Journal of the American Orthodontic Society • March

CASE STUDY Treatment Evolution: Orthodontic & Surgical Management of An Impacted Maxillary Canine B By Juan Carlos Echeverri, DDS, FAOS ringing an impacted or unerupted tooth into the arch creates a series of special problems with alignment, especially if the tooth is a long way from the line of occlusion.1 The most frequent problem of this type is an impacted maxillary canine. The problems to deal with will be: (1) surgical exposure, (2) attachment to the tooth, and (3) orthodontic mechanics to bring the tooth into the arch. This case report will present an adolescent patient who was diagnosed with a high impaction position right maxillary canine. It will show how the patient was treated using a combination of surgical and orthodontic techniques to bring tooth #6 into occlusion for the ulti- mate benefit of the patient’s dental, esthetics and psychological being. It is a very interesting situation, as the impacted maxillary cuspid’s position on the roof of the palate is in a horizontal position. It demonstrates that if handled in a careful and well-planned manner, even teeth in this position may be brought into a correct position. (For more specifics on the surgical aspect of the treatment, the article by Echeverri JC2 will show step-by- step on the surgical aspects of the treatment. This case report was presented at the JAOS meeting in Chicago, August 2009 as one of the case presentations for the fellowship award of the American Orthodontic Society.) Patient Medical and Dental History Hanna is a patient of record who is seen for hygiene and restorative needs based on 6-month recall, when possible, due to economic constraints. Her medical history is unremarkable for sickness, allergies or other medical conditions. Over-retention of tooth #C and impaction of cuspid #6 is diagnosed. Tooth #C is removed on June 2005 to stimulate eruption of tooth #6. In October 2005, after 12 March/April 2010 JAOS Fig. 2: Initial panoramic. Notice cuspid #6 on roof of palate. High impaction case. Fig. 1: Hanna, 13 years, 10-month, Hispanic female with Jewish background with initial clinical images.