###### Abstract  
Introduction and aim: Orthodontic treatment of impacted maxillary canines is challenging and expensive. This study investigated factors associated with impaction risk and the need for surgical exposure. **Methods:** Seventy-five participants of similar age, skeletal maturity, and gender (32 impacted canines, 43 controls) were included in the case-controlled trial. Three-dimensional study models were created (Trios 3, 3 Shape), and panoramic radiographs were taken. The 3D digital models were measured using software to obtain morphological characteristics of the maxilla, such as maxillary surface area (mm\({}^{2}\)) and volume (mm\({}^{3}\)). **Results:** The impacted canine group displayed a significantly higher prevalence of deep bite (OR = 5.01), hypoplastic lateral incisors (OR = 5.47), and rotated adjacent teeth (OR = 3.56) compared to the control group. The impacted canine group exhibited a smaller maxillary surface area and volume. Within the impacted canine group, factors associated with a greater need for surgical exposure included the presence of a persistent deciduous canine (OR = 10.15), a palatal canine position (OR = 7.50), and a steeper canine angulation (\(p<0.001\)). **Conclusions:** These findings suggest that several signs can serve as potential predictors of increased risk for maxillary canine impaction and the need for surgical intervention. Identifying these factors can aid in early diagnosis and treatment planning for improved patient outcomes. m 2024  
canines. These include local mechanical obstructions (supernumerary tooth and odontoma), local odontogenic pathology, defects in incisor development, incorrect positions of the canine bud, and a lack of space for eruption or trauma in this area [8]. The panoramic radiograph shows the maxillary and mandibular teeth, the condyles, the maxillary sinuses, and the nasal cavity. As panoramic radiographs are widely used in clinical practice, it is one of the most recognized tools for detecting canine impactions [9; 10; 11]. Despite some disadvantages such as inaccuracy, image distortion, and the overlapping of anatomical structures, experiments and mathematical modeling have shown that panoramic radiographs can be reliably used to measure distances and angles and may allow certain predictions of possible dental impaction [12; 13]. [PERSON] and [PERSON]'s diagnosis of impaction risk considers parameters such as the angle between the canine and the median line, the extent of mesiodistal overlap with neighbouring teeth, and the distance between the canine position and the occlusal line in the vertical dimension [14]. Various clinical signs and conditions such as delayed tooth maturation, hypoplasia or hypodontia of the lateral incisor, maxillary crowding, smaller transverse dimensions of the maxilla, and the absence of a vestibular canine bulge have been frequently associated with impacted maxillary amines [8; 15; 16; 17; 18]. Since the treatment of impacted amines is usually lengthy and often very challenging and may require surgical exposure of the canines, it is better to diagnose the position of the canines early and prevent their impaction [4; 18]. Canine impaction can be unfavorable since it may cause resorption of the roots of neighboring teeth, most commonly lateral incisors [19]. Furthermore, impacted canines that underwent orthodontic and surgical means show higher amounts of root resorption compared to spontaneously erupted canines [20]. Our research hypothesized that several signs and conditions that are observable before the expected eruption of permanent maxillary canine are associated with canine impaction.