Open versus closed surgical exposure of canine teeth that are displaced in the roof of the mouth

Canines in the upper jaw usually erupt in the mouth between the age of 11 to 12 years. In 2% to 3% of the population these teeth fail to erupt into the mouth and become lodged in the roof of the mouth (palate), they are then referred to as 'palatally impacted'. Their impaction can cause damage to the roots of neighbouring teeth and the damage may be so severe that these neighbouring teeth are subsequently lost. The tissue around these impacted canine teeth may undergo cystic change. Also, impaction of these teeth can lead to aesthetic problems.
Management of this problem is both time consuming and expensive and involves surgical exposure (uncovering) followed by fixed braces for 2 to 3 years to bring the canine into its correct position. Two techniques for exposing palatal canines are routinely used in the UK: One method (closed technique) involves surgically uncovering the tooth, gluing an attachment on the exposed tooth and repositioning the palatal flap. Shortly after surgery, an orthodontic brace is used to apply gentle forces to bring the canine into its correct position within the dental arch. The canine moves into position beneath the mucosa. An alternative method (open technique) is to surgically uncover the canine tooth as before, but instead of gluing an attachment on the exposed tooth, removing a window of tissue from around the tooth and placing a dressing (pack) to cover the exposed area. Approximately 10 days later, this pack is removed and the canine is allowed to erupt naturally. Once the tooth has erupted sufficiently for an orthodontic attachment to be glued onto its surface, orthodontic brace treatment is commenced to bring the tooth into line. The canine moves into its correct position above the mucosa.
This review has revealed that currently, there is no evidence to support one surgical technique over the other in terms of dental health, aesthetics, economics and patient factors. Until high quality clinical trials with participants randomly allocated into the two treatment groups are conducted, methods of exposing canines will be left to the personal choice of the surgeon and orthodontist.