Surgical Exposure and Orthodontic Traction of Bilaterally Impacted Upper Canines (#13 & #23) with Extraction of #14 & #24
Surgical Procedure
Chief Complaint
Patient presented with bilaterally impacted upper canines (#13 and #23) requiring surgical exposure and orthodontic traction as part of comprehensive orthodontic treatment.
Clinical Findings
Bilaterally impacted maxillary canines (#13 and #23).
Adjacent first premolars (#14 and #24) planned for extraction to create space for canine eruption.
Tooth #14 exhibited severely bent roots.
Tooth #24 exhibited curved roots, increasing extraction difficulty.
Pre-operative CBCT reviewed for surgical planning and localisation of impacted canines.
Treatment Plan
Extraction of teeth #14 and #24.
Surgical exposure of impacted canines #13 and #23.
Bone removal to expose the crowns.
Creation of eruption pathways.
Bonding of orthodontic brackets to impacted canines.
Placement of orthodontic traction using power chains connected to crimpable hooks.
Pre-operative Assessment
CBCT imaging was reviewed to determine the position of the impacted canines and plan the surgical approach.
The patient and parent were informed of:
The surgical and orthodontic procedures.
Expected healing process.
Risks and possible complications.
Need for continued orthodontic traction following surgery.
All questions were answered, and informed consent was obtained.
Anesthesia
Local anaesthetic infiltration administered to the regions of:
#13
#14
#23
#24
Surgical Procedure
The patient was cleaned and draped under sterile protocol.
Extraction Phase
Teeth #14 and #24 were extracted.
Extraction was technically challenging due to the severely bent root morphology of #14 and the curved roots of #24.
Surgical Exposure & Orthodontic Traction
Full-thickness flaps were raised over the impacted canines.
Bone guttering performed to expose the crowns of #13 and #23.
Bone channels created to guide eruption toward the extraction spaces.
Existing orthodontic brackets were repositioned and bonded onto the exposed canines.
Surgical sites closed with interrupted sutures:
Two sutures placed at #23.
Three sutures placed at #13.
Crimpable hooks attached to the orthodontic archwire.
Hooks secured and bent inward to minimise soft tissue irritation.
Power chains connected from the impacted canines to the crimpable hooks to initiate orthodontic traction.
Haemostasis achieved.
Post-operative Assessment
Surgical exposure and orthodontic traction completed successfully.
Orthodontic traction mechanics remained stable.
Haemostasis achieved.
No immediate complications observed.
As the patient was unable to swallow tablets, ibuprofen syrup already available at home was advised for pain management.
No additional medications were prescribed.