ORIGINAL RESEARCH

Prevalence of Ectopic Canine in Different Sagittal

and Vertical Skeletal Patterns
Bhagabati Prasad Dash1, Pavithra K Ramanna2, George Sam3, Prasanth Prathapan Santhakumari4,
Mithun K Naik5, Ankita Das6

A b s t r ac t
Aim: The present investigation aims to find out the prevalence of ectopic canines among skeletal class I, II, and III malocclusions and to evaluate
its variability among different genders and their growth patterns.
Material and methods: The study sample included orthopantomograms (OPGs), lateral skull views, and study models of 999 patients collected
from departmental archives. Among the selected samples, 258 were males and 738 were females. They were divided into skeletal class I, II, and III
malocclusions sagittally and hypodivergent, normodivergent, and hyperdivergent groups according to their angle formed between point A-Nasion –
point B (ANB) and angle formed between the Sella-Nasion (SN) plane and Gonion (Go) – Gnathion (Gn) plane (SnGoGn) values respectively.
Results: Of the 999 samples, 738 (73.9%) were female and 260 (25.8%) were male patients. When compared to men, females had a higher
proportion of ectopic canines. An estimated 62.3% of skeletal class I, 29.1% of skeletal class II, and 8.6% of skeletal class III cases were found
to have ectopic canines. An estimated 720 (72.1%) patients were found to have maxillary ectopic canines and out of the available sample, 474
patients have horizontal growth patterns, 335 have average growth patterns and 190 patients have vertical growth patterns. Labial impaction
was the commonest (65.4%) followed by palatal (24.8%). Bilateral impaction was comparatively more (51.1%) than unilateral impaction (48.2%).
Maxilla was more prevalent (72.1%) as compared to the mandible (16.3%) and for both the arches it was (11.6%). Ectopic canines were identified
in a total of 62.3% of cases with skeletal class I, 29.1% of cases with skeletal class II, and 8.6% of cases with skeletal class III.
Conclusion: The bilateral ectopic canine was mostly seen in skeletal class I and class III malocclusions, whereas, a unilateral presentation was
mostly seen in skeletal class II malocclusions.
Clinical significance: Knowing the likelihood of a maxillary canine erupting ectopically will aid clinicians in starting with interceptive therapy
since this condition necessitates complex orthodontic mechanics.
Keywords: Ectopic canine, Growth pattern, Malocclusion, Prevalence.
The Journal of Contemporary Dental Practice (2023): 10.5005/jp-journals-10024-3470

Introduction 1
Department of Orthodontics, Kalinga Institute of Dental Sciences, KIIT
Ectopically erupting canine refers to the intraosseous abnormal (Deemed to be University), Bhubaneswar, Odisha, India
position of the canine prior to its anticipated eruption period. 2
Department of Prosthodontics, Crown and Bridge and Implantology,
It can cause root resorption of the adjacent teeth.1 In addition Vydehi Institute of Dental Sciences and Research Hospital, Bengaluru,
to being long and tortuous, the maxillary permanent canine’s Karnataka, India
eruption path also leans slightly buccal in reference to the dental 3
Department of Orthodontics, Al-Tabeeb Specialist Centre, Muscat, Oman
arch. Additionally, it emerges after the first premolar and the lateral 4
Department of Orthodontics, Indira Gandhi Institute of Dental
incisor.2 According to Coulter and Richardson, the maxillary canine Sciences, Kothamangalam, Kerala, India
travels 22 mm before it erupts in the oral cavity.3 5
Department of Orthodontics, AJ Institute of Dental Sciences,
Ectopic eruption of the maxillary permanent canine is explained Mangaluru, Karnataka, India
by genetic and guidance theories. According to the Guidance 6
Department of Orthodontics, Guru Nanak Dental College, Kolkata,
theory, the lateral incisor guides the erupting canine in its proper West Bengal, India
place in the dental arch. When this function is impaired due to
Corresponding Author: Ankita Das, Department of Orthodontics,
lateral incisor aplasia or hypoplasia, the canine crown advances Guru Nanak Dental College, Kolkata, West Bengal, India, Phone:
palatally.4 The Genetic theory states that genetics governs the +91 7751020383, e-mail: [email protected]
palatal displacement of the canines.5 How to cite this article: Dash BP, Ramanna PK, Sam G, et al. Prevalence
The labial displacements of maxillary canines are generally due of Ectopic Canine in Different Sagittal and Vertical Skeletal Patterns.
to inadequate space in the maxillary dental arch. Jacoby found that J Contemp Dent Pract 2023;24(4):268–273.
83% of archers had a labial displacement of the maxillary canines, Source of support: Nil
which indicated a lack of space in the dental arch.6 According to
Conflict of interest: None
Thilander and Jakobsson, dental crowding frequently caused the
canine to move in a labial path, delaying its eruption but rarely
resulting in a persistent impaction.7 to Sacerdoti and Baccetti, palatally displaced canines and
Despite comprehensive analysis regarding ectopic placed vertical craniofacial features are significantly associated, with the
maxillary canines, few studies have evaluated the relationship prevalence of hypo divergent cases in PDC subjects being three
between the displaced canines and craniofacial traits. According times higher than in control subjects.8 According to Larsen et al.,

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 Prevalence of Ectopic Canines among Various Growth Patterns

Table 1: Prevalence of data in the present study

Prevalence Percent Chi-Square p-value
Gender Male 258 25.8 231.325 <0.0001*
Female 738 73.9
Total 996 99.7
Growth pattern Hypodivergent 474 47.4 121.123 <0.0001*
Normodivergent 335 33.5
Hyperdivergent 190 19.0
Total 999 100.0
Malocclusion Class I 622 62.3 439.321 <0.0001*
Class II 291 29.1
Class III 86   8.6
Total 999 100.0
Impacted Labially 653 65.4 182.048 <0.0001*
Palatally 248 24.8
Total 901 90.2
Ectopic Unilateral 482 48.2   0.790 0.374
Bilateral 510 51.1
Total 992 99.3
Site Maxilla 720 72.1 677.952 <0.0001*
Mandible 163 16.3
Both 116 11.6
Total 999 100.0
*Statistically significant

in people with ectopic canines, the area of the maxillary complex Using the Lateral cephalograms the patients were divided
was more transversally but insufficient vertically and sagitally.9 into Sagittal and vertical skeletal relationships. Sagittaly skeletal
Knowing the likelihood of a maxillary canine erupting relationships were defined as Skeletal class I [angle formed between
ectopically will aid clinicians in starting with interceptive therapy point A-Nasion – point B (ANB) = 0–4°], Class II (ANB >4°), and
since this condition necessitates complex orthodontic mechanics. Class III (ANB <0°).10 Vertical skeletal relationships were defined
Also, the chance of root resorption of the adjacent teeth reduces. as normodivergent [angle formed between the Sella-Nasion (SN)
Hence, the aim of the present study was to find out the prevalence plane and Gonion (Go) – Gnathion (Gn) plane (SnGoGn) = 27–37°],
of ectopic canines among skeletal class I, II, and III malocclusions hypodivergent (SnGoGn <27°) and hyperdivergent (SnGoGn >37°).10
and to evaluate their variability among different genders and Diagnosis of impaction, unilateral or bilateral, was based on the
their growth patterns. Secondarily, the gender difference was also OPG. The position of the impacted canine was based on the clinical
evaluated. examination to check for the presence of a “canine bulge” of the
buccal or palatal side mentioned in the clinical records. In the case
M at e r ia l and Methods of ectopic canine, their positions in both arches were confirmed
from the study models.
The research was carried out at the Kalinga Institute of Dental
Sciences in Bhubaneswar’s Department of Orthodontics and Statistical Analysis
Dentofacial Orthopedics. Pre-treatment orthopantomograms Data was entered using MS Excel 2016. The data were analyzed using
(OPG), Lateral Cephalograms, and study models of 999 patients SPSS Statistical software (version 25). The raw data was categorized,
(male = 260; female = 738) who reported to the Department and descriptive statistics were represented in terms of percentages
of Orthodontics and Dentofacial Orthopedics were observed and prevalence. Inferential statistics were computed with Mann
retrospectively. The patients’ age range was established at 15–35 Whitney U-Test.
years old and the time period of the study was January 2020–2023.
Patients had to fulfill the following inclusion criteria in order
to be included in the study the presence of lateral skull view and R e s u lts
panoramic dental radiographs in acceptable quality, presence of Table 1 shows that there is a comparatively higher prevalence
ectopic or impacted maxillary or mandibular canine, presence of of ectopic canine among females (73.9%) as compared to males
pre-treatment study models and no prior orthodontic treatment (25.8%). The majority of the ectopic canines showed hypodivergent
history. Patients with impacted incisors, cleft of the orofacial growth patterns (47.4%), followed by normodivergent (33.5%) and
region, syndromes, supernumerary teeth, odontomes, cysts, and then hyperdivergent (19.0%). Skeletal class I malocclusion was the
any history of traumatic injury to the dentition were excluded from commonest malocclusion observed (62.3%), followed by class II
the study. (29.1%) and class III (8.6%). Labial impaction was the commonest

The Journal of Contemporary Dental Practice, Volume 24 Issue 4 (April 2023) 269
 Prevalence of Ectopic Canines among Various Growth Patterns

Fig. 1: Graphical representation of the distribution of the data

Table 2: Prevalence of data based on gender

Male Female
Prevalence Percent Prevalence Percent Z-score p-value
Growth pattern Hypodivergent 109 42.2 365 49.5 –4.565 <0.0001*
Normodivergent 57 22.1 275 37.3
Hyperdivergent 92 35.7 98 13.3
Total 258 100.0 738 100.0
Malocclusion Class I 141 54.7 478 64.8 –2.954 0.003*
Class II 88 34.1 203 27.5
Class III 29 11.2 57   7.7
Total 258 100.0 738 100.0
Impacted Labially 140 54.3 510 69.1 –1.991 0.046*
Palatally 69 26.7 179 24.3
Total 209 81.0 689 93.4
Ectopic Unilateral 118 45.7 364 49.3 –1.121 0.262
Bilateral 140 54.3 367 49.7
Total 258 100.0 731 99.1
Maxilla 186 72.1 531 72.0 –0.583 0.560
Mandible 28 10.9 135 18.3
Both 44 17.1 72   9.8
Site Total 258 100.0 738 100.0
*Statistically significant

(65.4%) followed by palatal (24.8%). Bilateral impaction was no statistically significant difference noted for the site of occurrence.
comparatively more (51.1%) than unilateral impaction (48.2%). Maxilla The same has been represented in Figure 2.
was more prevalent (72.1%) as compared to the mandible (16.3%) Table 3 states the distribution of the ectopic canines based on
and for both sites it was (11.6%). A statistically significant difference the growth pattern, malocclusion type, impacted nature, and site.
was noted for gender distribution, growth pattern, malocclusion, the It was observed that unilateral ectopic canine was noted more
position of impacted, and the jaw involved. There was no statistically in the case of a hypodivergent growth pattern, followed by a
significant difference observed for the ectopic type category. The normodivergent and hyperdivergent growth patterns. There was
same has been graphically represented in Figure 1. the more unilateral ectopic presentation for the hypodivergent and
Table 2 When a comparison was made between the gender normodivergent growth pattern while bilateral ectopic was more
categories, due to an increased prevalence among females, females for hyperdivergent growth pattern.
showed an increased number in all the growth patterns, skeletal Bilateral ectopic was more for skeletal class I and III malocclusion;
class I malocclusion, bilaterally and labially impacted canines, and in while unilateral ectopic was more common for skeletal class II
the maxillary site. A statistically significant difference was noted for malocclusion. Labially impacted canines were more unilateral as
the growth pattern, malocclusion, and impacted canines. There was compared to bilateral canines being more palatally placed. Maxilla was

270 The Journal of Contemporary Dental Practice, Volume 24 Issue 4 (April 2023)
 Prevalence of Ectopic Canines among Various Growth Patterns

Fig. 2: Graphical representation of gender-wise distribution of the data

Table 3: Prevalence of ectopic canines based on the growth pattern, malocclusion, position in the arch and between the arches
Ectopic
Unilateral Bilateral
Prevalence Percent Prevalence Percent Z-score p-value
Growth pattern Horizontal 244 50.6 223 43.7 –3.120 0.002*
Average 169 35.1 166 32.5
Vertical 69 14.3 121 23.7
Total 482 100.0 510 100.0
Malocclusion Class I 282 58.5 333 65.3 –1.005 0.315
Class II 178 36.9 113 22.2
Class III 22   4.6 64 12.5
Total 482 100.0 510 100.0
Impacted Labially 337 69.9 309 60.6 –2.090 0.037*
Palatally 110 22.8 138 27.1
Total 447 92.7 447 87.6
Site Maxilla 324 67.2 396 77.6 –3.389 0.001*
Mandible 101 21.0 62 12.2
Both 57 11.8 52 10.2
Total 482 100.0 510 100.0
*Statistically significant

a common site compared to the mandible in cases of ectopic canine The prevalence of ectopic canine was seen more in females
location. The same has been graphically represented in Figures 3 to 6. compared to males. It might be because more females visit
orthodontic clinics on a regular basis. This agrees with the study
done by Anand et al.11 According to Rohrer et al., it was hypothesized
Discussion that the smaller female cranium causes the jaws and facial skeleton
This retrospective study was done in the Department of to shrink, contributing to the greater incidence in females, raising
Orthodontics and Dentofacial Orthopedics, Kalinga Institute a maxillary canine’s likelihood to get impacted or ectopically
of Dental Sciences. The aim of the study was to evaluate the placed.12 Alternately, it might be associated with the more frequent
prevalence of ectopically placed canines in different sagittal and occurrence of impaction of palatally displaced canines and missing
vertical skeletal patterns. As a secondary finding, the prevalence and peg-shaped lateral incisors in females.13
of ectopic canine in males and females was also investigated. In our study, the prevalence of labial impaction was more
Depending on their ANB levels, the samples were classified as compared to palatal impaction like the research conducted by
skeletal class I, class II, and class III. Vertically they were divided as Anand et al. who did an investigation on the Chinese population and
hyperdivergent, normodivergent, and hypodivergent according concluded that compared to Asians, Caucasians may be anticipated
to their SnGoGn values. to have palatally impacted canines 1.5 times more commonly.11

The Journal of Contemporary Dental Practice, Volume 24 Issue 4 (April 2023) 271
 Prevalence of Ectopic Canines among Various Growth Patterns

Fig. 3: Graphical representation of growth pattern distribution among Fig. 6: Graphical representation of the occurrence of unilateral and
the unilateral and bilateral ectopic presentation of canine bilateral ectopic canines in the maxillary and mandibular arches

Unlike these studies, Mai Lin et al.14 Herrera-Atoche et al.15 and

Ericson and Kurol15 found canines to be palatally impacted more
frequently than labial.
The probability of bilateral impaction is more than unilateral
impaction in this study. Unlike our results, Janani A et al. concluded
that the prevalence of unilateral ectopic canine was more.16
However, the study was performed on Iranian population. Similarly,
Nagani et al.17 and Rahamneh et al.18 and Lovgren at al.19 reported
that the occurrence of unilateral impacted canine was more
frequent than bilateral impactions. Whereas, Anoush et al.,20 found
no significant difference in the occurrence of bilateral and unilateral
impacted canines.
The results from our study stated that the prevalence of ectopic
canine in the maxilla is more than in the mandible. Batwa et al.21
found an association between the presence of ectopic mandibular
canine with ectopic maxillary canine. He asserts that there is a link
between maxillary and mandibular ectopic canines and that the
Fig. 4: Graphical representation of the prevalence of unilateral and likelihood of having an ectopic mandibular canine is greater when
bilateral ectopic canines in different sagittal skeletal malocclusions there are ectopic maxillary canines.
Characteristics expressing sagittal and vertical skeletal
patterns were referred for the assessment of skeletal craniofacial
morphology. The prevalence of bilateral ectopically positioned
canine was found more in the case of skeletal class I and III
malocclusions whereas unilateral ectopic canine was more common
in skeletal class II malocclusion. According to Larsen et al.9 the
maxillary complex is shorter sagitally in patients with ectopically
placed maxillary canine. This may be due to shorter maxillary length
and hence crowding in the maxillary arch. Pavlina et al. concluded
that both the prognathic maxilla and the prevalence of skeletal
class I abnormalities were considerably higher in the palatally
displaced canine patients, whereas, skeletal class III was associated
with buccally displaced canine.22
Comparing the vertical skeletal patterns, the prevalence of
ectopic canine was higher in horizontal growers followed by
average and vertical growers. The study done by Bharathi et al.23 on
the Dravidian population reported that the prevalence of ectopic
canine was more in patients with vertical growth patterns. This
was the same as the research was done by Manuela et al.24 who
Fig. 5: Graphical representation of the prevalence of unilateral and concluded that buccally displaced canine was more frequent in
bilateral impacted canines positioned labially and palatally hyper divergent growth patterns. Whereas, Pavlina et al.22 found

272 The Journal of Contemporary Dental Practice, Volume 24 Issue 4 (April 2023)
 Prevalence of Ectopic Canines among Various Growth Patterns

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