Impacted Canines Localization and Its Impact on Dental Arch in Orthodontic Patients: A Novel CBCT Clinical Study

Life Sciences -Orthodontics


  • Yahya H. Y. Alfarra Orthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Malaysia
  • Tahir Yusuf Noorani Conservative Dentistry Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Malaysia
  • Jawaad Ahmed Asif Oral and Maxillofacial Surgery Unit, Prince Mutaib Bin Abdul Aziz Hospital, Ministry of Health, Kingdom of Saudi Arabia
  • Wan Muhamad Amir Wan Ahmad Biostatistics Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Malaysia
  • Zainul Ahmad Rajion Department of Oral Maxillofacial Surgery and Oral Diagnosis, Kulliyyah of Dentistry, Kuantan Campus, International Islamic University Malaysia, Malaysia



Canines, Impaction, Orthodontics, Patients, CBCT, Dental arch


Although impacted canines concerning dental arch have been analyzed in prior studies. However, there is a lack of evidence to analyze the impact of impacted canines on dental arch characteristics using cone beam computed tomography (CBCT) models; therefore, knowing the impact of impacted canines on the dental arch can enhance awareness, contribute knowledge, and aid clinicians in managing impacted canine cases. Hence, it is critical to emphasize the strategies of proper diagnosis and interception for this clinical condition prior to any orthosurgical treatment procedures. This study aimed to analyze the impact of impacted canines on dental arch characteristics in orthodontic patients using CBCT. The method used was the review of clinical records of 350 patients with impacted canines who had CBCT scans and visited the dental clinics for orthodontic treatment pertaining to their arch by dividing them into a control group and a study group. The results revealed a significant relationship based on the dental arch dimension; inter first premolar width (IPW) (P = 0.012), inter first molar width (IMW) (P = 0.010), arch length (AL) (P = 0.041), palatal height (PH) (P = 0.019), and palatal height index (PHI) (P = 0.020). The article concludes that patients with impacted canines had significant changes in dental arch dimension compared to the control group. Dental arch dimensions were significantly deficient, with a higher palatal vault seen in impacted canine patients. The anatomical position of impacted canines has an effect on the dental arches and adjacent anatomical structures. These three-dimensional (3D) findings may provide clinical reference data for impacted canines and provide a valuable basis for delivering information and education on impacted canines assessment and treatment. CPD/Clinical Relevance: Canine impactions are common during routine examinations. Understanding the influence of impacted canines on the dental arch will help clinicians manage impacted canine patients.


Ireland A., Williams J., Atack N., and Sandy J. What is the truth behind the smile? Aust. Orthod. J. Special Edition.2017;65-72.

Schroder AGD., Guariza-Filho O., de Araujo CM., Ruellas AC., Tanaka OM., and Porporatti AL. To what extent are impacted canines associated with root resorption of the adjacent tooth? J. Am. Dent. Assoc.2018;149(9):765-777. doi: 10.1016/j.adaj.2018.05.012, PMID 30165975.

Zufia J., Abella F., Meda RG., Blanco H., and Roig, M. Autotransplantation of impacted maxillary canines into surgically modified sockets and orthodontic treatment: A 4-year follow-up case report. Int. J. Esthet. Dent.2020;15(2):196-210. PMID 32467948.

Eslami E., Barkhordar H., Abramovitch K., Kim J., and Masoud MI. Cone beam computed tomography vs conventional radiography in the visualization of maxillary impacted canine localization: A systematic review of comparative studies. Am. J. Orthod. Dentofacial Orthop.2017;151(2):248-58. doi: 10.1016/j.ajodo.2016.07.018. PMID 28153153.

Hamada Y., Timothius CJC., Shin D., and John V. Canine impaction - A review of the prevalence, etiology, diagnosis, and treatment. Semin. Orthod.2019;25:117-123. doi: 10.1053/j.sodo.2019.05.002.

Cassina C., Papageorgiou SN., and Eliades T. Open versus closed surgical exposure for permanent impacted canines: A systematic review and meta-analyses. Eur. J. Orthod.2017;40(1):1-10. doi: 10.1093/ejo/cjx047, PMID 29106474.

Sampaziotis D., Tsolakis IA., Bitsanis E., and Tsolakis AI. Open versus closed surgical exposure of palatally impacted maxillary canines: Comparison of the different treatment outcomes - a systematic review. Eur. J. Orthod.2017;40(1):11-22. doi: 10.1093/ejo/cjw077, PMID 28486586.

Grisar K., Luyten J., Preda F., Martin C., Hoppenreijs T., Politis C., and Jacobs R. Interventions for impacted maxillary canines: A systematic review on the relationship between initial canine position and treatment outcome. Orthod. Craniofac. Res.2020;00:1-14. doi: 10.1111/ocr.12423. PMID 32799419.

Rodrigues MFB., de Amorim Rocha LL., da Franca Acioly R., da Rocha CCL., and do Carmo Carvalho D. Piezosurgery-assisted surgical treatment in impacted canine transmigration. Case Rep. Dent.2020;13. doi: 10.1155/2020/2687827, PMID 32411488.

Seager L., Shah J., and Trevor-Burke FJ. The management and fate of palatally ectopic maxillary canines. Dent. Update.2020;47:153-161. doi: 10.12968/denu.2020.47.2.153.

Pakravan AH., Nabizadeh MM., Nafarzadeh S., Jafari S., and Shiva A. Evaluation of impact teeth prevalence and related pathologic lesions in patients in Northern part of Iran. J. Contemp. Med. Sci.2018;4(1):30-32.

Sarikir C., Toraman Alkurt M., Degerli S., Altunkaynak B., and Peke RI. Comparison of panoramic radiography and cone beam computed tomography for qualitative and quantitative measurements regarding localization of permanent impacted maxillary canines. Acta. Odontol. Turc.2017;34(1):1-7. doi: 10.17214/gaziaot.277844.

Schroeder MA., Schroeder DK., Capelli Junior J., and Santos DJS. Orthodontic traction of impacted maxillary canines using segmented arch mechanics. Dental Press J. Orthod.2019;24(5):79-89. doi: 10.1590/2177-6709.24.5.079-089.sar, PMID 31721951.

Cruz RM. Orthodontic traction of impacted canines: Concepts and clinical application. Dental Press J. Orthod.2019;24(1):74-87. doi: 10.1590/2177-6709.24.1.074-087.bbo, PMID 30916252.

Goyal B., Munjal S., Singh S., Natt AS., and Singh H. Impacted canine: An arduous task. J. App. Dent. Med. Sci.2018;4(1).

Alfarra Y. H. Y., Ismail K., and Kamaruddin A. F. Soft tissue cephalometric analysis of Malay orthodontic patients. Int. J. Pharma Bio. Sci.2018;9(4):157-165. (doi: 10.22376/ijpbs.2018.9.4.b157-165).

Arriola-Guillen LE., Ruiz-Mora GA., Rodriguez Cardenas YA., Aliaga-Del Castillo A., Boessio-Vizzotto M., and Dias-Da Silveira HL. Influence of impacted maxillary canine orthodontic traction complexity on root resorption of incisors: A retrospective longitudinal study. Am. J. Orthod. Dentofacial Orthop.2019;155(1):28-39. doi: 10.1016/j.ajodo.2018.02.011, PMID 30591160.

Pico CLVR., do Vale FJF., Caramelo FJSFA., Corte-Real A., and Pereira SMA. Comparative analysis of impacted upper canines: Panoramic radiograph vs cone beam computed tomography. J. Clin. Exp. Dent.2017;9(10):1176-82. doi: 10.4317/jced.53652, PMID 29167705.

Alfarra Y. H. Y., Noorani T. Y., Asif J. A., W. Ahmad W. M. A., and Rajion Z. A. Impacted canines classification systems among orthodontic patients. Int. J. Life Sci. Pharma Res.2022;12(3):L80-94. (doi: 10.22376/ijpbs/lpr.2022.12.3.L80-94).

Fattahi H., Ghaeed F., and Alipour A. Association between maxillary canine impaction and arch dimensions. Aust. Orthod. J.2012;28(1):57-62. PMID 22866595.

McConnell TL., Hoffman DL., Forbes DP., Janzen EK., and Weintraub NH. Maxillary canine impaction in patients with transverse maxillary deficiency. ASDC J. Dent.1996;63:190-5. PMID 8853823.

Langberg BJ. and Peck S. Adequacy of maxillary dental arch width in patients with palatally displaced canines. Am. J. Orthod. Dentofacial Orthop.2000;118:220-3. doi: 10.1067/mod.2000.104819, PMID 10935964.

Houston WJ. The analysis of errors in orthodontic measurements. Am. J. Orthod. Dentofacial Orthop.1983;83:382-90. doi: 10.1016/0002-9416(83)90322-6, PMID 6573846.

Patel S. and Harvey S. Guidelines for reporting on CBCT scans. Int. Endod. J.2020;13443. doi: 10.1111/iej.13443. PMID 33170952.

Rakosi T., Jonas I., and Graber TM. Study cast analysis. In: Color atlas of dental medicine - Orthodontic diagnosis. 1st ed. New York: Thieme Med. Publ, Inc.1993;207-234.

Refaat WE. and El-Desouky GG. Cone beam computed tomography assessment of the relation between sex and morphology of maxilla in patients with the impacted maxillary canine. Egypt. Dent. J.2017;63(1):157-167. doi: 10.21608/edj.2017.74383.

Piya A., Shrestha BV., Khapung A., and Bhattarai P. Prevalence and pattern of canine impaction and its associated anomalies among orthodontic patients attending tertiary care dental hospital in Kathmandu. Orthod. J. Nepal.2020;10(1):6-10. doi: 10.3126/ojn.v10i1.30996.

Cacciatore G., Poletti L., and Sforza C. Early diagnosed impacted maxillary canines and the morphology of the maxilla: A three-dimensional study. Prog. Orthod.2018;19:20. doi: 10.1186/s40510-018-0220-6, PMID 30009340.

Ngo CTT., Fishman LS., Rossouw PM., Wang H., and Said O. Correlation between panoramic radiography and cone beam computed tomography in assessing maxillary impacted canines. Angle Orthod.2018;88(4). doi: 10.2319/103117-739.1, PMID 29561656.

Hsu Yu-Cheng, Kao Chia-Tze, Chou Chih-Chen, Tai Wen-Ken, and Yang Po-Yu. Diagnosis and management of impacted maxillary canines. Taiwan J. Orthod.2019;31(1):4-11.

Ericson S. and Kurol J. Resorption of maxillary lateral incisors caused by ectopic eruption of the canines. A clinical and radiographic analysis of predisposing factors. Am. J. Orthod. Dentofacial Orthop.1988;94:503-13.

Becker A. and Chaushu S. Success rate and duration of orthodontic treatment for adult patients with palatally impacted maxillary canines. Am. J. Orthod. Dentofacial Orthop.2003;124:509-14. doi: 10.1016/s0889-5406(03)00578-x, PMID 14614417.

Thilagavathy N., Jayachandran S., and Sivaranjani P. Evaluation of impacted maxillary canine using panoramic radiograph and cone beam computed tomography. Oral Surg. Oral Med. Oral Pathol. Oral Radiol.2020;6(1):19-23. doi: 10.18231/j.jooo.2020.006.

Becker A. and Chaushu S. Etiology of maxillary canine impaction: A review. Am. J. Orthod. Dentofacial Orthop.2015;148:557-567. doi: 10.1016/j.ajodo.2015.06.013, PMID 26432311.

Singh AS. and Masuku MB. Sampling techniques and determination of sample size in applied statistics research: An overview. Int. J. Economics Commerce Manag.2014;2(11):1-22.



How to Cite

Alfarra, Y. H. Y., Noorani, T. Y., Asif, J. A., Wan Ahmad, W. M. A., & Ahmad Rajion, Z. (2023). Impacted Canines Localization and Its Impact on Dental Arch in Orthodontic Patients: A Novel CBCT Clinical Study: Life Sciences -Orthodontics. International Journal of Life Science and Pharma Research, 13(2), L211–218.



Research Articles