Authors: Dr. Julia Steinmaier (née Funke), Dr. Werner Schupp, Dr. Julia Haubrich, Dr. Britta A. Jung
Introduction: The challenge of displaced canines
Misaligned canines are a common orthodontic problem with a prevalence of 1-3% in the Western population. Girls are particularly affected, with the upper canine being displaced ten times more frequently than the lower canine. The most common position is palatal displacement (50 %), followed by the buccal (30 %) and the position in the alveolar ridge (20 %). If eruption does not occur on its own, a complex treatment task arises that requires interdisciplinary cooperation between orthodontists and oral and maxillofacial surgeons.
Diagnosis and risks of untreated canine displacement
A displaced canine can be clinically noticeable due to a lack of space, midline deviation or tilting of adjacent teeth. Radiologically, an increased angle between the canine axis and the anterior nasal spine is an indication of displacement. If treatment is not carried out, ectopic eruptions, root resorption on neighboring teeth or the canine remaining in the jaw can occur.
Therapeutic options
If detected early, milk tooth extraction or gap opening can promote eruption. In many cases, however, active orthodontic intervention is necessary. Aligner therapy in combination with additional appliances (auxiliaries) is a modern treatment option.
Case report: Treatment of a palatally displaced canine with aligners
A 13-year-old female patient presented to the orthodontic practice with an impacted and palatally displaced upper left canine (tooth 23). Her deciduous tooth 63 was still in situ and there was a Class II/2 occlusion with a deep bite. The diagnosis was confirmed by clinical and radiographic examinations.
Treatment plan
1. Preparatory measuresRemoval of the persistent deciduous tooth 63 to open the eruption path.
2. Creating space through distalization: The upper posterior teeth were treated with the Invisalign system distally, supported by Class II elastics. Attachments and hooks were placed to optimize tooth movement.
3. Surgical exposure of the canine toothSince there was no spontaneous adjustment, the tooth was surgically exposed and a traction chain attached.
4. Extrusion with mechanical supportWith the help of a directly bonded partial archwire, the canine was guided step by step into the dental arch.
5. Refinement phaseAfter complete extrusion, the treatment plan was revised in the ClinCheck software and a further 38 aligners were inserted for fine adjustment.
6. RetentionAfter successful correction, a removable retention splint was used for the upper jaw and a fixed retainer for the lower jaw for long-term stabilization.
Discussion and conclusion
Over the last 20 years, aligner therapy has become an established orthodontic method, even for complex tooth movements such as the adjustment of misaligned canines. It is essential to combine aligner techniques with additional anchorage elements such as partial archwires or skeletal anchorage. With careful planning and a high level of patient compliance, excellent treatment results can be achieved.
Source:
Funke, J., Schupp, W., Haubrich, J., & Jung, B. A. (2020). Setting a palatally displaced canine using aligner therapy - ein Fallbericht [Insertion of a palatally displaced canine using aligner therapy - A case report]. Information from Orthodontics & Orthodontics, 52(4), 259-265. https://doi.org/10.1055/a-1242-0044