Buccally Placed Canines If the canine is buccally placed and easily palpable a semilunar incision, at least 0.5cm above the gingival margin of the erupted teeth may be used. Otherwise an incision is made around the gingival margins of the erupted teeth one tooth forwards and one tooth behind the position of the unerupted canine, with an anterior relieving incision carried up towards the buccal sulcus. The bone is usually thin and may be removed with an elevator, or bur to uncover the crown. The tooth can then be elevated. Palatally Placed Canines Most canines are palatally placed. Unilateral impaction the incision can be made on the palatal gingival margins from the first molar on the impacted side to the canine on the opposite side Bilateral impaction the incision can be made from the first molar on the left to the gingival margin of the first molar on the right. The flap is raised usually with a curved Warwick-James elevator to peel back the gingival margins. The Howarth can then be used to complete the raising of the palatal flap. The incisive neurovascular bundle rising from the incisive foramen can be cut, and rarely gives rise to any clinically perceptible anaesthesia. Bone can then be removed with a bur; to expose the whole of the crown, and the tooth elevated. Care must be taken to palpate and prevent movement of adjacent teeth. The tooth may require decoronating, and further bone removed to allow its removal without damaging adjacent teeth. Tie the suture knots so that they lie buccally to reduce irritation to the tongue.