Four impacted permanent canines: an unusual case.

Impacted permanent canines in a child, particularly in the maxilla, pose a functional as well as an esthetic concern for the patient and parents alike. Informing the parties involved that all the permanent canines are impacted is, needless to say, a distressful dilemma for the parents and a unique challenge for the orthodontist. The response to the treatment in this case was quite acceptable. All 4 canines were properly aligned with the aid of orthodontic traction and surgical assistance, and now the patient possesses confidence to smile and has enhanced self-esteem. There is no additional cost or burden of prosthesis for the parents, since all 4 impacted canines were successfully positioned, and all are natural and beautiful teeth. The root resorption that occurred may have been the result of the long treatment time or the result of root movement during incisor uprighting, both of which have been associated with this phenomenon. As in many of these cases, proper gingival contours of one of the orthodontically erupted mandibular canines was a problem and may require the service of a periodontist.