Bella Smile ↗Case report · Clear aligners (Invisalign)
Saving an Impacted Canine with Autotransplantation
The patient first presented at age 11 with a severe overbite and delayed eruption of her permanent canines. Her mother was hesitant about dental X-rays, so imaging had been deferred. When radiographs were ultimately obtained, tooth #27 was severely impacted horizontally near the apices of #25 and #26. With delayed detection, the canine became increasingly displaced and difficult to manage orthodontically, requiring a more complex surgical approach.
- Patient
- Child (under 12), female
- Classification
- Class II div 2
- Active treatment
- 22 months
- Published
- September 14, 2026
Presentation
Chief complaint. I want to fix my overbite."
Diagnosis. Class II molar relationships with unerupted maxillary canines. Tooth #27 is horizontally impacted buccally near the apices of #25 and #26. Tooth #20 is congenitally missing. Severe overbite is also present.
Records
Before — Intraoral Photos
After — Intraoral Photos
Before — Lateral Ceph Radiograph
After — Lateral Ceph Radiograph
Before — Panoramic Radiograph
After — Panoramic RadiographMeasurements
| Measure | Norm | Pre | Post |
|---|---|---|---|
| SNA | 82 | 80 | 80 |
| SNB | 80 | 77 | 77 |
| ANB | 2 | 3 | 3 |
| Wits | 0 | 0 | -2 |
| SN-MP | 32 | 33 | 31 |
| U1-SN | 102 | 104 | 103 |
| L1-MP | 90 | 105 | 96 |
| Overjet (mm) | 2–3 | 4 | 2 |
| Overbite (mm) | 2–3 | 2 | 2 |
Treatment
Objectives. Correct the overbite, bring the impacted canine into its proper position, level and align both arches, and maintain tooth K as long as possible, with future implant replacement if needed.
Plan. Begin with an upper bite-plate expander to open the deep bite and expand the maxilla. Because #27 was horizontally impacted near the apices of #25 and #26, conventional orthodontic traction was considered high-risk and unpredictable. The primary canine was removed, a recipient site was surgically prepared, and #27 was carefully transplanted/uprighted into a more favorable position while preserving the periodontal ligament. The canine was stabilized during initial healing, then orthodontic movement was started once adequate periodontal healing and stability were confirmed, typically after several weeks to a few months. Invisalign Teen was then used to level and align both arches, guide the transplanted canine into its final position, correct the overbite, and finish the occlusion while maintaining tooth K as long as possible.
Appliances and materials
- Bite plane Hawley retainer with expander screw
- Invisalign
Progress records
Outcome
The outcome was remarkable. The impacted canine was extracted , a new recipient socket was surgically created after removal of the primary canine, and the permanent canine was autotransplanted into its new position. This can only be done if the apex of the tooth is not closed. The tooth healed without ankylosis and was successfully moved orthodontically with Invisalign. There was no evidence of internal or external root resorption involving the transplanted canine or adjacent teeth. The deep bite was corrected, the dental midlines were coordinated, and Class I molar and canine relationships were achieved. Tooth K was retained on the left side and can be maintained as long as possible, with implant replacement considered in the future if needed. The final occlusion is well aligned, functional, and stable.
Retention
- Fixed U2-2 permanent retainer
- Fixed 3-3 retainer with pontic
- Invisalign Vivera retainers to be worn at night
References
Case reports are shared with patient authorisation. Individual results vary.