Ectopic Canine Management — ORE Part 1 MCQ

Correct answer: E — Surgical exposure of the canine and orthodontic traction to align it into the arch

In a 14-year-old with an ectopic maxillary canine in the buccal sulcus and severe crowding, the gold-standard approach is combined surgical-orthodontic management. Surgical exposure uncovers the impacted tooth, allowing attachment of an orthodontic device for controlled traction and alignment into the arch. This preserves the canine—a critical cornerstone tooth—and restores proper arch form and function. Space must be created or maintained through crowding relief and fixed appliances; the patient must be motivated and have good dental health. Option A (extraction) is reserved only when surgical-orthodontic management is contraindicated (e.g., ankylosed tooth, severe malposition, patient refusal). Option B (acceptance) is inappropriate at this age. Option D (extraction without exposure) leaves the tooth impacted and will not resolve the malocclusion. Option C (waiting) is ineffective at age 14 with ectopic positioning high in the sulcus; the eruption window has effectively closed.

Reference: Royal College of Surgeons of England, Faculty of Dental Surgery. Management of the Palatally Ectopic Maxillary Canine (Revised 2022/2023). https://www.rcseng.ac.uk/-/media/files/rcs/fds/guidelines/2management-of-the-palatally-ectopic-maxillary-canine--revised-with-edits-25-jan-2023.pdf