An impacted tooth is a tooth that, based on its developmental stage, should have already erupted into the oral cavity but has not erupted for various reasons.

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Common Causes of Tooth Impaction

1. Lack of space for tooth eruption – This is particularly common with impacted wisdom teeth.

2. Improper eruption path – The tooth "gets lost" within the jaw and fails to reach its intended position.

3. Obstruction of the eruption path – For example, by a supernumerary tooth that causes another tooth to become impacted.

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Teeth Most Frequently Impacted

1. Wisdom teeth

2. Upper canines

Impacted wisdom teeth typically do not pose an orthodontic problem. If orthodontic treatment is required, the need for extraction of impacted wisdom teeth will be considered.
Impacted canines, on the other hand, represent a significant orthodontic challenge, both aesthetically and functionally. Therefore, such cases require special consideration and planning for the optimal treatment approach.

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Prevalence of Impacted Canines in the Population
Impacted canines are relatively common, occurring in approximately 2% of the population.

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Why Treat Impacted Canines During Adolescence?

1. The canine is a strategic tooth, serving as the transition between the anterior and posterior regions. It is important both aesthetically and functionally for maintaining occlusal stability. If the impacted canine can be brought into proper occlusion, it is highly beneficial to do so.

2. As age increases, the likelihood of successfully erupting an impacted canine with orthodontic treatment decreases. With professional orthodontic treatment, the chances of erupting the canine are very high during adolescence, whereas by the fourth decade of life, the success rate drops to around 50%. Therefore, orthodontic treatment for eruption of impacted canines should be performed during adolescence.

3. An impacted tooth may damage its surrounding structures. In cases where the crown of the impacted canine is in contact with the root of an adjacent tooth, significant root damage can occur due to resorption caused by the impacted crown. Therefore, it is crucial to move the impacted canine and eliminate contact with the adjacent root.

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Challenges in Treating Impacted Teeth

1. Diagnostic Challenges – Determining the exact position and angle of the tooth. This requires special imaging and 3D imaging modalities such as CBCT, which provides a three-dimensional view of the impacted tooth and surrounding teeth.

2. Treatment Challenges – Several clinical decisions must be made to ensure successful treatment, including the timing of treatment, the correct sequence of procedures, and the method of applying force to the impacted tooth.

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How Is an Impacted Canine Treated?

1. After diagnostic imaging and precise evaluation, the first step is usually to create space for the impacted canine.

2. Next, surgical exposure of the canine is performed, and a bracket is bonded to it.

3. Gradual traction is applied to the impacted canine to bring it into the correct position.

4. Orthodontic alignment of the teeth is completed to finalize the process.

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Disadvantages and Risks of Erupting Impacted Canines

1. Orthodontic treatment involving the eruption of an impacted canine is inherently more complex and prolonged than standard orthodontic treatment.

2. The success rate of erupting an impacted canine decreases as the patient’s age increases.

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Alternatives to Erupting an Impacted Canine

1. No treatment – The risk is that the impacted canine may damage the roots of adjacent teeth, especially if there is contact between them. Additionally, delaying eruption until an older age reduces the likelihood of success.

2. Extraction of the impacted canine – This would require prosthetic restoration of the missing canine with an implant.