Radiographic factors affecting the management of impacted upper permanent canines

The aim of the investigation was to evaluate which radiographic factors influenced the orthodontists' decision whether to expose or remove an impacted upper permanent canine and was a retrospective, cross-sectional design. The sample consisted of all radiographic records of patients referred to the Orthodontic Department at Manchester University Dental Hospital with impacted upper permanent canines between 1994-1998 (n = 44). The following canine position measurements were made from the OPG: angulation to the midline, vertical height, antero-posterior position of the root, overlap of the adjacent incisor, and presence of root resorption of adjacent incisor(s). The labio-palatal position of the impacted canine was assessed from the lateral skull radiograph. Whether the impacted canine had been exposed and orthodontically aligned or removed was also recorded. Stepwise logistic regression analysis showed that the labio-palatal position of the crown influenced the treatment decision, with palatally positioned impacted canines more likely to be surgically exposed and those in the line of the arch, or labially situated, removed (P < 0.05). Additionally, as the canine angulation to the midline increased, the canine was more likely to be removed (P < 0.05). The orthodontists' decision to expose or remove an impacted upper permanent canine, based on radiographic information, seems to be primarily guided by two factors: labio-palatal crown position and angulation to the midline.