Canine extractions in orthodontics are relatively rare, as canines are considered to play a pivotal role in dental function and aesthetics. However, in certain clinical scenarios, extracting a canine tooth becomes a viable and sometimes necessary treatment option. The decision to proceed with a canine extraction is made after a thorough evaluation of the patient's dental and skeletal relationships, as well as the position, condition, and potential impact of the canine on the surrounding teeth. This blog will delve into the scenarios where canine extractions might be indicated, the considerations involved, and the outcomes that can be achieved.
Indications for Canine Extraction
1. Ectopic Canines
One of the most common reasons for canine extraction is ectopic positioning. Ectopic canines may be displaced either buccally or palatally, creating a lack of space for proper alignment within the dental arch. If orthodontic intervention to reposition the canine poses significant risks, such as root resorption of adjacent teeth, or if the canine’s alignment is deemed infeasible, extraction may be the preferred course of action (Becker & Chaushu, 2015). Early diagnosis and intervention can sometimes prevent extraction, but in severe cases, it remains a pragmatic solution.
2. Dental and Periodontal Health
Canines with poor dental or periodontal health are often good candidates for extraction. When a canine tooth is compromised by decay or periodontal compromise, retaining the tooth may pose a risk in the long term. In such cases, removing the canine instead of alternative teeth can be the most prudent course of action to preserve overall oral health and prevent further complications.
3. Severe Dental Crowding
In cases where there is significant dental crowding, the available arch space might not accommodate all teeth. While premolar extractions are more commonly performed to address crowding, in some situations, the extraction of a canine may achieve better results. For instance, if the canine is severely displaced such as when the lateral incisor and first premolar have an established contact and the impact of the canine position on the arch is unfavourable. Removal in such cases may facilitate optimal alignment and occlusion (Kokich & Mathews, 2016).
4. Impacted Canines
Canines that are impacted and linked to pathological conditions, such as cyst formation, may necessitate extraction. Similarly, if the impacted tooth exerts adverse effects on adjacent teeth (for example, causing root resorption) or is deemed unfavourable for exposure and alignment through orthodontic traction, removal may be indicated to preserve overall dental health (Sajnani & King, 2014).
5. Functional and Aesthetic Considerations
While canines are important in guiding occlusion and supporting aesthetics, their removal does not necessarily lead to compromised outcomes. Studies have shown that with appropriate treatment planning and execution, acceptable functional and aesthetic results can be achieved. Shortened treatment times and reduced complexity may also be added benefits in certain cases (Baccetti, 1998).
6. Patient Preference to Reduce Treatment Time
In some cases, patients may express a preference for shorter treatment durations. Extraction of a canine can simplify the orthodontic plan and lead to faster treatment completion. In a class II case, removal of canines will reduce complexity by reducing the posterior anchorage demand and allowing potentially faster overjet reduction.
7. Sub-Optimal Patient Compliance
Orthodontic treatment success heavily relies on patient compliance. For individuals with poor compliance (e.g., inconsistent use of orthodontic elastics or aligners), canine extraction may simplify the treatment plan and improve predictability of results. These types of plans often require less input from the patient, for example, use of elastics in a class II case with OJ reduction may not be pragmatic in a patient with poor compliance.
8. Extraction-Only Treatment
In rare cases where patients decline orthodontics altogether but have a displaced or ectopic canine that negatively affects appearance, extraction alone might be recommended to improve aesthetics and maintain functional harmony.
The above are general indications and factors to consider in overall orthodontic treatment planning, the decision for each patient is made on a case-by-case basis.
Conclusion
While canine extractions are not routine in orthodontic practice, they are a valuable and pragmatic option in specific clinical scenarios where alternative treatments may be more complex or carry other risks. With careful planning, thorough evaluation, and tailored treatment strategies, excellent functional and aesthetic outcomes can be achieved. Collaboration between orthodontists, general dentists, and the patient is essential to ensure that the chosen treatment aligns with the patient’s needs and expectations.
References
Becker, A., & Chaushu, S. (2015). Etiology of maxillary canine impaction: A review. American Journal of Orthodontics and Dentofacial Orthopedics, 148(4), 557-567.
Kokich, V. G., & Mathews, D. P. (2016). Surgical and orthodontic management of impacted teeth. Dental Clinics of North America, 60(1), 235-247.
Baccetti, T. (1998). A controlled study of associated dental anomalies. The Angle Orthodontist, 68(3), 267-274.
Sajnani, A. K., & King, N. M. (2014). Management of impacted canines: A comprehensive review. International Journal of Oral and Maxillofacial Surgery, 43(2), 239-246.
Shapira, Y., & Kuftinec, M. M. (2001). Early diagnosis and interception of potential maxillary canine impaction. Journal of the American Dental Association, 132(3), 293-298.
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