root Resorptions on Adjacent Teeth Associated with Impacted Maxillary Canines. Diagnostics (Basel). 2022;12(2).
23. Koral S, Özçırpıcı AA, Tunçer Nİ. Association between Impacted maxillary canines and adjacent lateral incisors: A retrospective study with cone beam computed tomography.
Turkish Journal of Orthodontics. 2021;34(4):207.
24. Noroozian M, Merati M, Heravi F, Shafaee H. Introducing a User-Friendly Technique for Treatment of Palatally-Impacted Canines with the Aid of Temporary Anchorage Devices. J Dent (Shiraz). 2022;23(4):511-9.
25. de Oliveira MV, Pithon MM. Attempted traction of impacted and ankylosed maxillary canines. Am J Orthod Dentofacial Orthop. 2012;142(1):106-14.
26. Becker A, Chaushu G, Chaushu S. Analysis of failure in the treatment of impacted maxillary canines. Am J Orthod Dentofacial Orthop. 2010;137(6):743-54.
27. Grisar K, Luyten J, Preda F, Martin C, Hoppenreijs T, Politis C, Jacobs R. Interventions for impacted maxillary canines: A systematic review of the relationship between initial canine position and treatment outcome. Orthod Craniofac Res. 2021;24(2):180-93.
28. Parkin NA, Milner RS, Deery C, Tinsley D, Smith AM, Germain P, et al. Periodontal health of palatally displaced canines treated with open or closed surgical technique: a multicenter, randomized controlled trial. Am J Orthod Dentofacial Orthop. 2013;144(2):176-84.
29. Migliorati M, Drago S, Bocchino T, Michelotti A, D’Antò V. Treatment of Palatally Displaced Canines Using Miniscrews for Direct or Indirect Anchorage: A Three-Dimensional Prospective Cohort Study on Tooth Movement Speed. Applied Sciences. 2022;12(21):10935.
30. Capuozzo R, Caruso S, Caruso S, De Felice ME, Gatto R. Canine Impaction: Digital Orthodontic Planning in Conjunction with TADs (Temporary Anchorage Devices) and Aligners. Applied Sciences. 2023;13(12):6914.
- Abstract Viewed: 31 times
- PDF Downloaded: 28 times