Use of closed surgical exposure for the treatment labially impacted maxillary canine containing dentigerous cyst: case report

The most prevalent impacted teeth are the mandibular third molars, maxillary canines, mandibular second premolars, and maxillary central incisors. Maxillary canines are the 2nd most commonly impacted teeth encountered during orthodontic treatment. Studies by Johnston WD have shown that about two-thirds of maxillary canines are impacted on palatal side, one third are impacted labial side.(1) during the ages of 11 and 12 years permanent maxillary canine usually erupts into the oral cavity; but approximately 1-3% of the population has missing one or both the cuspids.(2) The incidence of impacted canine has been reported between 0.92% to 1.7% in the literature review .Dachi and Howell reported an incidence of 0.92%, Ericson and Kurol also reported an incidence of 1.7%,commonly seen in females (1.17%) than in men (0.51%) with a ratio of 2:1.4 .Bilateral impaction is rare seen in approx 8% of people with maxillary impacted cuspids.(3,4,5) Yamaoka et al, suggested that there was no difference in the incidence of completely impacted canines in the edentulous as compared with the maxillary arch having teeth.(6) Dewel concluded that the maxillary canines have not only the longest duration of evolution, but also the longest and perhaps most tortuous route to migrate from their point of origin, lateral to the piriform fossa, before they reach the point in full-occlusion .developmental point of view the crowns of the permanent canines is in close contact with the roots of the lateral incisors.(7) The management of a impacted cuspid commonly comprises of a surgical procedure to enable the tooth to be aligned via orthodontics. Two techniques of surgical exposure are given: An ‘Open’ exposure, which involves raising a mucoperiosteal flap, followed by removal of bone and mucosa overlying the tooth and placement of a surgical pack. The cuspid is subsequently aligned above the mucosa by orthodontics. shorter treatment time, and improved hygiene during treatment ,minimal effects on the periodontium are one of the advantages of open exposure. A ‘Closed’ exposure, comprises of raising a mucoperiosteal flap, limited removal of bone and instead of excision of the overlying mucosa, an attachment is bonded to the crown of the exposed cuspid, enabling proper alignment of the tooth from below the mucosa (2,8)