Management of an extremely displaced maxillary canine

Aligning a displaced maxillary canine into the dental arch is one of the most complicated problems in orthodontics. In cases of extremely high displacement, the tooth is frequently removed surgically. Because of the upper canines' significance to dental esthetics and functional occlusion, such a decision is a very serious one. This case report illustrates the treatment of an extremely high displaced maxillary canine.

The main diagnosis was the displacement and the retention of tooth 13 (in nearly horizontal position, apical to the neighboring teeth); further diagnoses were: transversal maxillary deficiency with frontal crowding and a distal bite of one premolar in width, a deep bite of 6 mm with contact in the palatal mucosa, mandibular midline deviation of 2.5 mm to the right, lingual eruption of teeth 32 and 42, retroinclination of the maxillary incisors, and retarded eruption of the permanent teeth.

Initial treatment with active and functional appliances to correct the distal bite, midline deviation and deep bite. Surgical exposure of the high displaced canine at the age of 14. Onset of cuspid elongation with removable appliances and elastics, further movement with a transpalatinal bar and welded arm, and full alignment of the upper and lower arches with fixed appliances in both jaws. Stabilization of the orthodontic treatment results with retention devices. Duration of treatment: 5 years and 8 months. For the alignment of tooth 13, 2 years and 10 months were required; 1 year and 4 months were necessary with complete fixed appliance.

The aim of this case report was to demonstrate the potential of aligning an extremely displaced canine. Because of the esthetic and functional importance of the upper canines, therapeutic alignment should be initiated, provided there are no indications to the contrary.