Impacted Canines (When Adult Canine Teeth Don't Come In)
What Is an Impacted Canine?
Have you ever noticed that your child's baby canine tooth is still present while other adult teeth have already come in?
Maybe one canine erupted normally, but the other never showed up.
These are often the first signs of an impacted canine.
An impacted canine is a permanent canine tooth that becomes trapped beneath the gums instead of erupting into its normal position.
Canine teeth are some of the most important teeth in the mouth. They help guide the bite, support the lips and smile, and play an important role in long-term oral health.
After wisdom teeth, canine teeth are the second most commonly impacted teeth.
The good news is that orthodontists can often identify potential problems years before the tooth is expected to erupt, allowing treatment to be simpler and more successful.
Why Do Canines Become Impacted?
Most impacted canines occur because the tooth loses its normal eruption path.
Common causes include:
Crowding
Lack of space
Genetics
Abnormal eruption patterns
Missing lateral incisors
Small or undersized lateral incisors ("peg laterals")
Extra teeth
Developmental differences
One of the most important factors is guidance from the lateral incisor.
As the canine develops, it normally follows the root of the lateral incisor into position. When the lateral incisor is small, missing, or developing differently than expected, the canine may lose its way and begin drifting toward the roof of the mouth instead of erupting normally.
Many impacted canines are not caused by anything a parent or child did wrong. In fact, genetics often plays a significant role.
How Does an Impacted Canine Change Over Time?
Impacted Canines in Young Children
Most impacted canines cannot be diagnosed by simply looking inside the mouth.
At this stage, the canine is still developing deep within the jaw.
This is why routine orthodontic evaluations and x-rays are so valuable.
Impacted Canines During the Transition to Adult Teeth
This is when orthodontists often begin identifying early warning signs.
Parents may notice:
A baby canine that is not becoming loose
Crowding in the upper front teeth
Delayed eruption compared to other children
One canine erupting while the other remains missing
This is often the stage when treatment can have the greatest impact.
Impacted Canines in Adolescents
If the canine remains trapped, it becomes less likely to erupt on its own.
Without treatment, impacted canines may:
Remain trapped beneath the gums
Damage neighboring tooth roots
Become more difficult to move
Require surgical intervention
Impacted Canines in Adults
Impacted canines can still be treated in adults, but the prognosis becomes more guarded.
As patients age, impacted teeth become more likely to develop ankylosis, a condition where the tooth becomes fused to the surrounding bone.
When this happens, orthodontic movement can become much more difficult and, in some cases, impossible.
This is one reason early diagnosis is so important.
Will My Child Outgrow an Impacted Canine?
Unfortunately, no.
Once a canine has become significantly displaced from its normal eruption path, it is unlikely to correct itself.
The key is identifying the problem early enough that we can improve the chances of normal eruption and reduce the complexity of treatment.
This is where careful diagnosis becomes incredibly important.
Does an Impacted Canine Need to Be Fixed?
In most cases, yes.
Canine teeth play an important role in both function and appearance.
Without treatment, impacted canines may lead to:
Damage to neighboring tooth roots
Loss of adjacent teeth
Cyst formation
Bite problems
Smile concerns
More complex treatment later in life
The earlier we identify the problem, the more treatment options may be available.
How Do Orthodontists Predict Whether a Canine Will Become Impacted?
Parents are often surprised to learn that orthodontists can frequently identify a potentially impacted canine years before the tooth is expected to erupt.
At Smile Squad, diagnosing impacted canines involves much more than simply looking to see whether a tooth is present or missing.
When evaluating a developing canine, Dr. Martinez carefully considers several factors.
Angulation
The angle of the canine helps us determine whether the tooth is moving toward its proper position or drifting away from its normal eruption path.
Vertical Position
We evaluate how high the canine sits within the jaw relative to the child's age and stage of development.
A canine positioned unusually high in the jaw often requires closer monitoring.
Position Relative to the Lateral Incisor and Midline
One of the most important predictors of future impaction is where the canine is located relative to the root of the lateral incisor and the center of the face.
As the canine moves farther toward the midline, the likelihood of normal eruption often decreases.
Other Findings That Raise Concern
Additional findings that may influence treatment recommendations include:
Enlarged dental follicles
Root resorption of adjacent teeth
Delayed development of lateral incisors
Severe crowding
Lack of eruption space
Taken together, these factors help us determine whether a canine is developing normally or whether intervention may be beneficial.
Why Are X-Rays So Important?
Most impacted canines cannot be diagnosed by looking inside the mouth alone.
Panoramic x-rays are an excellent screening tool and allow us to monitor developing teeth throughout childhood and adolescence.
When additional information is needed, Smile Squad has advanced CBCT imaging available in our office.
A CBCT scan provides a three-dimensional view of the teeth and surrounding structures, allowing us to evaluate:
The exact position of the canine
Root development
Available space
Relationship to neighboring teeth
Root resorption
Dental follicle size
Overall eruption potential
Having CBCT technology available in our office allows us to provide families with detailed information, accurate diagnoses, and personalized treatment recommendations without the need for outside imaging appointments.
When Is the Best Time to Fix an Impacted Canine?
The best time to treat an impacted canine is often before it becomes fully impacted.
This is one of the clearest examples of how early diagnosis can change outcomes.
Many canine problems can be identified years before the tooth would normally erupt.
For younger patients, treatment during the mixed dentition years often provides the greatest opportunity to improve eruption and avoid more complicated treatment later.
As patients get older, treatment often becomes more difficult and less predictable.
The goal is not to treat every child early. The goal is to identify problems early enough to make treatment simpler and more successful.
How Is an Impacted Canine Fixed?
Treatment depends on the patient's age, the position of the canine, and the severity of the impaction.
Observation
Not every ectopically erupting canine requires immediate treatment.
Some patients simply need careful monitoring as the tooth continues to develop.
Mixed Dentition Treatment
For younger patients, treatment often focuses on improving the eruption path of the canine.
This may include:
Rapid Palatal Expansion (RPE)
Extraction of primary canine teeth
Braces
Space creation
The goal is to encourage the canine to erupt naturally whenever possible.
Adolescent Treatment
For adolescents, our first goal is often to create adequate space for the canine.
Once space has been created, we typically monitor the tooth for approximately six months to determine whether it will erupt on its own.
Many canines will begin moving into the correct position once sufficient space is available.
Surgical Exposure and Bonding
If the canine does not begin erupting after space has been created, an expose-and-bond procedure may be recommended.
During this procedure, an oral surgeon uncovers the impacted tooth and places a small orthodontic attachment on it.
The orthodontist can then guide the tooth into its proper position using braces.
Adult Treatment
Impacted canines can often be treated successfully in adults, but treatment tends to be more challenging.
As patients age, the risk of ankylosis increases, making orthodontic movement less predictable.
Every adult impacted canine requires careful evaluation to determine the most appropriate treatment approach.
Signs Parents Should Watch For
You may want to schedule an orthodontic evaluation if you notice:
A baby canine that is still present long after other baby teeth have fallen out
One canine erupting while the other remains missing
Crowding in the upper front teeth
Delayed tooth eruption
A family history of impacted teeth
Missing adult canine teeth
Teeth erupting in unusual positions
Why Early Diagnosis Matters
Few orthodontic problems demonstrate the value of early diagnosis as clearly as impacted canines.
The earlier a developing problem is identified, the more opportunities we have to guide eruption and reduce treatment complexity.
In many cases, identifying a canine problem early may help avoid more invasive procedures later.
The purpose of an early orthodontic evaluation is not to treat every child.
The purpose is to identify concerns, monitor development, and intervene when it provides a meaningful benefit.
The goal is to provide the right treatment at the right time.
Why Families Trust Smile Squad
Diagnosing impacted canines requires experience, advanced imaging, and a deep understanding of dental development.
Dr. Martinez has spent more than a decade treating orthodontic patients and has a special interest in the diagnosis and management of ectopically erupting and impacted canine teeth.
In addition to private practice, Dr. Martinez teaches this subject to orthodontic residents at UNLV as part of his faculty responsibilities. His expertise allows him to identify subtle warning signs years before a canine becomes fully impacted and develop treatment plans designed to maximize the likelihood of successful eruption.
At Smile Squad, our heavy focus on growing patients allows us to identify potential problems early. Combined with our in-house CBCT technology and comprehensive orthodontic evaluations, we are able to provide families with detailed information, accurate diagnoses, and personalized treatment recommendations.
Our goal is simple: identify problems early, create thoughtful treatment plans, and help every patient achieve the healthiest possible outcome.
Frequently Asked Questions About Impacted Canines
What is an impacted canine?
An impacted canine is a permanent canine tooth that becomes trapped beneath the gums instead of erupting normally.
What causes impacted canines?
Common causes include crowding, lack of space, genetics, abnormal eruption patterns, and developmental differences involving nearby teeth.
Can an impacted canine erupt on its own?
Sometimes. If the problem is identified early and adequate space is created, some canines will erupt naturally. Severely impacted canines are less likely to do so.
At what age should impacted canines be evaluated?
Most children should have an orthodontic evaluation around age 7. This allows developing canine teeth to be monitored as they grow.
What is a CBCT scan?
A CBCT scan is a three-dimensional x-ray that provides detailed information about the position of impacted teeth and their relationship to nearby structures.
Why would my child need a CBCT scan?
A CBCT scan may be recommended when additional information is needed to accurately diagnose the position of a canine and develop the best treatment plan.
What is an expose-and-bond procedure?
This procedure involves an oral surgeon uncovering the impacted tooth and placing a small orthodontic attachment on it so the orthodontist can guide it into position.
Can impacted canines damage other teeth?
Yes. In some cases, impacted canines can cause root resorption or damage to neighboring teeth.
Can impacted canines be treated in adults?
Yes, although treatment can be more challenging because impacted teeth are more likely to become fused to the surrounding bone over time.
Concerned About a Missing Canine Tooth?
If your child still has a baby canine, one canine has erupted while the other has not, or you've been told a tooth may be impacted, an orthodontic evaluation can provide answers.
Dr. Martinez and the Smile Squad team have extensive experience diagnosing and treating impacted canines. Together, we'll evaluate your child's growth, eruption patterns, and imaging to determine the best path forward and give that canine the best possible chance of erupting successfully.