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Treatment Options for Impacted Canines

April 28, 2023

A child with impacted canines may have more options than commonly expected. In this case study, Dr. Bockow demonstrates that through careful and slow expansion, it is often possible to preserve all of the child's teeth and give them a great foundation for a beautiful smile.

Dr. Rebecca Bockow is a dual-trained board-certified orthodontist and periodontist – one of only a handful in the country. She lectures nationally on periodontics, orthodontics, interdisciplinary orthodontics, airway, and skeletal growth and development.

"So, and then another one... these impacted canines can be tricky. So, this is an interesting case because it combines impacted canines and expansion and comprehensive Ortho. See when in Orthodontics, the way we define an impacted canine is when the crown of the tooth radiographically crosses the distal line angle of the lateral incisor. So, these would be considered doubly impacted canines. And so we see them here when you see them right on top of the lateral incisors. You see the lack of tongue space here.

"And so, if we look here, we see those canines right on top of those teeth, and if we look here we don't have room for the canines. How are we how are we going to make room for those canines? Um,a lot of my colleagues might take out teeth here, and maybe that's a fine option. Maybe it's not a fine option.

"I'm going to share with you an alternative. Maybe the way I'm about to show you takes a little bit longer, but it can be done. So, what we did here is we distalize the upper posterior teeth. Creating space for those canines, and you can see as we distalize the teeth, the gingival fibers can create more space for those teeth to come in. We're uprighting the lower teeth.

"So here she is before and after distilization. And now we wait until the canines come in. Now, we do upper expansion. You can see we have some secondary tipping in the upper molars, but doing everything we can to create that space. So, this is distalization expansion. Here she is again. We're watching, watching, waiting for the teeth to come in. So here before and after distilization and expansion with some time.

"And so now we line everything up. So, here she is. We're watching her grow. Once again, this is not the fastest way to treat these patients. Here she is in retention. And now we line everything up - waiting for the teeth to come in. So, treating her non-extraction by creating that space distilization and expansion and ensuring that we have nice incisor positioning. We didn't flare the front teeth, but rather created space for the canines.

"So one might argue and probably maybe not the most efficient, but certainly a really nice alternative to taking out teeth. Creating that periodontal support.

And then people always ask me. Well, did you protect the profile? A lot of what we're taught in Orthodontics is we take out teeth to protect the profile, and I think we've done a really nice job of protecting the profile here."

Dr. Bockow loves to create beautiful smiles for her patients, setting them up for a lifetime of dental and airway health.

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