13 years old female patient presented with bilateral ectopic canines. Orthodontic treatment by: Dr. Yossi Bar-Zion, DDS, MS. Surgical exposure by: Dr. Jon Nakano, DDS.

Impacted canines can present a series of challenges including delayed eruption, root resorption to adjacent teeth, potential periodontal compromises, arch-length discrepancies, and esthetic as well as functional compromises. There are several treatment approaches to address the ectopically erupting /impacted canines; the predictability of the treatment options is often determined by various factors including: patient’s age, root formation, tooth position, tooth angulation, proximity to adjacent teeth, etc.

The canines for this particular patient were rather horizontal in angulation and the crowns of the canines were in close proximity to the roots of the central incisors. This presented risk not only to the roots of the lateral incisors but also to the central incisors. We elected to address the canine with surgical exposure of the canines and utilizing orthodontic treatment to guide the impacted teeth into their proper position. The primary canines were extracted, the canines were exposed, and buttons with micro-chains were placed on the impacted teeth. Orthodontic treatment was used to create the space needed for the canine in the maxillary arch and specific orthodontic mechanics were applied to guide the teeth in a distal vector of force – away from the adjacent roots and teeth; this careful approach helps minimize potential root damage as well as other compromises.

Orthodontic treatment by: Dr. Yossi Bar-Zion, DDS, MS

Surgical exposure by: Dr. Jon Nakano, DDS.

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This 14 years old male patient presented to our office with a concern of impacted mandibular 2nd molars. His initial radiographic evaluation reveals a significantly impacted  mandibular 2nd molars; while the mandibular left 2nd molar is approximately 60 degrees impacted, the mandibular right 2nd molar is virtually horizontal and far below the height of contour. The options included extraction of the impacted 2nd molars, however, due to his young age and his occlusion, we decided to surgically expose and upright the impacted molars.

The following pictures show the progress during his orthodontic treatment. The 2nd molars were quite successfully uprighted and erupted in functional occlusion. The thirds molars were subsequently extracted.

Orthodontic Treatment by: Dr. Yossi Bar-Zion, DDS, MS

Surgical Treatment by: Dr. Brijesh Patel, DDS, MD

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