Positional factors affecting the surgical management of impacted permanent mandibular canines.

Objective: To assess which positional factors influence the decision to surgically remove or expose an impacted mandibular canine. Clinical and radiographic assessment are important considerations when treatment planning for the management of impacted mandibular canines.

Design: A cross-sectional study.

Setting: The Royal Surrey County Hospital, Guildford, UK.

Methods: The clinical notes and orthopantomogram radiographs were assessed for all patients aged 21 years or under who underwent surgical management of impacted mandibular canine teeth between 2017 and 2019. The following variables were recorded: angulation, horizontal position, vertical height, overlap of the adjacent tooth and bucco-lingual position of the canine.

Results: From the 67 patients and 77 canines included, surgical extraction was performed for 48 canines (62%) and surgical exposure was performed for 29 canines (38%). Chi-square and multivariable logistic regression revealed canine angulation to the midline, horizontal position of the canine root apex, vertical height of the canine crown and canine overlap of the adjacent tooth to be associated with the decision to remove or expose an impacted permanent mandibular canine ( < 0.001). The bucco-lingual position of the canine did not influence the decision to remove or expose an impacted permanent mandibular canine ( = 0.159).

Conclusion: The decision to expose or remove an impacted mandibular canine is guided by its angulation, horizontal position and vertical position, and by the degree of overlap of the adjacent tooth. However, the bucco-lingual position is not related to the decision to surgically remove or expose an impacted permanent mandibular canine.