Orthodontic Treatment Strategies for Impacted Canines: A Comprehensive Review

Abstract The primary objective of this narrative review was to examine the current orthodontic treatment strategies for managing impacted maxillary canines. This includes discussing etiological factors, modern diagnostic approaches, particularly the role of cone-beam computed tomography (CBCT), and established therapeutic modalities that integrate surgical exposure and orthodontic traction to achieve optimal esthetic, functional, and periodontal outcomes. A comprehensive literature search was performed using databases including PubMed, Scopus, and Web of Science. The search terms applied were: “impacted canine,” “orthodontic management,” “maxillary canine,” “cone-beam computed tomography (CBCT),” “surgical exposure,” and “orthodontic traction.” Boolean operators (AND, OR) were employed to refine results. Filters included English language, peer-reviewed articles published between 1990 and 2023. Articles focusing on orthodontic management strategies, diagnostic imaging, surgical exposure techniques, and biomechanical considerations in canine impaction were included; studies unrelated to orthodontic management of impacted canines or lacking methodological clarity were excluded. The literature supports that timely and accurate diagnosis – facilitated by CBCT – coupled with early interceptive measures (e.g., extraction of primary canines and expansion of the arch) can significantly reduce the severity or incidence of canine impaction. Definitive treatment strategies often involve a multidisciplinary approach: Surgical exposure of the impacted canine followed by orthodontic traction to guide it into the dental arch. The application of light, continuous forces, biomechanically optimized mechanics, and the use of temporary anchorage devices (TADs) have improved the predictability of outcomes, reduced treatment times, and minimized complications, such as root resorption and periodontal damage. Treatment modalities include interceptive approaches (extraction of deciduous canines and arch expansion) and definitive interventions. Surgical procedures range from open eruption to closed eruption techniques, followed by controlled orthodontic forces to align the canine. Advances in imaging and anchorage (e.g., TADs) have enabled more targeted and efficient tooth movement. Orthodontic management of impacted maxillary canines is complex and requires a thorough understanding of etiology, precise diagnosis facilitated by CBCT, and a carefully planned combination of surgical exposure and orthodontic traction. With proper interceptive measures and integration of advanced diagnostic and therapeutic tools, successful alignment with reduced morbidity can be achieved. However, further standardized, prospective studies are necessary to refine protocols and ensure consistent, long-term stability, and periodontal health.