Impacted Canine Treatment in Kent and Sammamish
Reviewed and approved by Dr. Cameron Freelove, DDS, MS · Last updated
What Is an Impacted Canine?
An impacted canine is an upper or lower eye tooth that fails to erupt into its normal position in the dental arch. The tooth is present in the jaw, but it is blocked, angled wrong, or stuck under bone or gum tissue and cannot come in on its own.
Canines are usually the last front teeth to erupt, typically between ages 11 and 13. Because of that late timing, a canine has more opportunity to drift off course or get trapped behind other teeth before it is due to appear.
Impaction is often first noticed when a baby canine has not fallen out on schedule, when the adult tooth is missing from the arch well past the age it should have erupted, or on an X-ray or 3D scan taken during a routine evaluation.
Why Canine Teeth Are Worth Saving
Canine teeth sit at the corners of the mouth, where the arch curves from the front teeth to the back teeth. They carry a disproportionate amount of biting and chewing force and act as a guide for how the rest of the teeth come together.
Because of that position and root shape, canines tend to be some of the strongest and most stable teeth in the mouth over a lifetime. Losing one changes the bite, the smile line, and the support for neighboring teeth.
- They guide the jaw’s side-to-side movement during chewing.
- They anchor the corner of the smile, supporting the lips and cheeks.
- Their long, strong roots make them well suited to lasting a lifetime when they erupt normally or are guided into place.
Saving the natural canine, when possible, is generally preferred over removing it and relying on another tooth to take its place.
The Freelove Approach to Impacted Canines
When clinically indicated, the CBCT scan shows an impacted canine in three dimensions: its exact position, its angle, and how close it sits to neighboring roots. From that scan Dr. Freelove plans the path: guided eruption where creating space is enough, or a coordinated exposure with an oral surgeon followed by orthodontic traction that he directs personally.
Expose-and-Bond vs. Premolar Substitution
There are two general paths for treating an impacted canine, and the right one depends on the tooth’s position, angle, and how close it sits to the roots of neighboring teeth.
Expose-and-bond is the preferred route whenever the impacted canine is healthy and positioned so it can realistically be guided into the arch. An oral surgeon exposes the tooth surgically and bonds a small attachment to it. Braces or a fixed appliance then apply light, steady traction to pull the tooth into its proper position over time.
Premolar substitution is considered when the canine cannot be saved, for example if it is severely displaced, ankylosed (fused to bone), or resorbing the roots of nearby teeth. In this route, the impacted canine is removed and a nearby premolar is orthodontically moved into the canine’s position, then reshaped to blend in with the smile.
Both routes are legitimate treatment plans. The decision comes down to what a careful evaluation of the tooth’s exact position shows, not a default preference.
Early Detection: The Age 9–10 Window
An orthodontic evaluation around ages 9 to 10 is the window when an impacted or poorly positioned canine is most catchable while there is still time to influence its path.
At this age, the adult canine is still developing under the gum and has not yet fully committed to an errant path. If a retained baby canine is holding up the eruption, removing that baby tooth can be enough on its own to let the adult canine self-correct and erupt into place.
Waiting past this window narrows the options. Once the canine has fully diverted off course or the roots of neighboring teeth are involved, interceptive steps like baby tooth removal are less likely to work, and surgical exposure becomes the more likely path.
What Happens If an Impacted Canine Is Not Treated
An impacted canine does not resolve itself. Left alone, it can continue to shift and can gradually damage nearby structures.
- It can push against and resorb the roots of neighboring teeth, threatening those teeth.
- It can form a cyst around the crown of the unerupted tooth, which can damage bone and nearby teeth over time.
- The bite and the arrangement of surrounding teeth can shift as space meant for the canine is not filled correctly.
- The longer it stays impacted, the more limited and involved treatment tends to become.
Early evaluation gives more treatment options and typically a simpler path than waiting until problems develop.
The Impacted Canine Treatment Process at Freelove
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CBCT Localization
3D imaging determines the exact position, angulation, depth, and relationship to adjacent roots. This guides the surgical approach and the direction of orthodontic traction.
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Create Space
Braces are placed and the teeth are aligned to create a gap in the arch where the canine belongs. If the arch is narrow, palatal expansion may be needed first. The baby canine is extracted if still present.
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Surgical Exposure
An oral surgeon lifts the gum tissue, removes any overlying bone, and bonds an orthodontic bracket with a small chain onto the impacted canine. Closed technique (gum replaced) or open technique (gum left open) is chosen based on the tooth’s position. Takes approximately 1 hour under local anesthesia.
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Orthodontic Traction
Dr. Freelove uses the chain to apply light, slow traction, gradually guiding the canine through the bone and into its correct position over 6–12 months. Force must be light to avoid ankylosis (tooth fusing to bone) or root resorption.
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Final Alignment
Once the canine has erupted into the arch, comprehensive braces fine-tune its position, establish proper canine guidance, and align the rest of the teeth. Total treatment: 18–30 months.
Why Dr. Freelove Handles Impacted Canines Carefully
At Freelove Orthodontics & Smile Design, an iCat 3D CBCT scan is complimentary when clinically indicated at the consultation. For an impacted canine, that scan shows the tooth’s exact three-dimensional position relative to the roots of neighboring teeth, not just a flat, two-dimensional view.
That level of detail lets Dr. Freelove see precisely how close the impacted canine sits to adjacent roots and plan the safest path to bring it into the arch, rather than guessing from a standard X-ray.
When surgical exposure is needed, Dr. Freelove coordinates with an oral surgeon for that step and shares the 3D records directly. Dr. Freelove personally plans and runs the orthodontic guidance himself, from the initial evaluation through the traction phase that brings the tooth into place.
Treatment Timeline
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Screening & imaging
1 visit
Panorex, CBCT 3D localization
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Interceptive (ages 10 and under)
6–12 months
Baby canine extraction, monitor eruption
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Space creation
4–8 months
Braces, expansion is often indicated
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Surgical exposure
1 day procedure
Oral surgeon exposes and bonds bracket
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Traction + alignment
3-6 months
Light traction to guide canine into arch
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Detailing & retention
3–12 months
Establish canine guidance, retainers
What to Expect at Your Consultation
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Digital intake
Dental history, presence of baby canines, any noticed asymmetry.
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Comprehensive records
Digital scan, clinical photos, panoramic x-ray, and a CBCT when indicated for 3D localization.
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Diagnosis with Dr. Freelove
Canine position, angulation, impact on adjacent teeth.
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Decision: save vs. substitute
Honest discussion of both paths with risks and timelines.
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Exact pricing
Including oral surgeon coordination and insurance pre-authorization.
Treatment Examples
See more impacted canine cases in our treated cases gallery.
How Much Does Impacted Canine Treatment Cost?
Comprehensive braces (includes canine management): from $5,000
Clear ceramic braces: from $5,000
Surgical exposure: separate oral surgeon fee, typically $800–$1,500 per tooth
The practice coordinates directly with the surgeon for scheduling and insurance pre-authorization. Most dental insurance covers both the orthodontic treatment and the surgical exposure when medical necessity is documented (impacted tooth, risk of root resorption).
Insurance & Financing
Freelove Orthodontics accepts all PPO orthodontic insurance plans and files every claim directly as a courtesy. Being out-of-network with a particular plan does not mean treatment is out-of-pocket. A plan’s lifetime maximum usually pays out the same whether the practice is in-network or out-of-network.
Washington Apple Health (Medicaid) is accepted when orthodontic benefits apply, which requires a medical-necessity determination. HMO plans other than DeltaCare are not accepted.
- In-house financing: 0% financing options, no credit check, starting at $300 down and $199 a month.
- CareCredit: $0 down for approved credit, with a 0% promotional period (interest and credit check apply after that period).
- Paying in full receives a 5% discount.
- HSA and FSA funds are accepted.
Every case includes written pricing before leaving the free consultation, so families know the cost before deciding on treatment.
Common Appliances Used at Freelove
Treating an impacted canine typically calls on a small set of appliances, chosen based on how the tooth is positioned once it has been exposed.
- Braces are the workhorse for this condition, using light, steady traction on a bonded attachment to guide an exposed canine into the arch.
- TADs (temporary anchorage devices) are small mini-screws placed in-office that provide extra anchorage for pulling a stubborn or deeply impacted canine into position.
- Clear aligners are used where suitable, for cases where the canine’s position and the rest of the treatment plan allow for aligner-based movement instead of braces.
Frequently Asked Questions About Impacted Canines
How do I know if my child has an impacted canine?
Check for asymmetric canine bulge, feel the palate near the gumline on both sides. If one side has a bump and the other doesn’t, imaging is warranted. Also: baby canine still present after age 13, visible gap, or asymmetry between left and right. CBCT at age 7–10 can identify ectopic canines early.
What happens if an impacted canine is not treated?
Root resorption of adjacent teeth (lateral incisor most at risk, silent, no symptoms until damage is severe), dentigerous cyst formation, eventual loss of the baby canine leaving a gap, and progressive arch collapse.
Can an impacted canine erupt on its own?
If caught early, extracting the baby canine removes the obstruction and allows self-correction in 62–78% of palatal cases. Once fully impacted, surgical exposure and orthodontic traction are needed.
What is the expose and bond procedure?
Oral surgeon lifts gum tissue, removes overlying bone, bonds a bracket + chain onto the impacted canine. Approximately 1 hour under local anesthesia. Orthodontist then uses the chain to guide the tooth into position over 6–12 months.
Is the surgery painful?
Done under local anesthesia with sedation available. Post-op discomfort is mild to moderate, generally less than wisdom tooth extraction. OTC pain medication for 2–3 days. Soft diet for one week.
How long does the entire treatment take?
18–30 months depending on canine position. Space creation: 4–8 months. Surgical exposure: 1 day. Traction and alignment: 3-6 months.
When is extraction the better option?
When the canine is in an extreme position, is ankylosed (fused to bone), or in older patients where guided eruption has a poor prognosis. Depending on the patient’s occlusion and esthetic factors, the premolar may be substituted for the canine, or patient’s occlusion will be set up for addition of implant to replace the missing tooth.
Related Conditions
Concerned About an Impacted Canine?
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