The unilateral maxillary canine impaction is more commonly seen in females than in males, with a prevalence of 1% to 9.7%. The maxillary canines have a long tortuous path of eruption around 22 millimeters below the orbital floor. The maxillary canine is positioned high along the distal side of the apical third of the maxillary lateral incisor root which serves as a guide along which the canine erupts.

Interestingly, the development of the lateral incisor plays a big role in guiding the upper canine into its position. Disturbance with the shape, size, and number of these teeth can contribute to the impaction of the upper canine, especially towards the palatal side.

There are various factors that can lead to impaction of the maxillary canine which include local and systemic factors such as anomalies in tooth size and shape, early loss of deciduous teeth, or cysts, endocrine deficiencies or genetic factors. Researchers have proposed several theories to explain the palatal impaction of canine. Becker et al suggested that canine follow the path guided by neighboring lateral incisor root. Another theory by Peck et al accounts for the genetic factors and other dental anomalies for maxillary canine impaction.

The orthodontic treatment of impacted maxillary canine is complicated, which aims to move teeth in three-dimensional spaces. This can be intricate due to nearby important structures like nerves and sinuses, particularly the large air-filled space in the upper jaw known as the maxillary sinus. Complications of impacted canines can include root resorption of neighboring teeth. There’s also a link between canine impaction and deviation of the nasal septum, the cartilage and bone that separates the nostrils. According to Ellaithy MM et al Nasal septum deviation was significantly greater in the impaction groups compared with the control group (no impaction).

Cone beam computed tomography (CBCT) provides detailed three-dimensional images which is used in the accurate and precise diagnosis and treatment planning of the impacted canine. Overall, dealing with impacted canines involves understanding about the anatomy of the jaw and sinuses, how teeth develop and how these factors interact. With careful diagnosis and treatment planning, orthodontists can help patients overcome these challenges and achieve a healthy smile.