dr. Amanda from street smile solutions and today we're going to talk about impacted canine so who
here sees the canines I do they're practically up in this patient's palate or nose so where are
these teeth supposed to be this tooth which is basically sitting horizontal is supposed to be
vertical right there and this one too right it's supposed to be here so we've talked a little bit
about impacted canines on our Facebook forum but patients have a hard time understanding them and
I think one of the most frustrating thing is that it's easy to swap these occurring as young as age
six seven but a lot of times dentists are missing it because they're not taking the right kinds of
x-rays to identify it and this comes up kind of tricky this looks like a perfectly good tooth but
that's actually a baby tooth so you know so what do we do so it really depends on and hey my own
daughter has an impacted canine so you know not only have I treated easily hundreds of them but
they run in families and I don't know who she got it from and we were surprised just like everyone
else when she got it luckily we noticed it at age eight and now we're doing things to prevent the
damage and the trauma and some of the things that can happen with them but they're really a big pain
in the rear they're very difficult for not only patient parents and dentists so let me tell you a
little bit about it and kind of how we decide what we're gonna do with them and you may want to get
multiple opinions if someone tells you you have an impacted canine because there's all different
ways to all different opinions all different ways to treat them some are very invasive some can be
expensive some aren't so are better looking so I recommend you get at least three or four different
opinions before you decide for sure what you want to do with it but I kind of give you my thought
process when I see these I mean of course it depends on the age of the patient if the patient
is still growing there's a lot more options and if the patient's an adult this patient is clearly
an adult the other thing that we're gonna look at is are the canines buccal or lingual so what
that means is if they're impacted they're stuck somewhere so they stuck on the front side of the
teeth like the side facing in the bone facing the lip where they stuck in the palatal bone the bone
behind the teeth they'll poke the bone in your roof in the mouth so they're in one or the other
okay so you can't tell from a flat 2d image where they are I mean we can have some idea so sometimes
we need to take something called a CB CT and we've done some videos on that before that's basically a
3d image of where it is in space so you totally know as long as we can just tell by taking a
couple different x-rays or we can feel around like if it's in the buckle under the lip you can feel a
bump there if it's in the palate as long as it's not too high up you can feel a bump like on the
roof of your mouth sometime just starting to show through someone's it's starting to pop out so we
need to find the where the location is localized it a little bit more in a 3d plane so most of the
time it is in the palate if you had the three if you had if you're a betting person most of
the time it's in the palate although the ones in the palate or more challenging and do worse than
the ones that are in the buccal so if you have one that's in the buccal it's actually a good thing so
that's a lot easier for the most part for it than just to get it down and a lot more successful but
don't stress out if you have a palatal one from there other things we're looking at we're looking
at the angle of the tooth so this one is clearly at a 90 degree angle from where it's supposed to
be right supposed to be here it's here so that's 90 degrees that's not so good ideally angulation
I'd like to see it less than 20 or 30 degrees just a little bit angulated or less or vertical if it's
impacted but they usually aren't impacted ones usually are at an angle so the lower the angle the
better because easier it is to get it up what else are we looking at we're looking at the tip of the
canine there's a lot of research that goes behind this so and how much it crosses over where it
should be so sometimes you'll see them like here you know they crossed all the way over here that's
not so good so these are not bad because the tip of them is actually almost where it's supposed to
be so that's good so not only are we looking at it like we said in terms of the angulation but we're
looking at it in this direction too like where are they supposed to be and how displaced are
they from where they're supposed to be so there's all different things we're looking at and then
like I said the age of the patient a little pain who's still growing has gonna have more success
than a patient that's full-grown a done growing so this patient is pretty much pretty screwed
if I have to say that so this is gonna be a very hard case to save these canines I'm not gonna say
it's impossible but you got to realize that you're gonna have to go up there surgically you're gonna
have to glue some stuff to these seat they're not gonna come down on their own they're gonna
take these teeth out you're going to have to like actually put some traction on these teeth through
an open cut you know an open wound and slowly put traction to guide them down into place it's
gonna take a long time I mean if you even were successful on this case it's gonna take easily two
years to get these down uprighted and straight and that's if you are successful what else can happen
on the way down lots of things can happen on the way down so as you're bringing them down they can
run into all these teeth and cause them to get damaged so for this case most likely depending on
where it is the risk the risk of bringing them in outweigh the benefits so sometimes they'll leave
them up there impacted but sometimes it can cause all sorts of other pathologies sometimes they'll
take them out but that's a pretty invasive surgery so yeah this is a hard case but I just wanted to
share it with you it's more of an extreme case most peoples are not like this but for sure if
you're on our facebook forum if you have x-rays as long it doesn't have any ph I identify information
do post your x-rays we'd love to take a look and give you some feedback of course we talked a lot
about third molars you see them here too that's a whole nother story we can whole nother discussion
so the measly impacted horizontal impacted versus the vertical so all right thanks so
much let us know if you have any questions about impacted canines all right thanks bye