Most people have heard of impacted wisdom teeth — but far fewer know that canine teeth (the "fangs" or "eye teeth") are the second most commonly impacted teeth in the mouth. When an upper canine fails to erupt properly, it can cause significant problems for bite alignment, the health of adjacent teeth, and facial appearance.
The good news is that impacted canines are highly treatable — often without extraction — using a coordinated approach between an oral surgeon and an orthodontist.
## What Is an Impacted Canine?
Canine teeth normally erupt between ages 11 and 13. When a canine becomes impacted, it fails to break through the gum and emerge in its proper position in the dental arch. Instead, it remains trapped within the bone — sometimes horizontally, sometimes angled toward adjacent roots, and sometimes in a position that threatens the roots of neighboring teeth.
Upper canines (maxillary canines) are impacted far more commonly than lower canines. The maxillary canine is the last permanent tooth to erupt (other than wisdom teeth) and has a long path to travel through the bone — making it more vulnerable to impaction.
Impaction is typically diagnosed on panoramic X-ray or cone beam CT during routine orthodontic evaluation in early adolescence. Early detection is important because the earlier treatment begins, the easier it is to guide the tooth into position.
## Why Does It Matter?
Canine teeth are critical teeth. They:
- **Guide the bite** — the upper canines establish how your upper and lower jaws come together
- **Provide essential chewing function** — canines bear significant lateral chewing force
- **Form the "corners" of the smile** — aesthetically, these teeth define the transition from front teeth to back teeth
- **Support the lip and cheek** — the prominent root of the canine supports the facial profile
A missing or poorly positioned canine creates functional, aesthetic, and structural problems that affect the entire bite.
## How Is an Impacted Canine Treated?
Treatment typically involves an oral surgeon and an orthodontist working together. The most common approach is called surgical exposure and orthodontic traction.
Step 1: Orthodontic preparation — Braces are placed to create space in the arch for the impacted canine to eventually occupy. Without adequate space, exposing the tooth serves no purpose.
Step 2: Surgical exposure — Your oral surgeon performs a brief procedure to uncover the impacted canine. Under local anesthesia or IV sedation, a small incision is made in the gum to expose the crown of the impacted tooth. The surgeon then bonds a small gold bracket and chain to the tooth.
Step 3: Orthodontic traction — Your orthodontist connects the chain to the braces arch wire, applying gentle, gradual force to guide the canine into its proper position. This process takes anywhere from several months to two years, depending on the severity of impaction and the distance the tooth needs to travel.
## What If the Tooth Can't Be Saved?
In some cases — particularly when the impacted canine has caused root resorption of adjacent teeth, when treatment was delayed until adulthood, or when the position makes eruption mechanically impossible — the canine may need to be removed and replaced with a dental implant.
A canine implant is an excellent functional solution and is placed at our office under IV sedation after the orthodontic space is prepared. The result is a tooth that looks and functions like the natural canine.
## What Age Should This Be Evaluated?
The ideal time to evaluate and treat an impacted canine is between ages 11 and 14 — while the bone is still relatively pliable and the tooth has a better chance of erupting spontaneously with guidance. After the mid-teens, the bone mineralizes and the window for guided eruption narrows.
If your child's dentist or orthodontist has mentioned a missing or impacted canine, don't delay the evaluation. Early intervention consistently produces better outcomes with less complex treatment.
## What to Expect
Surgical exposure is a brief, outpatient procedure typically performed under IV sedation or local anesthesia. Recovery is mild — most patients experience 2–3 days of soreness similar to a tooth extraction. The chain attached at surgery is not painful.
## What Happens If an Impacted Canine Is Ignored?
Parents and patients sometimes wonder whether they can simply wait. The short answer: not indefinitely. Left in place, an impacted canine can:
- **Continue to damage adjacent tooth roots** — resorption of neighboring teeth can progress silently until a previously healthy tooth becomes unrestorable
- **Form a cyst** — the sac surrounding the unerupted tooth can enlarge, causing bone loss in the jaw
- **Complicate future treatment** — the longer an impacted canine remains untreated, the more difficult it becomes to guide into position and the more likely that extraction and implant replacement become the only viable options
Monitoring without treatment is sometimes appropriate for very young children not yet ready for braces, or for adults in whom eruption is no longer feasible. However, in most patients between ages 11 and 30, active treatment is strongly preferred.
## Coordinated Care Between Our Office and Your Orthodontist
The best outcomes for impacted canines are achieved through coordinated care between the oral surgeon and the orthodontist. At Oral Surgeons of Indiana, we regularly communicate with referring orthodontists about timing, the position of the bracket and chain, and the progress of eruption. If your orthodontist has not yet been consulted about your impacted canine, we can help coordinate that referral.
Call (317) 876-1095 or schedule an evaluation online for an impacted canine tooth at Oral Surgeons of Indiana. We work closely with Indianapolis-area orthodontists to coordinate seamless treatment for our patients.
Learn more about oral surgery for impacted teeth, IV sedation, and dental implants at our practice.