Aligner Therapy for Impacted Canines

An impacted canine is one of the more demanding challenges in orthodontics. Of all permanent teeth, the canine travels the longest path through the jaw before reaching its position in the dental arch. If it becomes stuck along the way, it cannot erupt on its own and requires targeted intervention. The following real case from our Cologne practice demonstrates how such a canine can be guided into the dental arch using predominantly nearly invisible aligners.

What is an impacted canine?

Impaction occurs when a permanent tooth does not follow its natural eruption path into the mouth but remains malpositioned within the jawbone. This particularly affects the upper canines. Left untreated, an impacted canine can press against the roots of neighboring teeth and damage them – which is why timely, well-planned treatment is important.

The patient’s initial situation

A 13-year-old patient presented at our practice because an upper canine had not erupted. In its place, the primary canine was still present. Additionally, there was insufficient space for the permanent canine, and there were slight rotations and tilts as well as a deep bite. Precise three-dimensional diagnostics confirmed the position of the impacted tooth and formed the basis for treatment planning.

The treatment process

Creating space with clear aligners

First, the remaining primary canine was removed to clear the path. We then reshaped the dental arches using the aligner system and gradually moved the lateral teeth in the upper jaw backward. This systematically created the gap the impacted canine needed to move into position – nearly invisibly with removable aligners. Learn more about this treatment approach on our page about clear aligners..

Guiding the canine into the dental arch

Since the canine did not erupt on its own even with the newly created space, it was surgically exposed in a minor procedure and gently moved toward the dental arch using controlled traction mechanics. This intermediate step took only a limited time; the actual tooth alignment continued with aligners. Precise auxiliary elements bonded to the teeth supported the planned movements with accuracy.

The treatment outcome

In the end, the previously impacted canine stood fully and harmoniously in the dental arch. The bite was balanced, the midline was aligned, and the front teeth were evenly shaped. To maintain the result long-term, the patient wears a removable retainer in the upper jaw at night; in the lower jaw, a fixed wire bonded behind the front teeth – invisible from the outside – keeps the result stable.

What this case demonstrates

Today, even the alignment of an impacted canine can be achieved largely with clear aligners. A brief surgical step may be required to expose the tooth — but the visible, day-to-day treatment remains discreet and easy to keep clean. A successful outcome depends on careful planning and consistent wear of the aligners. You can also find an illustrative patient case on our blog.

Source of the underlying publication: Funke J, Schupp W, Haubrich J, Jung BA. Einstellung eines palatinal verlagerten Eckzahns mittels Alignertherapie – ein Fallbericht. Inf Orthod Kieferorthop 2020; 52: 259–265. DOI 10.1055/a-1242-0044