Impacted Canines Dublin: How the Orthodontist and Oral Surgeon Work Together

Last reviewed: September 2026

An impacted upper canine is one of the few orthodontic problems that cannot be solved by an orthodontist alone. The tooth is buried in bone, usually on the palatal side, and bringing it into the arch needs a surgeon to uncover and bond it and an orthodontist to guide it into place over many months. At the Institute of Specialist and Cosmetic Dentistry (ISCD) in Dublin’s IFSC, both specialists work in the same building and plan these cases together from the first set of records. This guide explains how that pathway works — for patients whose child has been told a canine is not coming through, and for referring dentists deciding when and to whom to send the case.

What is an impacted canine, and why does it matter?

An impacted canine is a permanent canine that has failed to erupt into the dental arch within its expected timeframe and remains held in bone. After the third molars, permanent canines are the teeth most commonly affected by impaction.

The upper permanent canine normally arrives between about ten and thirteen years of age. It has the longest journey of any tooth from where it forms — high in the maxilla, near the floor of the nose — down to its final position in the arch. That long path is why it goes wrong more often than other teeth, and why the direction of the error matters: most impacted upper canines end up displaced towards the palate rather than towards the lip.

The canine is not a tooth to give up on lightly. It carries the corner of the smile, it takes the heaviest load in lateral jaw movements, and it supports the upper lip. A missing canine is a restorative problem for the rest of a patient’s life, which is why the profession’s default position is to bring the tooth into the arch where that is realistic.

How do we find an impacted canine before it causes damage?

Palpation of the upper canine region from age nine to ten is the single most useful screening step available to a general dentist, because a canine that cannot be felt in the buccal sulcus at that age warrants radiographic assessment.

The clinical signs a general dentist can act on are straightforward: a deciduous canine that is still firm well past its expected exfoliation date, an absent bulge in the buccal sulcus where the permanent canine should be felt, a lateral incisor that is tipped or splayed, or marked asymmetry between the two sides. Any one of these justifies a radiograph.

Imaging then answers two separate questions. A panoramic radiograph establishes whether the canine is displaced and roughly where. Cone beam computed tomography answers the questions that actually change the plan: exactly where the crown sits in three dimensions, whether it is in contact with the roots of the incisors, and whether those roots have already resorbed. At ISCD a CT scan is €150 and a specialist orthodontic assessment is €150.

Can an impacted canine damage the teeth next to it?

Yes, and this is the main reason early detection matters. Using cone beam CT, Alemam and colleagues found root resorption in 74% of lateral incisors adjacent to palatally displaced canines, against 25.5% of laterals beside normally positioned canines.

That study (American Journal of Orthodontics and Dentofacial Orthopedics, 2020;157(1):80–90) examined 107 palatally displaced canines against 51 normally erupted controls. The finding that changes clinical decisions is not the headline percentage but what predicted it: 94.2% of the resorbed cases had the canine in direct contact with the adjacent root, compared with 23.6% of the cases without resorption. Contact with the incisor root was the only risk factor the analysis identified. A prediction model built on three variables — that contact, the size of the canine’s follicle, and the presence of a peg-shaped lateral incisor — correctly classified 83% of cases.

Two caveats belong with that 74% figure, and we would rather state them than let the number frighten anyone. First, it is a cone beam CT finding, and CBCT detects resorption that a conventional radiograph simply cannot see, so it is not comparable to older prevalence figures. Second, 89% of the resorption was in the middle and apical thirds of the root and 41% of it was on the lingual surface — much of it is not visible, not symptomatic, and not, on its own, a reason to lose a tooth. What it does justify is imaging the case properly and not waiting to see what happens.

Is it always worth taking the baby canine out?

No. Extracting the deciduous canine is a genuinely effective interceptive measure, but the evidence also defines the positions in which it is unnecessary and the positions in which it will not be enough.

This is the section where the honest answer is more useful than the simple one. In a randomised controlled trial published in The Angle Orthodontist (2014;84(1):3–10), Bazargani and colleagues studied 48 palatally displaced canines in 24 patients with bilateral displacement — each patient acting as their own control, with one deciduous canine extracted and the opposite side left alone. At eighteen months, 67% of the canines on the extraction side had erupted successfully, against 42% on the control side. The difference was statistically significant, and it was significantly more pronounced in the younger patients, which is why the authors recommend the intervention at ten to eleven years alongside early diagnosis.

The same trial recorded a real cost: arch perimeter decreased significantly on the extraction sides. Removing the deciduous canine gives the permanent tooth a better chance of erupting, but it also lets the arch collapse, which is why the authors recommend a palatal arch as a space-holding device during the observation period. An extraction on its own is not the whole treatment.

The more refined question — which cases actually need it — was addressed by Naoumova and colleagues in the European Journal of Orthodontics (2015;37(2):219–229), a randomised trial of 67 children aged ten to thirteen assessed with cone beam CT at baseline, six and twelve months. They identified cut-off points in both directions. Canines with a cusp tip 11 mm from the midline, 2.5 mm from the dental arch plane, or angled at 103 degrees tended to erupt spontaneously without any extraction at all. Canines in a markedly less favourable position — a cusp tip 6 mm from the midline, 5 mm from the arch plane, or angled at 116 degrees — went on to need surgical exposure despite the interceptive extraction. Distance from the midline was the best single predictor.

Read together, those two trials say something a blanket protocol cannot: interceptive extraction is worth doing, it is worth doing early, and there is a band of cases at each end where it is either unnecessary or insufficient. Deciding which band a particular child falls into is what the three-dimensional assessment is for.

What does surgical exposure and bonding actually involve?

Surgical exposure is a procedure in which the oral surgeon uncovers the buried crown and bonds an orthodontic attachment with a gold chain to it, so the orthodontist can apply controlled traction and move the tooth into the arch.

There are two established techniques. In an open exposure the tooth is uncovered and left exposed to the mouth, either erupting on its own or being bonded once accessible. In a closed exposure the attachment and chain are bonded at the time of surgery and the flap is sutured back over the tooth, with only the chain emerging.

Either way, the sequence at ISCD is the same. Dr Salloum plans the mechanics and, in most cases, fits the fixed appliance first, because the arch needs to be aligned and enough space created before there is anywhere for the canine to go. Dr Marie O’Neill, Specialist Oral Surgeon, then carries out the exposure and bonds the attachment. Traction begins a few weeks later and proceeds slowly and deliberately — this is not a phase that can be hurried without risking the tooth or the bone around it.

Because the two specialists work in the same practice, the surgical plan is made against the orthodontic plan rather than in isolation: where the chain emerges, which direction traction will come from, and how much space exists are decided before the patient goes to theatre, not afterwards.

Is open or closed exposure better?

The current evidence favours open exposure on treatment duration and ankylosis risk, but it is drawn from a small number of small trials and is not strong enough to make either technique a universal rule.

Cassina and colleagues addressed this in a systematic review and meta-analysis in the European Journal of Orthodontics (2018;40(1):1–10), pooling eight studies covering 433 patients and 453 impacted canines. Open exposure was associated with a shorter alignment period — a mean difference of 2.14 months — and with lower odds of the tooth becoming ankylosed (odds ratio 0.15, 95% confidence interval 0.03 to 0.83). Both findings were independent of whether the canine was palatal or labial.

We quote that result with its own authors’ qualification attached. The alignment-duration finding rests on two studies of moderate quality and the ankylosis finding on a single study graded low quality, and the review concludes that further research is needed before robust clinical recommendations can be made. A specialist who tells you one technique is simply better than the other is going beyond what the evidence currently supports. The technique is chosen case by case, on the depth and angulation of the tooth, the amount of attached gingiva available, and the patient’s age.

The same review contains a figure worth setting expectations against: initial alignment of palatally impacted canines took 8.87 months on average, compared with 4.17 months for labially impacted canines. Since most impacted upper canines are palatal, families should plan for the longer of those two numbers.

How long does the whole treatment take?

Bringing an impacted canine into the arch is measured in years rather than months, because alignment of the canine itself is only one stage within a full course of fixed orthodontic treatment.

A realistic sequence is: assessment and imaging; a preparatory phase of fixed appliance treatment to create space, typically several months; surgical exposure; traction to bring the canine down, which the Cassina data suggests averages a little under nine months for a palatal canine; then detailing and finishing the occlusion; then retention. Retention is not optional at the end of a case like this.

Two honest caveats. Not every impacted canine can be saved — a tooth that is ankylosed, severely resorbed, or in an extreme position may not respond to traction, and the alternative plans (space closure, or space maintenance for a future restoration) are discussed before treatment starts rather than after it fails. And an average is not a promise: these cases vary more than routine orthodontic treatment does.

What does treatment cost at ISCD?

Impacted canine treatment is quoted in two parts — the orthodontic course and the surgical procedure — and a full written breakdown is provided after assessment, before any treatment begins.

Our published fees are a specialist orthodontic assessment at €150, an oral surgery consultation including a panoramic radiograph where required at €150, a CT scan at €150, fixed metal or ceramic braces at €1,250 to €3,500 per arch, and interceptive treatment for children from €600. Where a deciduous canine needs to be removed, tooth removal starts from €150. Intravenous sedation, if it is appropriate for the surgical visit, is €395.

We do not publish a single figure for surgical exposure and bonding, because the procedure varies substantially with how deep the tooth sits, how it is angled and whether one canine or both are involved. It is quoted individually once the three-dimensional imaging has been reviewed. We would rather give a family an accurate number after seeing the case than a headline number before it.

When should a general dentist refer an impacted canine?

Refer at the point of suspicion rather than the point of certainty — a permanent canine that is not palpable in the buccal sulcus by age ten to eleven is a referral, because the interceptive window closes as the patient grows.

The evidence above makes the timing argument on its own: the interceptive effect Bazargani measured was significantly stronger in younger patients, and the resorption risk Alemam measured runs while the case is being observed. A referral at eleven has options that a referral at fourteen does not.

What helps us most in a referral: the reason for referral, any recent radiographs, whether the deciduous canine is still present and how mobile it is, and any orthodontic treatment already carried out or planned. We do not require radiographs to be taken before referral — if the appropriate imaging has not been done, we will do it here rather than have the patient irradiated twice.

Referrals can be made through our online referral process for Dublin dentists, and our guide to referring for oral surgery sets out the surgical side in more detail. Patients are also welcome to arrange a consultation directly. We keep the referring practice informed throughout and return the patient to you for continuing general care.

Why does this case type need a specialist orthodontist and a specialist oral surgeon?

An impacted canine is a multidisciplinary case by definition: the surgical access, the bonding position and the direction of traction are orthodontic decisions executed surgically, and separating those decisions across two practices introduces avoidable compromise.

Dr Erfan Salloum is a Specialist Orthodontist registered with the Dental Council of Ireland, with a particular clinical interest in complex and multidisciplinary treatment, including skeletal anchorage using temporary anchorage devices and maxillary expansion — both of which are directly relevant when an impacted canine has to be moved a long way with a limited anchorage base. He holds a Doctorate in Clinical Dentistry in Orthodontics from University College Cork and a Master’s Degree in Lingual Orthodontics from the University of Padova, and he is one of a small number of orthodontists in Ireland holding European distinctions across comprehensive, aligner and lingual orthodontics.

Dr Marie O’Neill is a Specialist Oral Surgeon who completed her specialist training with First Class Honours and was awarded Fellowship of the Royal College of Surgeons in Ireland in Oral Surgery. Ireland’s Dental Council recognises only two dental specialties — orthodontics and oral surgery — and an impacted canine happens to sit precisely at the join between them. That is unusual, and it is the reason this particular case type is well suited to a practice that holds both.

You can read more about our specialist orthodontic service, our oral surgery service, and Dr Salloum’s full specialist profile. For related reading, see our guides to braces for teenagers, treating dental crowding, adult brace options and how to choose a specialist orthodontist. A different tooth is involved, but our guide to impacted wisdom teeth covers impaction of the third molars, where removal rather than alignment is usually the goal. You can also meet the full specialist team and read about the practice.

Arranging an assessment

If your child’s canine has not come through, or your dentist has told you a canine is displaced, a specialist orthodontic assessment is the place to start. If the case turns out to need surgery, the surgical opinion happens in the same practice rather than somewhere else.

Institute of Specialist and Cosmetic Dentistry (ISCD)
4 NCI, Lower Mayor Street, IFSC, Dublin, D01 R7W7
Telephone: +353 1 504 2065
Email: info@iscd.ie

Written by Dr. Erfan Salloum, BDS, PGCert(Orth), DClinDent(Orth), MsLing(Orth), MFD RCSI, MFDS RCPSG, MOrth RCSEd, FFD(Orth) RCSI, MOrth RCSEng, FDS RCSEng, FDS RCPSG — Specialist Orthodontist at the Institute of Specialist and Cosmetic Dentistry, Dublin.

References

1. Cassina C, Papageorgiou SN, Eliades T. Open versus closed surgical exposure for permanent impacted canines: a systematic review and meta-analyses. European Journal of Orthodontics. 2018;40(1):1–10. doi:10.1093/ejo/cjx047
2. Bazargani F, Magnuson A, Lennartsson B. Effect of interceptive extraction of deciduous canine on palatally displaced maxillary canine: a prospective randomized controlled study. The Angle Orthodontist. 2014;84(1):3–10. doi:10.2319/031013-205.1
3. Naoumova J, Kürol J, Kjellberg H. Extraction of the deciduous canine as an interceptive treatment in children with palatally displaced canines — part II: possible predictors of success and cut-off points for a spontaneous eruption. European Journal of Orthodontics. 2015;37(2):219–229. doi:10.1093/ejo/cju102
4. Alemam AA, Abu Alhaija ES, Mortaja K, AlTawachi A. Incisor root resorption associated with palatally displaced maxillary canines: analysis and prediction using discriminant function analysis. American Journal of Orthodontics and Dentofacial Orthopedics. 2020;157(1):80–90. doi:10.1016/j.ajodo.2019.08.008