Impacted canines that do not erupt on their own can also be aligned into the arch with aligners. This case report shows the procedure step by step.
Alignment of a palatally impacted canine using aligner therapy and auxiliaries (case report).
An impacted canine is one of the more challenging tasks in orthodontics. Of all teeth, the permanent canine travels the longest path through the jaw before it reaches its place in the dental arch.1 If it becomes stuck along the way, it cannot erupt on its own and requires targeted assistance. The following real treatment case from our Cologne practice shows how such a canine can be guided into the dental arch primarily using nearly invisible aligners.
What is an impacted canine?
An impaction occurs when a permanent tooth does not follow its natural eruption path into the mouth but instead remains malpositioned in the jawbone. This most commonly affects the upper canines.2 Left untreated, an impacted canine can press on the roots of neighboring teeth and damage them — which is why timely, well-planned treatment is important.3
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 diagnostics4 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 way.5 Then we shaped the dental arches with the aligner system and moved the lateral teeth in the upper jaw step by step6. This deliberately created the space the impacted canine needed to align — and nearly invisibly with removable aligners. You can learn more about this form of treatment 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 exposed in a minor procedure and gently moved toward the dental arch using gentle traction mechanics7. This intermediate step took only a limited amount of time; the actual tooth alignment continued with the aligners. Fine auxiliary elements on the teeth supported the planned movements precisely.8
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.
Sources
- Dausch-Neumann, D. (1970). Der Durchbruchsweg bleibender Eckzähne. Fortschritte der Kieferorthopädie, 31(1), 9–16. https://doi.org/10.1007/BF02024846
- Bishara, S. (1992). Impacted maxillary canines: A review. American Journal of Orthodontics and Dentofacial Orthopedics, 101(2), 159–171. https://doi.org/10.1016/0889-5406(92)70008-X
- Patel, D., & Taylor, N. (2016). Are patients with impacted canines referred too late? British Dental Journal, 221(9), 561–564. https://doi.org/10.1038/sj.bdj.2016.816
- Watted, N., Proff, P., Reiser, V., et al. (2015). CBCT in clinical orthodontic practice. IOSR Journal of Dental and Medical Sciences, 14, 102–115.
- Ericson, S., & Kurol, J. (1988). Early treatment of palatally erupting maxillary canines by extraction of the primary canines. European Journal of Orthodontics, 10(4), 283–295. https://doi.org/10.1093/ejo/10.4.283
- Schupp, W., Neumann, I., & Haubrich, J. (2010). Class II correction with the Invisalign System. Journal of Clinical Orthodontics, 44, 28–35.
- Couchat, D. (2018). Traction of impacted teeth with the Invisalign System. Journal of Aligner Orthodontics, 2, 53–58.
- Schupp, W., & Haubrich, J. (Hrsg.). (2015). Aligner Orthodontics. Quintessenz.
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