<![CDATA[Background: Impaction of the maxillary canine and mandibular second premolar ranks among the most common dental impactions after third molars. However, the simultaneous occurrence of both in a single patient is relatively rare.Objective: To present the clinical management of concomitant impacted maxillary canine and mandibular second premolar using a combined surgical approach, emphasizing the importance of appropriate surgical intervention in facilitating subsequent orthodontic alignment.Case: A 19-year-old female presented with irregularly aligned teeth and sought orthodontic treatment. Examination revealed anterior crossbite, ectopic maxillary canine, multiple caries, retained root of tooth 75, persistence of tooth 53, and missing tooth 35. Radiographs confirmed impaction of tooth 13 and tooth 35, with the canine positioned palatally. A multidisciplinary pre-orthodontic treatment plan included extraction of tooth 35 due to space deficiency and surgical exposure of tooth 13 following removal of tooth 53. Procedures were performed under local anesthesia with appropriate pharmacological management.Outcome: The surgical phase was completed without complications. The patient showed good postoperative recovery and compliance. Orthodontic treatment has been initiated but remain ongoing, with alignment of the impacted canine planned in subsequent stages.Conclusion: Pre-orthodontic surgical management in essential for facilitating orthodontic outcomes. Careful planning, interdisciplinary collaboration, and staged treatment are critical, particularly in rare combined impaction cases]]>
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