Periodontal Outcomes of Surgically–Orthodontically Treated Impacted Maxillary Canines: Influence of Surgical Technique and Impaction Site—A Systematic Review

Maxillary canine impaction is a common clinical condition often requiring a combined surgical–orthodontic approach; however, the effect of different surgical strategies on periodontal outcomes remains unclear. This systematic review aimed to evaluate periodontal outcomes following treatment of impacted maxillary canines, with particular focus on the influence of surgical technique (open vs. closed) and impaction site (palatal vs. buccal). A comprehensive search of PubMed, Scopus, and Web of Science was conducted up to January 2026 in accordance with PRISMA guidelines, and the protocol was registered in PROSPERO. Randomized controlled trials, controlled clinical studies, observational studies, case series, and case reports reporting periodontal parameters were included. Primary outcomes comprised probing pocket depth, keratinized tissue width, gingival thickness, plaque and bleeding indices, and gingival recession. Twenty-seven studies were included. Overall, treated canines were associated with periodontal conditions comparable to normally erupted teeth, with probing depths generally within physiological limits and minimal gingival recession. Buccally impacted canines tended to show slightly reduced keratinized tissue compared with palatal impactions, although without clear clinical relevance. No consistent superiority of open or closed techniques was identified. Surgical–orthodontic treatment is generally associated with favorable periodontal outcomes, and treatment selection should be individualized according to anatomical and orthodontic factors.