Periodontal surgery of the maxillary impacted canine for orthodontic purposes: Proposal for a surgical decision tree

In a private practice, between January 2010 and December 2015, 621 impacted teeth were exposed for orthodontic purposes. The majority were maxillary canines (464 = 74.71%), followed by maxillary central incisors (36 = 5.80%), mandibular canines (32 = 5.15%) and, finally, second premolars (30 = 4.83%). The 464 maxillary canines were present in 356 patients with a mean age, at the time of the intervention, of 15 years and 3 months (7 years and 10 months to 45 years and one month). The gender distribution was 60.7% (F) to 39.3% (M); 32.8% of maxillary canines were buccal and 67.2% were palatal. Only 6 canines did not move, with a success rate of 98.7%. At the pretreatment interview, the orthodontists explained that orthodontic-surgical placement of an impacted canine lengthened treatment time by an average 6 months, but in some cases by 12 months or more. The purpose of this surgery is to help the orthodontist to position the impacted tooth in the dental arch with all the periodontal structures and with the best possible integration esthetics. The objective of this article is to illustrate the periodontal orthodontic surgery of the maxillary canine and to propose a surgical decision tree.