This document discusses the surgical removal of impacted maxillary canine teeth. It begins by defining an impacted tooth and describing that maxillary canine impaction is most common. It then covers classifying impacted canines, localization methods like clinical exams and radiographs, and factors that can complicate removal. The bulk of the document details surgical procedures for removing palatally, buccally, and intermediately impacted canines. It concludes by discussing treatment options and potential complications of impacted canine removal surgery.

2. By
Dr.Muhammad ATHAR Khan
PGR OMFS
Nid,Multan.

3. 
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Thick and Dense palatal mucoperiostium
Thick hard palate Bone
Long Distance to eruption
Last ant.tooth to erupt
Retained Primary canine
Inadeqaute space
Root development completed before eruption
Eruption of Tooth is dependent on increase in
apical development.

4. A Tooth wich Fails to Erupt into its Functional
position within expected time is called impacted
tooth.
The surgical removal of a deeply seated
maxillary canine in relation to the maxillary sinus
and the nasal cavity is one of the most difficult
oral surgical procedures

7. •Maxillary canine is 20 times
more than mandibular canine
• More frequent in females than
males
• Palatal impaction is 3 times
more than buccal impaction

8. •
•Classification
canine:
of impacted maxillary
ARCHER,S CLASSIFICATION
1)
Class I
Palatally Impacted canine
a) Horizontal
b) Vertical
c) semivertical
2)Class II
Buccally impacted canine
a) Horizontal
b) Vertical
c) Semivertical
3)Class III
Impacted canine located in both the palatal and labial
surfaces.
4)Class IV
Impacted canine located in the alveolar process.
5)Class V
Impacted canine located in an edentulous maxilla.
6) Class VI in aberrant position.

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◦ Localization of impacted maxillary
canine:
clinical examination
Radiographic examination
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Clinical examination:
By palpation:
Presence of distinct bulge
Deflection of crowns:
mostly of lateral incisors or premolars.

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Radiological examination:
a) Intra-oral periapical films

11. b) Occlusal radiographs
Canine will appear as a round radioapaque
structure.

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In This technique, the films are in the same
position while the cone is shifted,
if the canine moves with same direction of
the cone ,
it indicates that it is located far (palatally),
while if the canine moves opposite to the
direction of the cone ,
it indicates that it is near (buccally).
(SLOB Rule)

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d) Tomograms:
Sections are taken, if the
canine is impacted buccally ,
it's tip will appear first ,
while if impacted palatally,
the apex will appear first.

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To determine relation to maxillary sinus.

16. •..
•Contra-indications
for the removal
of an impacted maxillary canine:
When it can be brought into normal position
either by
surgical repositioning or
surgery and orthodontic
treatment

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Factors complicating the removal of the
impacted canine:
Close relationship to the roots of the
neighboring teeth.
Intimate relation to the maxillary sinus.
Curvature or hypercementosis of the root.
Difficulty in localization most important
factor.

18. ◦ SURGICAL REMOVAL OF IMPACTED MAXILLARY
CANINE
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Planning the operative procedure
X-ray examination
Classify the impaction
Extent of the flap
Sectioning of the tooth is needed or not

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Removal of palatally impacted canine:
1- If unilateral:
1. Reflection of flap from mesial of central
incisor to distal of first molar. The flap is
better to be envelop.
2. Bone removal by post stamp technique.
3. Decapitation removal of the crown.
4. A cryer elevator is used to push the root
to the empty space then remove it.

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2- If bilateral:
- The flap will result in cutting of nasopalatine
vessels & nerves leading to hemorrhage &
numbness in order.
- However, regeneration of the nerve fibers will
occur later so if you don't have anyother option,
do it.
- Anther solution is to make the flap crossing
around the incisive papilla to avoid injury to the
neurovasculature.
- Upon suturing a palatal flap always place the
knots buccally to prevent irritation of the tongue.

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Removal of labially impacted canine:
Easier since the buccal plate of bone is
thinner & better accessibility.
A pyramidal flap is preferred , followed by
similar steps as before..

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Removal of impacted canine from
intermediate position
Usually open the flap in the area where the
crown is present (mostly buccally),So a buccal
flap is reflected first.
The type of the flap differs according to the
height of the impacted tooth e.g. if the tooth
is very high, do semilunar flap or pyramidal.
After opening a buccal flap, decapitate &
remove the crown, follower them by the root.

27. open the buccal flap finding the root
remove it first then do a palatal flap &
remove the crown (keep the buccal flap
open because you might need it)
If the other half of the tooth can't be
reached, push it from the buccal side to
the palatal side or vice versa until it can
be held & removed.

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Removal of impacted canine in edentulous
ridge:
The problem here is the pneumatization of
the maxillary sinus & should be in mind while
doing such impaction.
If the tooth need the buccal side, do buccal
flap.
If the tooth need the palatal side do palatal
flap.

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Removal of impacted canine from unusual
position:
These situations will be managed according
to the position.
The canine could be in: Zygoma, below orbit,
inferior turbinate of the nose, maxillary sinus.
For example: if canine is impacted in
maxillary sinus then Caldwell-Luck operation
will be performed

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Surgical exposure of the impacted maxillary
canine for orthodontic treatment :
A flap is opened to expose the canine then a
bracket is placed over the exposed canine
with arch wire over the adjacent teeth
Replantation can be done i.e. remove the
canine & create a socket where you like to
place the tooth then do endo or retrograde
filling , be sure that the replanted tooth is in
vertical position & out of occlusion.

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Treatment Options:
Extraction.
Reposition.
Surgical exposure & orthodontics.
Replantation.

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Exposure of the inferior alveolar canal.
Injury or compression to the inferior alveolar nerve resulting in
paraesthesia.
Injury to inferior alveolar vessels resulting in  Hemorrhage
Fracture of roots and displacement into the maxillary sinus or
submandibular space
Necrosis of the flap due to improper placement.
Fracture of large segment of bone
Traumatization or dislodgement of adjacent teeth
Injury to the soft tissues from the instruments
Forcing a tooth into the maxillary sinus
Forcing maxillary third molar into the ptergopalatine fossa

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Opening into the nasal cavity oro-nasal communication.
Fracture of the alveolar process
Fracture of the lingual plate of bone
Fracture of maxillary tuberosity.
complete fracture of the mandible
Extensive laceration of the soft tissues
Extensive exposure of the roots of the adjacent teeth
Acute trismus
Pain of dry socket
Discoloration of the soft tissue due to ecchymosis
Necrosis of large segment of bone

37. THANX