Background: Maxillary canine impaction is one of the most challenging issues in orthodontics. The best treatment protocol in these cases is still debated. The purpose of this study is to describe the management of maxillary canine impaction in an adult female patient with the “Canine First Technique”. Case Report: A 21-years-old female attended our dental unit seeking orthodontic treatment. Clinical examination revealed a class II relationship, the persistence of both upper deciduous canines. The panoramic X-ray and Cone Beam Computed Tomography showed bilateral palatal permanent canine displacements and close proximity between crowns of impacted canines and roots of lateral incisors. The canines were disimpacted by means of two cantilevers inserted directly in two Temporary Anchorage Devices placed palatally and when canines were near the crest, the fixed orthodontic treatment was started. Results: At the end of the treatment, canine Class I relationships with torque correction of canines, normal overjet and overbite, and good alignment of dental arches were achieved. The radiographic evaluation showed ideal root parallelism and preserved periodontal health in the canine region. Conclusion: The Canine First Technique could provide some advantages compared to conventional approaches in terms of biomechanics, esthetics, oral hygiene, and risk reduction of root resorption of upper lateral incisors.

Palatally impacted canines are usually challenging to treat in terms of both biomechanics and possible side effects. Different therapeutic approaches have been reported with or without the use of temporary anchorage devices, including the canine-first approach. Two groups of patients with palatally impacted canines were compared, observing their canine movement measured on consecutive CBCTs after three months of treatment. In the control group, impacted canines were treated with direct anchorage on miniscrews, and in the test group with indirect anchorage using a miniscrew-supported transpalatal arch. The primary outcome was the canine movement speed; the secondary outcome was the change in the root length of adjacent teeth. The median monthly apex speed was 1.05 mm in the control group (IR [0.74, 1.64]) and 0.72 mm in the test group (IR [0.27, 1.30]). The median monthly cusp displacement was 1.89 mm in the control group (IR [1.04, 2.84]) and 1.08 mm in the test group (IR [0.81, 1.91]). Approximately 50% of teeth adjacent to an impacted canine underwent a negative root length change of less than 1 mm in the majority of cases, but no significant differences were found in root length changes between groups. No statistically significant differences in the reported speeds were found, and no miniscrew failures were observed in either group.