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Oral Radiology Orthodontics

oasisimage of the Week: What would you do with these highly impacted canines?

We’re adding a new feature this week called “Image of the Week”. Each Wednesday, an image (some xrays, some clinical shots and some random stuff) will be posted to the blog. In each case, a question will be posed, the answer to which will appear in the comments section a day or two later.

Enjoy the video and please participate in the discussion.

In this case, an 11 year old girl presents with unerupted 1.3 and 2.3. The height of them, on panorex, is extraordinary and you decide to get a cone beam CT.

See the CT below and tell us what you’d recommend.


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  1. Mark Venditti January 23, 2013

    This is really out of my “wheel house”, but for the sake of discussion, if the orthodontist and the oral surgeon thought they could expose and line up the cuspids, even if the laterals neeeded to be sacrificed, that would be fine. If the 1st bicuspids were at risk, I would think about just having the cuspids removed.


    1. You hit the nail on the head Mark- I can get up there and get a chain on it (esp the 1.3) but what’s the risk to 1.2/1.4? Also, can you get adequate torque to bring it down?

  2. Farel Anderson January 23, 2013

    I would leave them –they are too high up.Check them out every year or two for about 5years as to any changes. That’s what I would do if it were my child.

    1. Child was about to start ortho with mesialize the 1.4 2.4 – still leave them alone?

  3. Bill Abbott January 24, 2013

    In my opinion, these teeth would be easier to remove than you might expect. The patient would require general anesthesia, but the CBCT suggests a very easy labial access. Her bone is soft now, delaying surgery would make the procedure more difficult. I would not observe, they are not going to be easier to deal with in a few years.
    I defer to the surgeon orthodontic team regarding exposure and bonding.
    I believe it is possible to place attachments and the teeth could be brought into the arch.
    Impressive case.

    1. Bang on Bill – in the end, we didn’t think the right vector of torque could be achieved and the risk to the adjacent teeth was too high. Made a LeFort type incision and the teeth were “easy” to remove. Completely agree that another 5 years would have been a very different story and I may have just left them in place unless there was a real risk of root resorption during ortho. Ian

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