Impacted maxillary canine management in a patient waiting for orthognatic surgery

OBJECTIVES The purpose of this study is to analyse a clinical case in which several issues were simultane ously involved in a young patient with a third skeletal class, ex traction of a permanent central in cisor due to a dentigerous cyst and the inclusion of a maxillary canine. This case was challenging for a number of reasons: the extraction of the permanent central incisor, which was a complex decision due to the significant aesthetic and functional implications; in ad dition, the inclusion of the canine was an important unknown, as the risk of ankylosis could not be predicted. Finally, the cooperation required from the patient was a challenge. It should be noted that in some cases the simultaneous resolution of clinical problems is not possi ble. In fact, some malocclusions require early treatment, while oth ers can be intercepted but their resolution is required at the end of the patient’s growth. MATERIALS AND METHODS The aim of this present report is to describe a case of a young class III patient with an impacted maxillary canine which was repo sitioned in the site of the central incisor, previously extracted as affected by an odontogenic cyst. The deciduous upper right ca nine was maintained to replace the permanent canine which was relocated in the central incisor position. Orthodontic treatment involved two phases. Firstly, a lingual arch and a transpalatal bar were employed to maintain space in the upper and lower arches, and, subse quently, a Delaire face mask was applied in order to control growing skeletal class III maloc clusion. A phase 2 treatment multibracket therapy was performed to relocate the upper right canine in the right central incisor position and to re position the upper right lateral in cisor. Coronoplasty was then executed, reshaping the canine to resemble a central incisor. RESULTS The orthodontic repositioning of lateral incisor and canine was achieved, allowing a good align ment and a bone preservation. In order to correct skeletal class III malocclusion, the patient is aware that he will have to undergo max illa-facial surgery treatment at the end of his growth. CONCLUSIONS The present case report de scribes a management of an im pacted upper right canine aligned in the upper right central incisor position in a growing pa tient with severe class III maloc clusion. CLINICAL SIGNIFICANCE Describe a decisional procedure that can help the clinicians to set the therapeutic plan in similar sit uations.