Case report
Treatment of a horizontally impacted
mandibular canine in a girl with a Class II
Division 1 malocclusion
Robertus Henricus Josephus Peerlings
Vlissingen, The Netherlands
When a patient has an impacted tooth, the timing of orthodontic treatment, the type of surgical procedure to
expose the tooth, the orthodontic mechanics, and the potential problems vary depending on which tooth is
impacted and its position in the jaw. This case report describes the successful treatment of a patient with a
horizontally impacted mandibular canine. The impacted tooth was surgically exposed and then moved into
its normal position in the dental arch, combined with correction of a Class II Division 1 malocclusion. (Am J
Orthod Dentofacial Orthop 2010;137:S154-62)
M
ost permanent teeth erupt into occlusion. In
some people, however, a permanent tooth
fails to erupt and becomes impacted in the
alveolus. This problem has several solutions. The im-
pacted tooth could be extracted, an autotransplantation
could be performed, or the tooth could be surgically
exposed and moved into the dental arch orthodonti-
cally. The timing of orthodontic treatment, the type of
surgical procedure to expose the impacted tooth, the
necessary orthodontic mechanics, and potential prob-
lems with treatment vary depending on which tooth is
impacted and its position in the jaw.1 This case report
describes the treatment of a horizontally impacted
mandibular canine.
Diagnosis
A girl, aged 11 years 4 months, had chief com-
plaints of crowding of the maxillary anterior teeth and
an excessive overjet. Apart from a tonsillectomy and ad-
enoidectomy at the age of 4 years, her medical history
and temporomandibular joint function were normal.
The pretreatment facial photographs showed a con-
vex facial profile caused by a retruded mandible (Fig 1).
The pretreatment intraoral photographs and dental casts
showed a Class II Division 1 malocclusion, with a full
Private practice, Vlissingen, The Netherlands.
The author reports no commercial, proprietary, or financial interest in the prod-
ucts or companies described in this article.
Reprint requests to: Robertus Henricus Josephus Peerlings, Papegaaienburg 48,
4386 DA Vlissingen, The Netherlands; e-mail, drp@orthopeerlings.nl.
Submitted, July 2008; revised and accepted, August 2008.
0889-5406/$36.00
Copyright © 2010 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2008.08.025
S154
S154-162_AAOPRG_3035.indd 154
premolar width distoclusion of the molars and canines on
both sides (Figs 1 and 2). The patient had a deep overbite,
with the mandibular incisors touching the palatal mucosa.
She had a midline shift of 1 or 2 mm of the mandibular
teeth to the right. The maxillary right central incisor was
retroclined, probably caused by trauma to the deciduous
right central incisor at age 2.5 years. The tooth was bro-
ken and, after an infection, was extracted by the patient’s
dentist. Except for the third molars and the mandibular
left canine, all other teeth were present. The mandibular
left deciduous canine was still present. Apart from ha-
bitual lip biting, the patient had no functional problems.
The pretreatment lateral cephalometric and pan-
oramic radiographs showed impacted third molars and
a horizontally impacted mandibular left canine, api-
cal and labial of the apices of the mandibular anterior
teeth in the chin region (Fig 3). The canine was com-
pletely covered with bone. The root of the mandibular
left deciduous canine was almost completely resorbed.
Cephalometric analysis showed a skeletal Class II
relationship (ANB angle, 8.1°) with a normal man-
dibular plane angle (SN-GoGn, 31.9°), a retrognathic
mandible (SNB angle, 74°), proclination of the maxil-
lary incisors (+1 to NA, 33°) and mandibular incisors
(–1 to NB, 32.5°), and an interincisal angle of 106.4°
(Fig 3, Table). The other cephalometric values were
within 1 SD of normal.
The patient was diagnosed with a Class II Division 1
malocclusion, a retrognathic mandible, a deep overbite,
a retroclined maxillary right central incisor, a severely
impacted mandibular left canine, and impacted third
molars. She and her parents requested correction of the
malalignment of the maxillary anterior teeth and reduc-
tion of the overjet.
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Fig 1. Pretreatment intraoral and extraoral photographs.

Fig 2. Pretreatment dental models.

Etiology maxillary central incisors. Mandibular canines appear to

Our knowledge about the prevalence and etiology of
impactions has grown. Impactions in general are twice
as often seen in white people compared with people of
Asiatic origin, and 3 times more often in female patients.2
Third molars are the most frequently impacted teeth, fol-
lowed by maxillary canines, mandibular premolars, and
be impacted less often than maxillary canines.3 The re-
ported frequencies of mandibular canine impaction range
from 0.05% to 0.4%.4-7 The position of the tooth bud for
some reason might be such that  the root develops in a
horizontal direction. The canine then becomes impacted
horizontally in a labial position below the apices of the

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 S156  Peerlings American Journal of Orthodontics and Dentofacial Orthopedics
Fig 3. Pretreatment radiographs and cephalometric tracing.
incisors and, with the crown positioned mesially, often
crosses the midline.8 In these situations, it is difficult to
correct the impaction. In this patient, the radiographs
clearly show the exact location of the canine (Fig 3).
Treatment objectives
The treatment objectives, based on the cephalo-
metric and dental-cast analysis, were to correct the
retruded position of the mandible, the deep overbite,
and the malalignment of the maxillary anterior teeth;
achieve bilateral Class I canine and molar occlusion;
and improve facial balance. In addition, a solution
was needed for the impaction of the mandibular left
canine combined with the severely resorbed root of
the deciduous canine.
Treatment alternatives
For the impacted mandibular left canine, several
treatment alternatives were available.
One could choose surgical removal of the impacted
tooth, while preserving the deciduous canine as long as
possible. This patient had a diastema mesial and distal to
S154-162_AAOPRG_3035.indd 156
April 2010
the retained tooth, so a composite buildup could achieve
the mesiodistal width of a normal canine already at the
start of treatment. During the fixed appliance treatment
phase, this tooth would have to be left out to prevent
further resorption of its root. After the fixed appliance
phase, the vertical dimension of this tooth could be
restored with a composite buildup. For the long-term
preservation of this tooth, one should not create canine-
guided occlusion on the left side but take care that this
tooth is out of occlusion during lateral excursive move-
ments of the mandible. However, long-term preserva-
tion of a deciduous tooth is not realistic.
Short-term loss of this tooth would require prosthet-
ic replacement with a resin-bonded bridge. A long-term
solution would be a conventional bridge. If the tooth held
for several years with preservation of the bone, an im-
plant could be placed. However, because of the amount
of root resorption at the start of treatment, a short sur-
vival was a more realistic approach than long-term pres-
ervation of the deciduous canine. A resin-bonded bridge
could cover the time gap between loss of the deciduous
canine and placing of the implant. Disadvantages in-
cluded the irreversible tooth preparation that is required
and the uncertain longevity of this type of prosthesis.
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Volume 137, Number 4, Supplement 1
Fig 4. First treatment progress panoramic radiograph.
The survival rate is only 60% after 10 years. Conven-
9
tional fixed bridges have a median lifetime of about
20 years.10 In adolescents, preparation of the abutment
teeth might need to be delayed because of pulp size.
Autotransplantation, possibly followed by im-
mediate or postponed endodontic treatment of the
mandibular left canine, was another option. Root for-
mation of the mandibular canine was nearly or fully
completed. When mature teeth are transplanted, either
postponed endodontic treatment is carried out or revas-
cularization is anticipated. According to Andreasen,8
the 5-year survival rates for canines with complete root
formation are 82% for tooth survival, 22% for pulpal
healing, and 48% for periodontal ligament healing. A
disadvantage of this solution is that the tooth eventually
might become ankylosed. However, with this treatment
approach, one could expect survival of the canine until
the patient is old enough for an implant to be placed
without the need for bone augmentation.
The last treatment option was surgical exposure
followed by movement of the canine toward its normal
position in the dental arch. With the oral surgeon, the
parents, and the patient, it was decided to surgically
expose the mandibular left canine, place a button and a
ligature on it during surgery, close the wound, and start
moving the canine to its normal position.11
Correction of a Class II molar occlusion is possible
with headgear, functional appliance, or extraction of
the maxillary premolars and retraction of the anterior
teeth with fixed appliances. Since the upper part of the
face was well balanced and the lower jaw was clearly
retruded, a functional appliance to bring the mandible
forward was the preferred method of treatment.
Erupting the mandibular left canine into its normal
position in the arch was considered the most time-
consuming part of the treatment. Total treatment time
would be shortened with an appliance that would make
this possible from the start of treatment. For this rea-
son, it was decided not to use a bionator or functional
appliance but, rather, a Herbst appliance combined
with a fixed appliance on the maxillary and mandibular
S154-162_AAOPRG_3035.indd 157
anterior teeth. This would permit achieving all treat-
ment goals simultaneously from the start of treatment
and, therefore, shortening the total treatment time.
A Herbst appliance sometimes causes proclination
of the mandibular incisors. In this patient, this could
reduce the possibility of mandibular incisor root re-
sorption. If for some reason treatment did not work out
as hoped, we could still adjust the treatment strategy
and attempt autotransplantation.
Treatment progress
The Herbst appliance was placed together with
brackets (Omni-arch, 0.018-in slot Roth prescription;
GAC International, Bohemia, NY) on the maxillary
and mandibular anterior teeth and a .014‑in nickel-tita-
nium wire in the maxilla. In the mandible, no wire was
placed. Then the patient was sent to the oral surgeon.
Two months later, the mandibular left canine was
exposed under general anesthesia, a button was placed
labially near the tip of the cusp combined with a liga-
ture, and the wound was closed. The next day, a pas-
sive 0.016 × 0.016-in stainless steel wire was placed
in the mandibular arch with an elastic pulling from the
ligature toward the left lateral incisor. The next month,
movement of the mandibular left canine was already
evident by the length of the ligature coming out of
the mucosa.
Two months after ligation and 4 months after the
start of treatment, the canine was palpable labially.
The retruded position of the mandible and the canine
distoclusion had been corrected by that time. The
Herbst appliance was removed, and a panoramic ra-
diograph was taken to determine in which direction the
mandibular left canine was moving and to assess root
resorption of the mandibular incisors (Fig 4). After re-
moval of the Herbst appliance, there was some swell-
ing and irritation of the gingiva (Fig 5). It was decided
to continue treatment with the preadjusted edgewise
appliance with 0.018-in slots and the 0.014-in nickel-
titanium wire in the maxilla and mandible, combined
with a cervical headgear to retain the occlusion. Trac-
tion on the canine in the desired direction was contin-
ued with this appliance.
At the next control visit, 6 months after the start
of treatment, the occlusion appeared to be stable, and
it was decided to reduce headgear wear to nighttime
only. A new elastic was placed from the ligature to-
ward the mandibular left first premolar. A coil spring
was placed between the mandibular left lateral incisor
and the first premolar to retain the space necessary for
the canine. Treatment progressed by placing thicker
wires in the maxilla and mandible and new elastic trac-
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April 2010

Fig 5. Intraoral and extraoral photographs after Herbst therapy.

tion on the mandibular canine in the desired direction

for the next 10 months.
The third panoramic radiograph was taken, and
it was decided to send the patient to the oral surgeon
again to expose the canine (Fig 6). The idea was, with
the canine visible, treatment progress could be more
efficient and less risky. This took place the next month.
Unfortunately, the tooth was still too deep to expose,
and the wound was closed. Treatment continued more
or less in the dark. During the surgical procedure, the
Fig 6. Second treatment progress panoramic radiograph.
oral surgeon noticed that the canine was positioned la-
bially to the roots of the mandibular incisors. Damage
to the incisor roots from then on was unlikely. Table. Cephalometric measurements
Six months later, the occlusion was Class I. Head- Pretreatment Posttreatment
gear wear was reduced to 3 nights a week. After an Measurement Norm (11 y 4 mo) (15 y 0 mo)
additional 6 months, the canine was visible, and the SNA (°) 82 82.1 79
button on the canine was replaced for more efficient SNB (°) 80 74 76.5
ANB (°) 2 8.1 2.5
traction. This was repeated 1 month later. Then the pa- Pogonion to NB (mm) 4 2.8 3.3
tient was advised to stop wearing the headgear. Two Occlusal plane to SN (°) 14 12.3 15.7
months later, a bracket was placed on the canine, and, SN to GoGn (°) 32 31.9 31.2
Maxillary incisor to NA (°) 22 33 35.7
another 4 months later, 3 years after the start of treat- Maxillary incisor to NA
ment, the appliances were removed. During the fin- (mm) 4 3.5 8.2
ishing phase, the tooth was derotated, and the axial Mandibular incisor to NB
(°) 25 32.5 34.3
inclination was adjusted. It is important to position the Mandibular incisor to NB
root properly for esthetic reasons and to prevent poten- (mm) 4 5.9 8.7
tial relapse. Interincisal angle (°) 131 106.4 107.5

Treatment results aligned and had good interdigitation with Class I oc-
A well-aligned dentition and a harmonious facial clusion and proper overjet and overbite (Fig 8). The
profile were obtained (Fig 7). The teeth were well facial analysis showed a favorable profile (Fig 9). The

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Volume 137, Number 4, Supplement 1
Fig 7. Posttreatment intraoral and extraoral photographs.
retruded position of the mandible was completely
corrected. The posttreatment panoramic radiograph
showed some, but no significant, root resorption. The
cephalometric values representing the anteroposterior
positions of the jaws were brought into normal ranges
(Table). The cephalometric analysis showed a decrease
of the ANB angle of 5.6°, 8.1° pretreatment and 2.5°
posttreatment. This decrease consisted of a 3.1° de-
crease of the SNA angle and a 2.5° increase of the SNB
angle from pretreatment to posttreatment. The only
other relevant cephalometric changes were the posi-
tions of the incisors. The position of the maxillary in-
cisor changed from 3.5 to 8.2 mm relative to the NA
line, and the position of the mandibular incisor changed
from 5.9 to 8.7 mm relative to the NB line. The incisors
in the maxilla and mandible were already proclined at
the start of treatment, 33° and 32.5° to the NA and NB
lines, respectively. Proclinations at the end of treatment
increased another 2.7° for the maxillary incisors and
1.8° for the mandibular incisors. All other cephalomet-
ric values were in the normal ranges. Superimposition
showed favorable growth of the mandible and improve-
ment of overjet and overbite (Fig  10). The posttreat-
ment intraoral photographs showed a slightly longer
clinical crown of the mandibular left canine compared
with the right canine (Fig 7). The gingival tissue of the
mandibular left canine looked healthy, and there was
an adequate zone of attached keratinized gingiva. The
patient was pleased with the final treatment result. Lin-
gual bonded retainers were placed on the maxillary and
mandibular anterior teeth.
S154-162_AAOPRG_3035.indd 159
Discussion
A Herbst appliance was chosen to treat this patient
to combine the correction of the distorelationship and
the position of the impacted canine.12 It took some time
before the canine was ligated by the oral surgeon. The
retruded position of the mandible was corrected quick-
ly, and, therefore, the Herbst appliance was removed.
Thus, the argument to use a Herbst appliance to short-
en total treatment time in this case turned out to be of
minor importance.
Microscrews are becoming more popular when an-
chorage is an issue or as an additional tool during orth-
odontic treatment.13 A microscrew combined with an
activator or a functional appliance, followed by a fixed
appliance, could have been an alternative method of
treatment. Strategic placement and use of microsrews
can also be helpful to prevent root resorption.
Apical root resorption is a common complication of
orthodontic treatment. Treatment for long periods has
been suggested as a possible risk factor.14 Other authors
reported that root resorption increases with incisor in-
trusion.15,16 Walker et al17 found root resorption adjacent
to the impacted canine in 67% of lateral incisors and
11% of central incisors in the maxilla. A correlation has
also been found between the proximity of the impacted
canine to the incisors and their resorption. This patient
was treated for a long period, the mandibular incisors
were intruded, and the impacted canine had to pass the
roots on its way to a normal position in the mandible.
Although this patient had some root resorption of the
mandibular anterior teeth, the amount seemed to be
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Fig 8. Posttreatment dental models.

Fig 9. Posttreatment radiographs and cephalometric tracing.

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Volume 137, Number 4, Supplement 1
Fig 10. Superimposed pretreatment (black) and post-
treatment (red) tracings.
clinically irrelevant to the eventual longevity of these
teeth. One must consider that the perceptible amount
of root resorption on the available radiographs might
be less than a cone-beam computed tomography scan
would show.17,18
Other important issues for a successful treatment
outcome are the appearance of the gingiva and the po-
sition of the impacted tooth after treatment. Vermette
et al19 found that labially impacted anterior teeth un-
covered with an apically positioned flap have more
unesthetic sequelae than those uncovered with the
closed-eruption technique. The crown length was lon-
ger, gingival scarring was greater, and more intrusive
relapse occurred in the subjects with the apically po-
sitioned flap. Canines that erupt through the mucosa
often have insufficient attached gingiva with a poor es-
thetic and periodontal result.1,19-21 Becker et al22 found
no differences in the widths of attached gingivae or
crown lengths and no clinically significant differences
in sulcus depth and bone support of impacted maxil-
lary incisors treated with a closed-eruption surgical
technique. Another advantage of the closed-eruption
technique compared with open surgical exposure is a
shorter recovery time.23 This patient was treated with
a closed-eruption surgical exposure technique, and
the canine was brought into the oral cavity through
the attached gingiva. The disadvantage of the closed-
eruption technique is the uncontrollable orthodontic
force on the invisible impacted canine during orth-
odontic extrusion.24 In this patient, an apically posi-
tioned flap, a gingivectomy, or uncovering and open
eruption were impossible.
S154-162_AAOPRG_3035.indd 161
Vermette et al19 mentioned torque, gingiva, and
alignment as the 3 most common sequelae that identify
previously impacted canines. Alignment has to do with
a relapse tendency or a lack of complete alignment of
the impacted canine after orthodontic treatment. Gin-
giva refers to a perceived difference in amount of at-
tached gingiva, when compared with the contralateral
tooth or a difference in the relative heights of the gingi-
val margins. Torque differences reflect the difficulty in
moving the root of the impacted canine sufficiently to
mimic the contralateral canine eminence. The effects
of placing traction on an impacted canine after expo-
sure were studied by Woloshyn et al25 and others.26,27
Apart from these visual differences, they reported
posttreatment differences in pulpal status, attachment
level, crestal bone height, and probing pocket depth be-
tween previously impacted canines and control canines
not  previously  impacted.25 These differences were
small and considered of minor importance clinically.
The gingiva labial to the mandibular left canine
appeared healthy, and the torque and alignment at the
end of treatment also seemed adequate. There was an
adequate zone of attached keratinized gingiva. The
use of a closed-eruption technique might have con-
tributed to the good gingival result in this patient. A
minor difference in crown length of the mandibular
canines was perceptible on the posttreatment photo-
graphs. This small difference might disappear in the
long term.
The last issue to consider is duration of treatment.
A Class II Division 1 malocclusion with a deep over-
bite and crowding can be treated in about 2 years. This
patient’s treatment took 3 years. One might conclude
that the decision to align the mandibular left canine led
to an extra year of orthodontic treatment. The patient
and her parents were told about a long treatment time
at the start. Schatz et al28 considered autotransplanta-
tion to be a reasonable alternative for the orthodontic
treatment of severely impacted canines.29 The option
of autotransplantation of the mandibular left canine
would probably have shortened the treatment time.
However, root formation of the canine of this patient
was fully completed at the start of treatment. There
might be long-term complications such as loss of the
transplant, the need for an implant or other prosthetic
solution, and uncertainty about the longevity of this
solution. Therefore, autotransplantation was consid-
ered an alternative if ligation and alignment of the ca-
nine had failed.
The patient and her parents were satisfied with the
final result and the chosen treatment option. During
treatment, there is occasionally a long period of doubt
about the outcome. As long as the canine was covered
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 S162  Peerlings American Journal of Orthodontics and Dentofacial Orthopedics
by mucosa, the patient saw no improvement. To treat
a patient such as this, it is essential to develop a good
relationship with the patient and parents at the start
of treatment and ensure they are well informed. One
could criticize the protrusion of the incisors in the
maxilla and mandible at the end of treatment, but fa-
cial harmony, lip relationship, and the fullness of the
lips were acceptable.
The long-term stability of the treatment outcome
is expected to be good. Correction of the distoclusion
was remarkably easy to achieve, and it remains stable.
The patient’s growth pattern during treatment was fa-
vorable. There were no functional disorders at the start
of treatment, and the retainers from canine to canine
in the maxilla and the mandible prevented relapse of
incisor irregularity.
Conclusions
Alignment of horizontally impacted mandibu-
lar canines is possible and should be considered a vi-
able treatment alternative. One must take into account
that treatment time will be long, but the result can
be rewarding.
References
1. Kokich VG, Mathews DA. Impacted teeth: surgical and orth-
odontic considerations. In: McNamara Jr JA, editor. Orthodon-
tics and dentofacial orthopedics. Ann Arbor, Mich: Needham
Press; 2001.
2. Peck S, Peck L, Kataja M. The palatally displaced ca-
nine as a dental anomaly of genetic origin. Angle Orthod
1994;64:249-56.
3. Mead SV. Incidence of impacted teeth. Int J Orthod Oral Surg
Radiograph 1930;16:885-90.
4. Röhrer A. Displaced and impacted canines. Int J Orthod Oral
Surg 1929;15:1003-20.
5. Sinkovits V, Poelzer MG. Die häufigkeit retinierter zähne.
Dtsch Zahnärztl Z 1969;19:389-96.
6. Tränkmann J. Häufigkeit retinierter zähne der zweiten denti-
tion. Dtsch Zahnärztl Z 1973;28:415-20.
7. Shah RM, Boyd MA, Vakil TF. Studies of permanent tooth
anomalies in 7,386 Canadian individuals. I. Impacted teeth. J
Can Dent Assoc 1978;44:262-4.
8. Andreasen JO. Atlas of replantation and transplantation of
teeth. Fribourg, Switzerland: Mediglobe SA; 1992.
9. Pröbster B, Henrich GM. 11-year follow-up study of resin-bond-
ed fixed partial dentures. Int J Prosthodont 1997;10:259-68.
10. Øilo G. Expected lifetime and reasons for failure of fixed partial
dentures. Norske Tannlegeforenings Tidende 1998;108:10-3.
11. Becker A, Shpack N, Shteyer A. Attachment bonding to im-
pacted teeth at the time of surgical exposure. Eur J Orthod
1996;18:457-63.
S154-162_AAOPRG_3035.indd 162
April 2010
12. Pancherz H. The Herbst appliance, its biologic effects and clin-
ical use. Am J Orthod 1985;87:1-20.
13. Sung JH, Kyung HM, Bae SM, Park HS, Kwon OW, McNa-
mara JA Jr. Microimplants in orthodontics. Daegu, Korea:
Dentos Inc.
14. Linge BO, Linge L. Apical root resorption in upper anterior
teeth. Eur J Orthod 1983;5:173-83.
15. Dermaut LR, De Munck A. Apical root resorption of upper
incisors caused by intrusive tooth movement: a radiographic
study. Am J Orthod Dentofacial Orthop 1986;90:321-6.
16. Han G, Huang S, Von den Hoff JW, Zeng X, Kuijpers-Jagtman
AM. Root resorption after orthodontic intrusion and extrusion:
an intraindividual study. Angle Orthod 2005;75:912-8.
17. Walker L, Encisco R, Mah J. Three-dimensional localization of
maxillary canines with cone-beam computed tomography. Am
J Orthod Dentofacial Orthop 2005;128:418-23.
18. Liu DG, Zhang WL, Zhang ZY, Wu YT, Ma XC. Localization
of impacted maxillary canines and observation of adjacent in-
cisor resorption with cone-beam computed tomography. Oral
Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:91-8.
19. Vermette ME, Kokich VG, Kennedy DB. Uncovering labially
impacted teeth: apically positioned flap and closed-eruption
techniques. Angle Orthod 1995;65:23-33.
20. Kurol J, Ericson S, Andreasen JO. The impacted maxillary ca-
nine. In: Andreasen JO, Kolsen Petersen J, Laskin D, editors.
Textbook and color atlas of tooth impactions. Diagnosis, treat-
ment and prevention. Copenhagen, Denmark: Munksgaard;
1997.
21. Vanarsdall RL. Periodontal/orthodontic interrelationships. In:
Graber TM, Vanarsdall RL, Vig KWL, editors. Orthodontics:
current principles and techniques. St Louis: Elsevier Mosby;
2005.
22. Becker A, Brin I, Ben-Bassat Y, Zilberman Y, Chaushu S.
Closed-eruption surgical technique for impacted maxillary in-
cisors: a postorthodontic periodontal evaluation. Am J Orthod
Dentofacial Orthop 2002;122:9-14.
23. Chaushu S, Becker A, Zeltser R, Branski S, Vasker N, Chaushu
G. Patients’perception of recovery after exposure of impacted
teeth: a comparison of closed versus open-eruption techniques.
J Oral Maxillofac Surg 2005;63:323-9.
24. Swart RJ, Kiekens RMA, Bergé SJ, Kuijpers-Jagtman
AM. Orthodontie in de algemene tandartspraktijk 2. Be-
handeling van eruptieproblemen. Ned Tijdschr Tandheelkd
2007;114:416-22.
25. Woloshyn H, Årtun J, Kennedy DB, Joondeph DR. Pulpal and
periodontal reactions to orthodontic alignment of palatally im-
pacted canines. Angle Orthod 1994;64:257-64.
26. Hansson C, Rindler A. Periodontal conditions following surgi-
cal and orthodontic treatment of palatally impacted maxillary
canines—a follow up study. Angle Orthod 1998;68:167-72.
27. Wisth PJ, Norderval K, Boe OE. Periodontal status of ortho-
dontically treated impacted maxillary canines. Angle Orthod
1976;46:69-76.
28. Schatz JP, Byloff F, Bernard JP, Jogo JP. Severely impacted ca-
nines: autotransplantation as an alternative. Int J Adult Orthod
Orthognath Surg 1992;7:45-54.
29. Ioannidou E, Makris GP. Twelve-year follow-up of an autog-
enous mandibular canine transplant. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2003;96:582-90.
3/24/10 12:26 PM