A Complex Impacted Canine Case Managed Successfully at Summirow Dental Hospital

A young patient, Aadil Khatik, visited Summirow Dental Hospital with a chief complaint of a missing tooth in the upper front canine region, affecting both appearance and confidence while smiling. Since canine teeth play a vital role in facial aesthetics, bite function, and guidance during chewing, it was important to determine the exact reason for the missing tooth before planning treatment.

A thorough clinical examination was performed, followed by Digital OPG (Orthopantomogram) and CBCT (Cone Beam Computed Tomography) imaging. The investigations revealed a rare and complex condition. The upper right maxillary canine was impacted deep within the jawbone, while the lower right canine was also impacted and located unusually low in the chin region (mandibular symphysis).

After careful evaluation, a personalized treatment plan was formulated.

Understanding Impacted Canine Teeth

An impacted canine is a tooth that fails to erupt into its normal position because it is blocked by bone, adjacent teeth, or lacks sufficient space.

  • Canines are among the strongest teeth in the mouth and are essential for:
  • Supporting the lips and facial profile
  • Guiding proper bite movements
  • Maintaining alignment of surrounding teeth
  • Enhancing smile aesthetics

When impacted, they may remain completely hidden inside the jawbone and often require surgical management.

Diagnosis Using Advanced Digital Imaging

To accurately locate both impacted teeth, advanced radiographic investigations were performed.

OPG Findings

The panoramic X-ray confirmed:

  • Impacted upper right canine
  • Impacted lower right canine 

However, because panoramic images provide only a two-dimensional view, additional imaging was required.

CBCT Findings

A CBCT scan provided a detailed three-dimensional assessment of the impacted teeth.

The scan revealed:

  • The upper right canine was deeply embedded within the maxillary bone.
  • The lower right canine was positioned unusually low in the mandibular symphysis (chin region), making surgical intervention highly complex and unnecessary in the absence of symptoms.
  • The relationship of the impacted teeth to surrounding bone and adjacent roots was clearly visualized, allowing safe surgical planning.

This detailed imaging significantly improved treatment accuracy while minimizing surgical risks.

Treatment Planning

  • After discussing all available options with the patient, the treatment plan included:
  • Surgical extraction of the impacted upper right canine
  • Bone grafting of the extraction site to preserve bone for future replacement
  • Follow-up healing assessment
  • Future replacement of the missing canine with either a dental implant or fixed bridge after complete healing
  • Observation of the lower impacted canine since it was asymptomatic and positioned deep within the chin area

Surgical Removal of the Upper Impacted Canine

The procedure was performed under local anesthesia.

A small surgical flap was carefully raised to expose the impacted tooth.

Because of its deep position and orientation within the bone, the canine could not be removed in one piece. The tooth was sectioned into two parts, allowing safe removal while preserving the surrounding bone.

After complete extraction:

  • The surgical site was thoroughly cleaned.
  • Bone graft material was placed into the extraction socket to preserve bone volume and support future implant placement.
  • The surgical flap was repositioned carefully.
  • Sutures were placed to ensure proper healing.

The procedure was completed successfully without complications.

Post-Operative Evaluation

A post-operative OPG was taken to confirm:

  • Complete removal of the impacted upper canine
  • Proper surgical outcome
  • Adequate placement of the bone graft

The radiograph confirmed successful treatment.

Why Was the Lower Impacted Canine Not Removed?

One of the most interesting findings in this case was the lower right impacted canine located deep within the chin region.

Although impacted, this tooth was:

  • Completely asymptomatic
  • Not causing pain or infection
  • Not damaging adjacent teeth
  • Located in a surgically difficult position close to important anatomical structures

Removing such a tooth would involve significantly more surgical trauma than benefit.

Therefore, the decision was made to leave the lower impacted canine under periodic observation, which is considered an appropriate and evidence-based approach for asymptomatic impacted teeth.

Bone Grafting – Why It Was Important

Following extraction of a deeply impacted canine, bone grafting was performed to preserve the jawbone.

Benefits include:

  • Maintaining bone height and width
  • Preventing collapse of the extraction site
  • Supporting future implant placement
  • Improving long-term functional and aesthetic outcomes

Bone preservation is particularly important when planning a dental implant in the future.

Post-Operative Instructions

The patient was advised to:

  • Take prescribed medications as directed.
  • Apply ice packs during the first 24 hours.
  • Avoid hard and spicy foods for several days.
  • Maintain gentle oral hygiene around the surgical site.
  • Avoid smoking or tobacco use.
  • Return after 7 days for suture removal and healing assessment.

The patient recovered comfortably with satisfactory healing.

Future Treatment Plan

After complete healing of the surgical site, the missing upper canine can be replaced using one of the following options:

  • Dental Implant – the most natural and long-lasting replacement option.
  • Fixed Dental Bridge – an alternative solution when implant treatment is not preferred.

The final treatment decision will be made after evaluating bone healing and discussing the patient's preferences.

Why CBCT is Essential for Impacted Canine Surgery

CBCT imaging offers several advantages:

  • Three-dimensional visualization
  • Precise localization of impacted teeth
  • Better assessment of surrounding bone
  • Reduced surgical complicationsAccurate treatment planning
  • Improved patient safety

It has become the gold standard for managing complex impacted teeth

Conclusion

This case highlights how modern diagnostic imaging and advanced oral surgery techniques can successfully manage even complex impacted canine cases. Through detailed CBCT evaluation, careful surgical extraction, and bone grafting, the patient received safe and predictable treatment while preserving the option for future implant rehabilitation.

At Summirow Dental Hospital, every impacted tooth is evaluated individually to provide the most conservative, safe, and effective treatment plan. Whether the solution involves surgical removal, monitoring, bone grafting, or future implant placement, our goal is always to restore function, aesthetics, and long-term oral health with precision and patient comfort.