Early Interceptive Management of Bilateral Canine Impaction With Anterior Crossbite Using Double Extraction and a 2 ×...

Maxillary canine impaction is a common developmental eruption disturbance that may lead to root resorption of adjacent incisors, crowding, and prolonged treatment if not identified early. Early recognition during mixed dentition allows interceptive measures that may guide eruption and reduce the need for surgical exposure.

A 9-year-old Saudi girl presented with an anterior crossbite, functional mandibular shift, poor oral hygiene, and multiple carious deciduous molars. Clinical examination showed absence of palpable maxillary canine bulges, and panoramic radiography with CBCT confirmed bilateral palatal impaction of the maxillary permanent canines with S-sector 3, α-angle 60°, d-distance about 22 mm, and close proximity to the lateral incisor roots without resorption. Preventive and restorative care were completed first, followed by the extraction of deciduous canines and first deciduous molars (53, 54, 63, and 64) and the placement of a maxillary 2 × 4 fixed appliance to correct the anterior crossbite and maintain space. Over 14 months, both permanent canines erupted spontaneously into favorable positions without lateral incisor root resorption, and the mandibular shift resolved.

In this mixed-dentition patient with bilateral palatal canine impaction and moderate radiographic risk indicators, a double extraction protocol combined with a simple 2 × 4 appliance enabled successful nonsurgical eruption guidance and simultaneous correction of anterior crossbite.