**3.1 Background**

Canines are among the most commonly impacted teeth after the third molar teeth. Different causes have been suggested and investigated in literature [9]. The impacted canines need to be either exposed or removed to avoid some possible complications. Untreated canines may cause tooth malalignment, root resorption of adjacent teeth, infections, and cystic changes.

The location of an impacted canine will determine the access for surgical exposure or removal. About one-third of the impacted maxillary canines are positioned labially or within the alveolus, while two-thirds are located palatally [10]. Kokich [11, 12] suggested that the following four criteria related to tooth position within the alveolar bone housing need to be carefully evaluated before exposing the impacted canine:


#### **3.2 Labially impacted canine techniques**

Labial canine impaction is usually difficult to approach because aesthetic outcomes of final soft-tissue healing are a challenge. An inappropriate surgical technique or flap design may lead to compromised aesthetic results [12]. During the process of uncovering a labially impacted maxillary canine, mucogingival problems, such as an immersed clinical crown, limited keratinized gingiva, gingival recession, and scarring, may occur if an inappropriate surgical intervention is employed [13]. In addition, the vertical and horizontal locations of the impacted canine also greatly affect orthodontic tooth movements and soft-tissue responses. Therefore, it is

Limitations

• Pain

**198**

**Figure 3.**

**Figure 2.**

*Oral Diseases*

*Triangular flap for the removal of the third molar.*

• Swelling and trismus

surgery of the third molar [8]

*Modified triangular flap for removal of the third molar.*

• No significant difference in postoperative complications between the lingually based triangular flap and the traditional buccally based triangular flap after

#### **Figure 4.**

*Window excision at the labial soft tissue opposite to the crown of the impacted upper canine.*

critical to make the right decision about the choice of a proper surgical technique to expose labially impacted teeth.

The proposed flap techniques include the window excision of the soft tissue (**Figure 4**), apically positioned flap, closed eruption technique, and sequential approach.
