The comments

Dr Sylvain Chamberland, Orthodontiste says:

First of all, an impacted canine CAN NOT cause oral cancer. Period.
However, some pathology can arise from the dental follicule. The most common would be dentigerous cyst.

In my collection of oral pathology I found this:

1- Dentigerous cyst

This show an elargment of the follicule around the crown of the impacted canine.

2- Central giant cell tumor

This is an impacted canine of an 11 years old female.

Central giant cell tumor is seen predominantly in patients under 20 years of age and occurs more commonly in females than in males, more frequent in the mandible than the maxilla, generally anterior to the 1^st molar. This lesion is expansile producing a discernable enlargement and cortex destruction. It may displace adjacent teeth.

 

3- Odontogenic adenomatoid tumor (AOT)

This 9 years old girl that was refered to the oral surgon for an impacted canine and deformation of the cheek.

One can see an enlarge cyst with displaced adjacent teeth involving the lateral incisors and the 2 premolars. The CBCT scan see enlargment of the cortex, displacement of the impacted canine toward the orbit.

Approximately 70% of AOT's occur in females younger thant 20 years of age and 70% involve the anterior jaw. Association with impacted canine is common. Therefore on radiograph, it can be mistaken for dentigerous cyst.

 

3-Root resorption

Root resorption of teeth adjacent to an impacted canine is common. You should not take that risk lightly.

 

Conclusion

An impacted canine should not be left alone. It may cause  significant problems

Baskar SN, Synopsis of Oral Pathology, Mosby, 1977

Glick M et al, Burket's Oral Medecine 12^th ed. PMPH-USA, 2015

Dr Sylvain Chamberland, Orthodontiste says:

Chances are good that they will move, but some risk exist that they may not. It is worth to try and you should not regret it. I hope your orthodontist put them on traction.

Dr Sylvain Chamberland, Orthodontiste says:

Thank your for sending this panogram. It is sad that the direction of pull was not done in a palatal (distal) direction instead of pulling occlusally toward the dental arch.

You told me that there was a 1st orthodontist who realised the resoption and the 2d who pulled during 8 months without success. You told me the name of the 3rd orthodontist you are visiting. He know how to use cantilever and miniscrew. I am quite sure that he can success to move the canine away from the root of the incisors and avoid further damage.

I would trust the 3rd orthodontist. I think he ca do the job. Keep me informed and would  published the mechanics he use for your daughter  and his name in my website if he accept.

 

 

Maribel says:

I am really thankful for tour reply.
We are not sure at what stage took place the resorption. I am afraid it happened at starting ortodontics 3 years ago. We just realized after one year of ortodontic treatment when they were about to fenstrate. They did not do a CT before starting.
Yes, I think they did use a cantilever spring now but after 8 months after fenestration it seems that nothing happens and it was pulling so strong on the front teeth that they do not want to make more pressure on them. The front teeth are suffering to much and they are really weak.
Now we have a new proposal from a 3rd orthodontist to use a kind of “micro screws” and try to pull the canines into the palate to separate them from the roots.
We are really lost with the whole treatment. We have tried two different doctors and no success at all.
I enclose pictures of 2015, study afrer one year treatment, when they realized resorption, new radioagraphy of April 2017 and a sample of the new proposal
I appreciate your kind information and your knowledge. Thak you

Dr Sylvain Chamberland, Orthodontiste says:

Your impacted canine will erupt if a force is apply via an attachement bonded on the crown and a chain or a ligature to transmit the force. It can make some self eruption if it is exposed and leaved uncovered (open eruption technique) but it wont go into alignment by itself.

James says:

Hi there!

I'm 25 and having surgery on one of my canine teeth and I've been doing reading about the subject and authors keep noting that the teeth can naturally erupt after surgery and packing of the tooth. They also talk about placing something on the tooth causing it to erupt naturally??

I'm just wondering if you could confirm if this happens with people my age or are they likely just talking about rectifying the problem early with 10-12 year old and catching the end of the eruption period.

.. Could my impacted canine naturally erupt at my age with a little force and guidance?

Dr Sylvain Chamberland, Orthodontiste says:

There may be good reason to extract primary canine. You should ask the question to the dentist who did it or orthodontist who recommended it. It seems that there is not a good communication between you and the father of your son. Are you divorced?
You may send me the panogram to my professional Facebook page, but you can call the dentist to get an explanation.

Dr Sylvain Chamberland, Orthodontiste says:

It is bizarre to find out that the impacted canines is resorbing the roots of the incisors after 16 months or so of treatment. Canine impaction should have been addressed much earlier. WHen they dis fenestration, did they actively pull the canine with an elastomeric chain or a cantilever spring?
It is unlikely that at 15 years, canine can not be bring into the arch.
I would not have the reflex to extract the canine and recommend implants.
You can send the panogram via my professiional facebook page.

Maribel says:

Hello from Spain,

My daugther - 15 years old - has impacted canines with resorption of the roots of all 4 front teeth.
She is in ortodontic treatment for almost 2 years. 8 months ago she got the dental fenestration to pull the canines but it seems that there is no movement al all.

Now they propose to extract the canines and implant

Since the canines are near the roots I am not sure if this will be possible.

I would like to attach some pictures but I do not see the possibility

Thank you for your comments

Tina says:

My son is 9 and his father got my son's upper primary canine teeth pulled. I don't think it was necessary at all. His later inciders were sitting alittle high in the gums but not extreme. I am angry as i was not consulted at all. Can i send a before picture? So you can tell me if i am rightly angry or maybe it was needed.
Thank you

Duncan Higgins says:

Under the heading: "Xbow® and Forsus™" the final sentence reads:"There were no differences in the total time of treatment between both appliances."
In Dr. Miller's article in the Angle Orthodontist under Results in the Abstract he states:"The mean treatment time was 24.2 months for XB and 30.2 months for the FO group (P 5 .037).
XB patients averaged 10 fewer months of fixed edgewise appliances compared to FO patients. (XB=Xbow group, FO=Forsus to the archwire group)

At the recent AAO meeting in San Diego Dr.Proffit complimented you on your research. He also stated that as a profession we need to look at clinical significance over statistical significance.
If there was ever a clinically significant difference found in a study it was that found in Dr. Miller's.

In an unpublished study from the University of Alberta in 2015 involving 172 consecutively treated patients with Xbow followed by full edgewise the lower incisor changes were as follows:
L1MGo change from T1 (99.1) to T2 (102.2). Mean difference 3.1 degrees is significant (p<0.001).
L1MGo change from T2 (102.2) to T3 (103.7) Mean difference 1.5 degrees is significant (p=0.01).
L1MGo change from T1 (99.1) to T3 (103.7). Mean difference 4.6 degrees is significant (p<0.001).
For every extra mm of OB (greater than the ideal overbite of 2mm) there is an increase in lower incisor inclination of 1.3 degrees.
This result is similar to other studies done of inter arch Class II appliances.

We have never taken a ceph right after spring removal.
We know the lower incisor is in an unstable, over corrected, and overly proclined position that will relapse.
I would not be comfortable exposing a patient to an extra radiograph and it would certainly be questioned by the ethics committee.
Our protocol was developed after discussions with Dr. Hans Pancherz whom I have lectured with. He had shown over proclination and relapse with the non-edgewise Herbst. The important conclusions that he made were that overcorrection was important to end up with a solid Class I occlusion, and that there was no gingival recession.

A spring is a spring is a spring. The difference in lower incisor proclination depends on whether there is torque control with an edgewise appliance as in the SUS2 to the archwire and Forsus to the archwire, or tipping, overcorrection, and rebound, as with Xbow. At the end of phase two it is the same 5 degrees.
The advantages as I see them to the Xbow are:
1. Xbow has a Hyrax screw which is useful in practically all Class II's.
2. The unwanted side effects of posterior openbite, over proclination of lower incisors, occlusal plane tipping, and the overcorrection of the maxillary transverse and Class II mostly relapse before phase two.
3. There is no buccal flaring of upper molars with Xbow.
4. There is no anterior occlusal plane canting in asymmetric Class II's with Xbow.
5. In many cases we do not need to proceed with phase two.
6. In most cases phase two only takes approximately one year which decreases the rate of white spot lesions.
7. Xbow opens space for the erupting maxillary canines and probably reduces the number of surgical exposures.

Amanda says:

Hi my name is Mandy and I am aged 34 next month. I have just had my 2 impacted canine teeth exposed and bonding when I got out of surgery the surgeon said i have alot of bone surrounding the teeth and that he removed some, also everything I'm reading is telling me that they wont move should i just give up

HLM says:

Note, I'm an adult, aged 66. What kinds of changes can occur AND how long would they, typically, take to notice (minimum and maximum expected time). Thank you for your reply!

marika simone says:

Hi there, I appreciate the wealth of information you have provided on your website.
We recently had a consultation with an orthodontist which terrified my daughter and me. She is 13 years old with had impacted upper canines. During the consultation orthodontist said that impacted canines can cause oral cancer, and can also kill the roots of near by permanent teeth.
This was contrary to a previous orthodontist who two weeks ago said that if left alone the impacted teeth would cause no trouble.
Who can I believe?
What is the prevalence or oral cancer caused by impacted?

Dr Sylvain Chamberland, Orthodontiste says:

Je vous recommande Dr Dany Morais chirurgien buccal chez Maxillo Vendôme et Dr Johanne Séguin orthodontiste ou encore Dr Jean Poirier chirurgien buccal.

Dr Sylvain Chamberland, Orthodontiste says:

It is fairly commun to extract 4 premolars to accomodate the canine. If the orientation of the canine is vertical, chances are good. But why extract now? Is she ready, at 10, for a comprehensive orthodotnic treatment? Or is it a case of serial extraction that need early tratment?

Dr Sylvain Chamberland, Orthodontiste says:

I would recommend that you see the orthodontist first. He will plan the sequence of treatment. Chances are that space regain may be require to fit the canine into the arch. My preference is to have braces on or a removable appliance ready to fit in once the surgical ligature is done. I begin the traction one weeks after surgery.

Dr Sylvain Chamberland, Orthodontiste says:

It is possible that your canine was ankylosed like the the picture in the left. However, a skilled oral surgeon should be able to remove it.

If a part of the root is left in place, I hope it will not jeopardize the root of adjacnet teeth as they are moved to close the space of the extracted canine.

There is situation where it is indicated to partial odontectomy like in the removal of an impacted 3^rd molar.

I would recommend that your dentist or orthodontist follow up with panogram in 6 and 12 months to make sure it remain safe.

I have one question. How the orthodontist the asymmetry that is created by the extraction of 1 tooth?

 

 

Dr Sylvain Chamberland, Orthodontiste says:

Index of Treatment Need

An ITON of 2 describe a fairly mild malocclusion as you can see in the description in the left picture. It does not mean that an orthodontic treatment may not be necessary later if she want to have straight teeth.

It is a well accepted fact, that functional aplliances such as twin block, bionator or frankell do not grow mandible although they can correct class II malocclusion. This was demonstrated in the late 90's (1997-99 to be precise). It was 20 years ago...

Your daughter may be slightly too young, particularly if she is still in mixed dentition. I stop using removable functional appliance in early mixed dentition some 20 years ago. Nowadays, I use fixed functional appliance with braces in very late mixed dentition or early permanent dentition.

You can stop the treatment and it the correction will relapse. You can resume a comprehensive orthodontic treatment later with no problem.

An ITON of 2, an overjet of 3,5 mm and an  overbite of 3,5 mm is a piece of cake to treat. I mean "easy" to treat with braces only.

Best regards

 

 

Dr Sylvain Chamberland, Orthodontiste says:

If the pacifier is something that you bite on and keep between your upper and lower front teeth, there is a possibility that your teeth will move and your occlusion may change.