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 ( ISSN: 2814-2098 )                                                                                   RAKOTOSON Mariette ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

 

SURGICAL-ORTHODONTIC SYMBIOSIS IN THE 

TREATMENT OF MAXILLARY IMPACTED CANINES 

 

Autors : Rakotoson M1*, Njatosoa RF2, Rasoanirina MO1, Andriniaina FA1, 

Ratsirarisoa T1, Andrinjakarivony NN1, Rakotoharinivo HZM1,  Randrianarimanarivo 

HM1 

1Department of Dento-Facial Orthopedics, Institute of Tropical Odonto-Stomatology of 

Madagascar, University of Mahajanga, Madagascar 

2Department of Oral Surgery, Institute of Tropical Odonto-Stomatology of Madagascar, 

University of Mahajanga, Madagascar 

*Correspondig author: RAKOTOSON Mariette  

Department of Dento-Facial Orthopedics, Institute of Tropical Odonto-Stomatology of 

Madagascar, University of Mahajanga, Madagascar 

 

Abstract 

  
The maxillary permanent canine is the dental organ whose intra-osseous retention is 

frequent. The objective of our study was to describe the surgical-orthodontic 

symbiosis in the treatment of impacted maxillary canines. This is a cross-sectional 

retrospective descriptive study relating to a literature review including articles 

published from 2012 to 2021. The study was carried out from November 2019 to 

January 2021. We collected 15 recent articles. The pre-surgical and surgical 

orthodontic stages with the use of open and closed techniques have been described. 

Orthodontics with fixed appliances linked the treatment. Success was judged by 

dental alignment. Techniques and therapeutic means allow a better implementation 

of surgical and orthodontic protocols. This involves a complete and 

multidisciplinary clinical examination. 

Key words : Surgery, Orthodontics, Canine. 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                   RAKOTOSON Mariette ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

 

INTRODUCTION 
An impacted canine is defined as "a tooth retained in the maxillary or mandibular arch beyond 

its eruption date, surrounded by its pericoronal sac and without communication with the oral 

cavity" [1].  

The canine plays a role in occlusion (release during lateral movements, support of arch 

width...) and its positioning on the arch is essential to ensure occlusal function. In order to 

limit the consequences of inclusion, particularly root resorption in adjacent teeth, diagnosis 

must be early and precise, so that appropriate treatment can be initiated [2].  

Worldwide, maxillary canines rank third among dental inclusions, with a frequency of 0.92-

4%, far behind mandibular (22%) and maxillary (18%) wisdom teeth. This compares with a 

frequency of 0.10% to 0.35% for mandibular canines [3].  

The overall aim of this study was to describe the surgical-orthodontic symbiosis in the 

treatment of maxillary impacted canines.

 

METHODOLOGY 

 

This is a descriptive, retrospective, cross-sectional study using a literature review during the 

period from January 2012 to December 2021.  

Our study included articles on the surgical-orthodontic management of maxillary impacted 

canines, published from 2012 to 2021 and written in French or English.  

We excluded all articles on the surgical management of maxillary impacted canines published 

before 2012 and not in English or French. 

We opted for exhaustive sampling, reaching a sample size of 15 articles. 

The variables studied were: year of publication, type of article, radiological examinations, 

pre-surgical orthodontics, surgical techniques, orthodontic means and treatment success. 

Searches were carried out using PubMed, Google Scholar, Science direct and the Medline and 

Cochrane databases, using the following keywords and the Boolean operators "and", "and", 

"or", "or", "except", "not".  

Data were collected in a pre-tested and validated data extraction form corresponding to each 

article. The data obtained was then analyzed.

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                   RAKOTOSON Mariette ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

 

RESULTS 

 
Table 1 : Distribution of year of articles 

Years of articles Number (n) Pourcentage (%) 

2012 1 6,7 

2013 1 6,7 

2015 5 33,3 

2016 2 13,3 

2017 2 13,3 

2018 4 26,7 

Total 15 100 

 

 

Table 2 : Distribution of  type of articles 

Types of articles Number (n) Pourcentage (%) 

Original articles 13 86,7 

Clinical case 1 6,7 

General revue 1 6,7 

Total 15 100 

 

  

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                   RAKOTOSON Mariette ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

 

Table 3 : Distribution of articles by radiographic examination 

 

Radiography Number (n) Pourcentage (%) 

Retroalveolar 1 6,7 

Occlusal 1 6,7 

Teleradiography 1 6,7 

Panoramic 6 40 

Scanner 5 33,3 

Others 1 6,7 

Total 15 100 

 

Table 4 : Distribution of items by pre-surgical orthodontics 

Pré-chirurgical 
orthodontics 

Number (n) Pourcentage (%) 

Levelling, space opening 
Space maintenance 

8 53,3 

Not specified 7 46,7 

Total 15 100 

 

Table 5 : Distribution of items by surgical technique 

Surgical technique Number (n) Pourcentage (%) 

Open closed 8 53,3 

Others 2 13,3 

Not specified 5 33,3 

Total 15 100 

 

  

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                   RAKOTOSON Mariette ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

 

Table 6 : Distribution of items by orthodontic appliances 

Orthodontics appliances Number (n) Pourcentage (%) 

Amovible 1 6,7 

Fixed 10 66,6 

Mini-implant 2 13,3 

Others 1 6,7 

Not specified 1 6,7 

Total 15 100 

 
Table 7 : Distribution of articles according to therapeutic success 

Therapeutic success Number (n) Pourcentage (%) 

Parodontal health 1 6,7 

Teeth vitality 1 6,7 

Teeth alignement 2 13,3 

Not specified 11 73,3 

Total 15 100 

 

 

DISCUSSION 

 
The most advanced radiological examinations were panoramic (40%), followed by CT 

(33.3%). Retroalveolar, occlusal, teleradiography and others were equally important (6.7%). 

In the case of impacted teeth, the clinical examination can be used to hypothesize the presence 

of an impacted tooth, but it is really only the various radiological examinations that can 

confirm the diagnosis of an impacted canine. According to Fleury (1985) and Messaoudi: 

"The diagnosis of impacted canine is almost always made radiologically, since 79% of 

inclusions are asymptomatic. X-rays allow us to observe the general dental condition (caries, 

coronal and root fillings, pulpal or apical lesions, displacements) and the relationship between 

the impacted tooth and the other teeth, as well as the various anatomical elements (sinuses, 

nasal cavities, inferior dental nerve)". [4,5]. The recommendation put forward by the Société 

Française de Stomatologie, de Chirurgie Maxillo-Faciale et de Chirurgie Orale (SFSCMFCO) 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                   RAKOTOSON Mariette ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

 

and the Société Médicale d'Orthopédie Dento-Maxillo-Faciale in July 2015 states that: 

"Classically, in order to assess the position of the canine, it is proposed to take 2 conventional 

radiographs using the horizontal and vertical parallax technique. For the horizontal parallax 

technique, 1 anterior occlusal X-ray and one or 2 retroalveolar X-rays are recommended. For 

the vertical parallax technique, one anterior occlusal and one panoramic or one retro-alveolar 

and one panoramic are recommended, and the Cone Beam can be proposed to improve patient 

management." [6,7]. 

 

Figure 1: Panoramic radiograpy (Source : Randrianarimanarivo Henri Martial) 

Pre-surgical orthodontics is dominated by levelling, space opening and space 

maintenance (53.3%). According to Boileau in 2012: "Before any intervention, treatment 

most often begins with an orthodontic phase that has two main objectives: to create the 

necessary, or even slightly greater, space for the pulled tooth to take its place on the arch 

(mesio-distal diameter of the tooth to be pulled + approx. 2mm), this space can be measured 

using a caliper directly in the mouth, or on a plaster model from a study impression; and to 

prepare the arch to withstand the reaction induced by orthodontic traction on the impacted 

tooth. " [8]. 

 

Figure 2 : Pre-surgical orthodontic preparation (Source : Rakotoson Mariette) 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                   RAKOTOSON Mariette ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

 

Open and closed surgical techniques were the most explained (53.3%); however, other 

techniques were also put forward (13.3%). According to the Société Française de 

Stomatologie, de Chirurgie Maxillo-Faciale et Chirurgie Orale in 2015: Two main techniques, 

"open" and "closed" are proposed for canines included in the palatal position. The so-called 

"open" technique involves surgically exposing the tooth, prior to orthodontic treatment, by 

removing a window of tissue around the tooth and then placing a dressing to cover the area 

for around ten days. A surgical dressing is then removed and the canine can erupt 

spontaneously. Once sufficient eruption has taken place, an attachment is placed on the tooth 

to enable it to be properly positioned on the arch. The "closed" technique also involves 

surgically exposing the tooth and pulling it after repositioning the palatal flap. The closed 

technique requires the necessary emergence space for the canine to be prepared prior to 

traction [9,10]. 

 

Figures 3-4-5-6-7 : Closed surgical technique (Source : Delsol, 2008) 

The orthodontic appliance most frequently mentioned was the fixed appliance (66.6%), 

followed by the mini-implant (13.3%). Removable appliances and other means were also 

cited, with equal percentages (6.7%). Lecomte (2018) points out that orthodontic appliances 

are designed to retain the space created, prevent loss of anchorage and limit or even cancel 

parasitic movements that may occur in the anchorage teeth. Orthodontic appliances may 

include continuous archwires attached to other teeth with brackets, Nance palatal archwires, 

transpalatal archwires, Quadhelix, extra-oral force or lingual archwires [11]. 

 

Figure 8 : Fixed appliance fixe (Source : Rakotoson Mariette) 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                   RAKOTOSON Mariette ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

 

Treatment success was judged mainly by dental alignment (13.3%), followed by 

periodontal health and dental vitality at 6.7% respectively. The eruption success rate is more 

favourable in younger patients; clinical results conclude in better periodontal health, shorter 

operating time, reduced perception of post-operative pain and improved canine aesthetics 

[9,12].

 

CONCLUSION 
 

A total of 15 papers were reviewed, dominated by original papers of European origin, with a 

predominance of young women. Diagnosis remained complete before surgical decision, 

panoramic radiography was most recommended, pre-surgical orthodontics enabled surgical 

preparation, surgical techniques were most represented by open and closed techniques, fixed 

orthodontics was the most used means and treatment success depended mainly on dental 

alignment. 

Treatment of maxillary impacted canines using surgical-orthodontic symbiosis is a complex 

procedure requiring multidisciplinary expertise. We intend to broaden our scope of 

investigation through a clinical case study using mini-screws as an anchoring device in 

Madagascar

 

REFERENCES 
 

1. Delsol L, Orti V, Chouvin M, Canal P. . Canines et incisives maxillaires incluses. 

Diagnostic et traitement. Encyc Med Chir (Paris). 2008 ; 28-635-G-10. 

2. Auclair AC, Baralle MM, Bery A, Blanchard PY, Bourdillat MC, Fusari JP, et al. 

Management of an impacted canine tooth. Recommendations for good practice. Société 

Française de Stomatologie, Chirurgie Maxillo-Faciale et Chirurgie Orale.2015 ; 1 – 43. 

3. Dersot JM. Periodontal surgery of the maxillary impacted canine for orthodontic purposes : 

Proposal for a surgical decision tree. Elsevier Masson SAS, Paris, France.  Intern Orthod. 

2017 ; 15 : 221-37. 

4. Fleury J, Deboets D, Assad-Auclaire C, Maffre N, Sultan P. The impacted canine: update 

on 212 observations. General principles of treatment. Rev Stomatol Chir Maxillofac.1985 ; 

86 : 122-31. 

5.Messaoudi Y, Coudert JL, Aknin JJ. Contribution of three-dimensional reconstruction using 

3DNEO software in the surgical-orthodontic treatment of impacted teeth.EDP Sciences. 

2013 ; 84 : 147-55. 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                   RAKOTOSON Mariette ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

 

6. Blanchard PY, Kerbrat JB, Paulus C, Saint-Pierre F. Management of impacted cuspid july 

2015. Elsevier Masson SAS. 2018 ; 2-5. 

7. Cloitre A, Lemoine S, Lesclous P. Orthosurgical management of impacted maxillary 

canines. Clinical realities.2018 ; 29 : 2-5. 

8. Boileau M-J, Canal P. Orthodontics for children and young adults. Volume 2.Issy-les-

Moulineaux: Elsevier Masson; 2012. 312. 

9. French Society of Stomatology, Maxillofacial Surgery and Oral Surgery. Management of 

an impacted canine. Recommandations de Bonne Pratique.2015 ; 1-43. 

10. Bagard G. Orthosurgical traction failures: transplantation or implantology.Open Sciences. 

2017 ; 3-141. 

11. Lecomte N. Maxillary and mandibular impacted canines: anatomical setting and surgical 

techniques.Open sciences ; Sciences du vivant. 2018 ; 1-151. 

12. Zerouaoui MF, Bahije L, Zaoui F, Rerhrhaye W. Orthodontic-surgical placement of 

impacted canines: ways of predicting failure.EDP Sciences. 2012 ; 1-13. 

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