In the treatment of included canines, as in any type of orthodontic treatment, we have several common options for treatment, whether with Invisalign or invisible lingual braces or as well as with self-ligating or esthetic brackets.
Options for treating included canines
We can select one of the following options to deal with an included canine
One of the options is to use no treatment at all, with the risks that are involved in leaving an included canine untouched. If the patient is reluctant to accept any type of orthodontic treatment, for whatever reason, he or she must be warned about the possible occurrence of root resorption of neighboring teeth, particularly the lateral incisors. Another possible complication is the appearance of a cyst, in which case it would be mandatory to choose a treatment option of either extracting the canine or using orthodontic traction to bring it into the dental arch.
If the baby canine is present, the patient must be informed of its poor prognosis, since its root is usually reabsorbed; of its poor esthetic and functional characteristics; and of the future need for some type of treatment.
According to our experience and to the scientific literature, we recommend extraction of the included canine when:
1. The canine is ankylosed (can only be discovered with computed tomography or if orthodontic traction fails).
2. There are root resorptions of neighboring teeth or of the canine itself, and orthodontic movements may worsen this or threaten a healthy tooth.
3. The canine is very poorly positioned for orthodontic traction.
4. The canine has an anomalous anatomical shape, or presents pathological alterations such as a cyst or infection.
5. When the patient does not want to use traction and the premolar occupies or may occupy the place of the canine.
Fenestration, or surgical exposure, and orthodontic traction
Fortunately, this is the most frequent therapeutic option selected.
Canines impacted in the palate rarely erupt without intervention, due to the bone thickness in the palate and to the mucous. By contrast, canines that are included in vestibular position (facial side) can erupt on their own; however, they do so with certain significant gum complications that nearly always “force” some kind of intervention in these, too.
Methods of traction:
“Fishing rod” or “ballista spring”
Advantages of the system:
- None of the fixed appliances are required, thus we keep “danger” away from the adjacent teeth.
- Allows for good control of the eruption, so as to keep the canine crown away from the root of the lateral incisor and avoid its resorption.
- Continuous, controllable force, easy to modify and manipulate
- Keeps the patient’s discomfort to a minimum, and can be used in both young patients and adults.
- Duration of treatment from 3 to 6 months in favorable cases.
- The patient’s collaboration is not required.
Disadvantages and Possible Complications:
- Can be seen if placed in vestibular position (outside).
- Some patients comment that it can be uncomfortable.
- Ankylosis of the canine.
- Apical resorption of the neighboring teeth
- Periodontal problems with the canine.
Currently, the most efficient, comfortable, invisible, hygienic and simplest method is orthodontic traction of the canine with micro-screws, aided by devices like the “fishing rod”.
The following image shows before and after a 24-month self-ligating treatment in a 15-year-old patient with two included canines.
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