First, we thank Drs Kamak and Kamak for their comments about and interest in our article. To prevent the selection of an ambiguous impaction, our sample comprised obvious maxillary canine impactions as judged by clinical and radiologic examinations. These impactions were severe, each warranting surgical intervention to allow their proper alignment into the dental arch.

In stating that “a tooth was considered impacted if it was not erupted within the normal chronologic age range,” we assumed the reader’s knowledge of a typically normal range; maxillary canines emerge into the oral cavity at mean ages of 10 to 12 years in girls and 11 to 13 years in boys. However, because of immense individual variations in the chronologic timing of tooth emergence, a deviation in the usual tooth eruption sequence should be more alarming for clinicians. For example, the complete eruption of a second molar before the eruption of the maxillary canine might indicate its possible impaction.

In our retrospective study, we believed that inclusion of canines exposed surgically in our subjects was justified in categorizing them as impacted canines. In our opinion, Drs Kamak and Kamak’s definition of impaction based on the chorologic age of 16 years is too stringent and might even be detrimental to treatment. If a clinician’s judgment were delayed until this age in deciding an impacted tooth’s status, necessary well-timed treatment could be compromised. This could result in unwanted sequelae of canine impaction such as severe root resorption of the adjacent incisors.

Previous studies have shown that some systemic disorders cause delayed tooth eruption. It is often seen in the region of the maxillary canines because of their high positioning in the maxilla and also the long pathway that they must descend into the dental arch. Although we did not look at systemic disorders as an etiologic cause of canine impaction, delayed tooth eruption should be distinguished from impaction.

It is our opinion that canines impacted through delayed tooth eruption must have predisposing genetic factors affecting either the development of the canine tooth bud or both the tooth and systemic condition simultaneously. Thus, even patients with systemic disorders would be considered in our sample, and this should not disturb our findings of genetic factors affecting canine impaction.

We agree with Drs Kamak and Kamak that early diagnosis of tooth disturbances is essential, and that appropriate interceptive treatment can prevent many impacted canines.