Canine Exposure

When should canine exposure be done?
What is the technique?
Anesthesia options
Recovery
Orthodontic eruption

When should canine exposure be done?
Canine exposure is generally performed on patients between the ages of 11 to 14. The canine is suspected to be impacted when it has not erupted as expected, and the primary canine is still in place. The exposure may be done once orthodontic treatment has been initiated and adequate space for the canine has been created.

What is the technique?
The exposure of the impacted canine is done either through a labial or palatal approach. If labial, the flap may require apical repositioning with a band of keratinized gingiva. Following gingival and crestal incisions, a flap is raised to expose the region of the impacted tooth. Any bone covering the crown is carefully removed. The tooth is etched, and a gold bracket/chain is attached to the crown with special adhesives. The chain is then stabilized to the orthodontic wire with a suture to give easy access to the orthodontist. The tooth is slightly subluxated and flap is closed.

Anesthesia options
Exposure of impacted canine is a difficult procedure, and IV sedation is the anesthesia of choice. Nitrous oxide sedation may be considered for less impacted canines.

Recovery
Pain: The level and duration of pain generally depends upon the complexity of the surgery, the technique, and the child’s tolerance. Most patients complain very little of pain after the exposure procedure and do not require significant pain medications. Ibuprofen (Advil) or Acetaminophen (Tylenol) are certainly adequate for relief of most types of discomfort, and may be necessary for one to two days. Very rarely do patients need a stronger medication such as Tylenol with Codeine.
Swelling: No swelling is expected with most exposure procedures but it is certainly possible. Any swelling resolves in seven to 10 days.
Diet: Upon arrival home, patients may have water, juices, soups, purees, shakes, and very soft foods. A soft diet is recommended for up to three to five days. No hard, crispy, or very spicy foods should be eaten during this period. The general rule is, if they have to chew it, it’s probably too hard. After five to seven days, patients may gradually return to normal foods.
Activity: Parents should make sure that their children get plenty of rest on the day of the procedure. Some children feel quite well even on the day of extraction and can resume gentle activities. If IV sedation was given, it’s best to rest on the day of surgery and resume some activities the following day. No sports for two to three days.

Orthodontic eruption
The orthodontic eruption can be started within seven to 10 days after exposure. Elastic ligatures are often used for this purpose. Usually, the elastic ligatures are replaced once a month and monitored closely with both clinical examination and X-ray follow-up.