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Orthodontics/Exposing canine


Hi I'm 27 years old and have a horizontally impacted canine and still have the corisponding baby tooth. I recently had a few consultations with orthodontists. 2 of them said I would have to have an oral surgeon exposé the canine. And one said he could do everything himself. I do not believe this dr has any credentials for oral surgery.
My question is is it safe to have the orthodontist pull the baby tooth and have him expose the canine? Or does it need to be done by a specialist?

Thanks !


Hi Kara,

What I write here are only my opinions based on very limited information. My comments should not be viewed as a definitive diagnosis or any form of  treatment recommendation.  Indeed, in the ultimate analysis all final decisions, particularly clinical ones, should  only be made by qualified doctors who have had a chance to see you in person and who have had an opportunity to take and analyze proper diagnostic records.

Okay… having said  that…  Kara your  questions focused on the exposure f an adult horizontally impacted canine.  You  wrote: " Hi I'm 27 years old and have a horizontally impacted canine and still have the corisponding baby tooth. "

First of all Kara, I am not sure whether this is an upper or lower horizontally impacted canine. In any case, impacted canines are very difficult cases to manage, and lower horizontally impacted adult canines often are not able to be exposed and brought into proper position. In such cases they are extracted and a dental implant is often considered.

I am going to assume that you have the more common upper impacted canine. If the adult canine is more or less vertically oriented along the crown to root  axis, it may very well erupt on its own given enough space and the removal of the baby canine. If it is inclined or in fact horizontal the situation is more complex. Extracting the baby tooth may not be enough. Often a small bracket and gold chain are attached to the tooth and the canine slowly brought down into place. Whereas the removal of an already loose baby canine can be done by a general dentist or even occasionally by the orthodontist, for situations when a baby tooth extraction is followed by further surgical exposure of the adult impacted adult canine in order to bond on an attachment such as a bracket and chain, then the assistance of an oral surgeon or periodontist should be welcomed. A talented general dentist perhaps can do this also.

I would find it unlikely for the average orthodontist to attempt such surgical skills unless he/she is double trained in oral surgery, periodontics, or has had extensive advanced general dentistry surgical training.

My recommendation would likely be to consider going to one or two board certified orthodontists and getting an opinion. If surgical exposure of the adult canine is needed, I am sure they will give you appropriate advice. I do not have the benefit of any x-rays or other diagnostic records.

Kara, good luck getting this taken care of. I have done many such cases, including bilateral ( left and right )  impacted canines. I have always personally welcomed the help of an oral surgeon or periodontist.  


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Paul Supan, DDS, MA, MPH


First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites and are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.


Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

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BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

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