Impacted Canines brought in without braces

Presentation

Chief complaint. "My canines never came in and my dentist says they are stuck."

Diagnosis. Class I malocclusion with retained maxillary primary canines, palatally impacted UR3, and mesially angulated #11. Moderate overbite with adequate spacing in both arches.

Why I chose this approach

My goal was to bring both permanent canines into the arch and achieve a functional bite while offering an esthetic treatment option without braces. I chose Invisalign with auxiliary traction because the impacted canine required a directed pulling force before it could be incorporated into the aligners. I first used Invisalign to create adequate space for the canines. Pontics within the trays helped maintain the appearance of a complete smile during treatment, especially after removal of the retained primary teeth. For the palatally impacted upper right canine, I combined surgical exposure with a bonded traction arm and elastic thread to guide the tooth toward the arch. This allowed us to apply traction while the patient continued wearing his aligners. As the canine emerged, I added a bonded button and elastics to guide it downward and outward into position. Once enough of the canine was visible to capture in a scan, I incorporated it into the Invisalign plan for final alignment. This staged approach allowed each appliance to serve a specific purpose, with auxiliary mechanics bringing the impacted tooth into reach and aligners completing its positioning. Both canines were successfully brought into the arch, and we finished with Class I molar and canine relationships without using full braces.

Measurements

Cephalometric values before and after treatment
Measure	Norm	Pre	Post
SNA	82	82	82
SNB	80	78	78
ANB	2	3	3
Wits	0	-1	-2
SN-MP	32	101	101
U1-SN	102	28	80
L1-MP	90	90	89
Overjet (mm)	2–3	2	2
Overbite (mm)	2–3	2	1

Treatment

Objectives. Provide an esthetic, braces-free treatment option using Invisalign with auxiliaries to bring the impacted canines into the arch while using tray pontics to maintain appearance and avoid visible gaps during treatment

Plan. Begin Invisalign treatment with bonded attachments and bite turbos on the maxillary central incisors. Use the initial aligners to open adequate space for the impacted canine while maintaining esthetics with a tray pontic. Once adequate space is created, extract the retained primary canine, surgically expose and bond the impacted canine, and attach a traction arm. Scan and order additional aligners with a pontic, then tie the upper right canine to the aligner loop to begin traction into the arch. As the canine erupts, bond a button and use elastics as needed to guide it into position. Once the canine has erupted sufficiently to scan, rescan and incorporate it into the Invisalign treatment plan for final alignment with the aligners.

Appliances and materials

Invisalign — with bonded bite turbos
use 030 wire to make a bonded arm to bring in canine — Tie in with elastic thread

Progress records

Bond button on canine — Cut slits to lower tray to wear elastics to pull canine buccally and down

Outcome

Brought both canines in and finished with Class I molars and canines. Did not need braces.

Retention

Fixed U2-2 permanent retainer
Fixed 3-3 retainer with pontic
Invisalign Vivera retainers to be worn at night

Upper Retainer has Bite ramps to help maintain bite opening