Conventionally, Treatment of Impacted upper canines in adults included either;

• 1. An orthodontic/braces procedure to bring the un-erupted tooth to its original position in the dental arch or
• 2. Prosthetic replacement of the missing tooth using a Ceramic Bridge or denture prosthesis.

Nowadays, a third alternative treatment that involves immediate placement of an implant into the extraction socket of the tooth is being done.

A patient with an upper impacted canine can now choose to have the un-erupted tooth removed and replaced in the same sitting with an immediate implant and crown.

Why does it happen?

Epidemiological data shows that with the exception of third molars, the most frequently impacted teeth in adults are your upper canines (up to 3% of people have this condition).

Disturbances in the eruption of permanent upper canines are common because

• They develop deep within your upper jaw and
• They have the longest path to travel compared with any other tooth in the oral cavity.

Why do we need Canines?

Canines play a vital role in

• Your facial appearance,
• Dental esthetics and your jaw/ arch development and
• Functional biting of food.

Abnormal eruption paths within the dent alveolar jaw process can have serious clinical ramifications.

It has been found that impacted teeth may cause

• Migration of the neighboring teeth.
• Loss of jaw/arch length.
• Un-erupted canines may even increase the patient's risk of developing a cystic lesion and infection.
• May also cause root restoration of the nearby incisors.

When to do it?

When impacted maxillary canines are not amenable to orthodontic traction or re-implantation, in some cases extraction is the only option available followed by immediate implant placement or prosthetic replacement of missing tooth.

The Clinical Process

We, at our Smilessence Specialist Dental Centre, have often followed a new surgical technique that allows an immediate implant placement after the immediate extraction of the maxillary canine.

The Implant screw threads and the bone defect around the dental implant are covered with the bone shavings collected during Extraction and osteotomy. The bone defects remaining around the Dental Implant are filled with the collected bone shavings and bone grafts/ bone membranes.

Advantages

The advantage of performing extraction and dental implant placement in the same procedure is that

• The number of operations is minimized.
• Waiting times are minimized.
• Avoids the need for conventional preparation of surrounding healthy teeth as part of Bridge/prosthetic replacement.
• Prolonged orthodontic treatment that may take months and even years aimed at bringing the impacted canine to the dental arch is avoided.

Prerequisites for Case to case Selection Basis

When possible, impacted upper canines are subjected to orthodontic / braces traction. However, If

• Traction by braces is not possible
• Re-implantation of an extracted tooth is not feasible or
• The patient is unwilling to wait a long time for his orthodontic treatment.

In all these cases immediate extraction followed by dental implant placement is the best option.

Success Rate

More recently there has been an increase in the number of extractions of impacted teeth and the use of immediate dental implants. Several authors have reported success rates of more than 90 percent for implants placed into fresh extraction sites.

Conclusion

The simultaneous placement of an implant into the extraction site of a palatally impacted canine in conjunction with bone grafting minimizes the number of surgical interventions and the waiting time. We need to emphasize, however, that a prerequisite for immediate placement of an implant into an extraction site is much dependent upon the expertise and increased surgical skill of the specialist dentist.