Exposure Of Impacted Canine With Apically Positioned Flap

The apically repositioned flap(ARF) technique facilitates impacted tooth eruption by surgically repositioning gingival tissue to prevent crown re-coverage while preserving keratinized gingiva. This method combines flap design with orthodontic traction. An 11-year-old systemically healthy male undergoing orthodontic treatment presented with impacted teeth 11,13,21-23 after failed spontaneous eruption. Intraoral examination revealed the labial gingiva exhibited palpable crown contours of teeth 13 and 23. CBCT revealed lingually impacted teeth 11,21 (tooth 11 had a 90°apical bend) with near-closed apices, while 13,23 were displaced mesiolabially over 12,22 crowns without alveolar bone coverage. Surgical intervention involved horizontal incisions at 13,23’s incisal edges in keratinized tissue, vertical releasing incisions, reflection of a full-thickness flap exposing two-thirds of the crowns, and partial-thickness dissection at the alveolar crest, with the trapezoidal flap apically repositioned and sutured. Orthodontic attachments bonding for traction, follow-up showed aligned teeth with stable keratinized gingiva and no recession. This case highlights that utilizing an apically repositioned flap effectively exposed impacted tooth crowns while preserving attached gingival width post-eruption. One year post-surgery, the treated teeth maintained stable keratinized tissue dimensions and gingival contours without recession during orthodontic alignment, demonstrating the effectiveness of this method. Considering the advantages of maintaining gingival health and aesthetic results, this surgical technique, combined with orthodontic treatment, yields satisfactory results for shallowly positioned impacted teeth (subgingival or superficially osseous), such as impacted canines.