Association Between Bone Density and Maxillary Canine Impaction: A CBCT-Based Study

Background/Objective: Maxillary canine impaction is a frequent orthodontic challenge. Three-dimensional CBCT assessment allows precise evaluation of periradicular bone density, which may play a role in eruption failure. This study aimed to compare bone density (HU) around impacted canines with that of the contralateral erupted tooth and to assess correlations with age and sex. Methods: A total of 26 patients (10 males, 16 females; 13-19 years) with unilateral maxillary canine impaction were examined. Pre-treatment CBCT scans acquired were analyzed. Bone density was measured in HU at three root levels (cervical, middle, apical) and in four regions (buccal, palatal, mesial, distal). Statistical analyses included Student's t-tests, linear regression, and correlation coefficients, with significance set at p < 0.05. Results: Tooth 2.3 was the most frequently impacted (61.5%), with a slight predominance of palatal impactions (53.8%). Bone density was significantly higher around impacted canines than around the contralateral erupted teeth in all regions and levels (p = 0.000), with values increasing from the cervical portion toward the apex. In impacted canines, bone density increased significantly with age, whereas no meaningful differences were found between males and females. Conclusions: Higher bone density surrounding impacted canines supports its potential role in eruption failure. The age-related increase highlights the clinical importance of early diagnosis and timely orthodontic-surgical intervention.