I'm a practicing oral surgeon, and I have been asked on several occasions to surgically expose impacted cuspids on similar cases that have all had success in orthodontically assisted eruption. The success is usually less age dependent and more the maturity of the cuspid roots. Since these cuspids have only 1/3 to 1/2 of their final root structure formation, it seems that this case would likely be successful with traditional exposure and bonding of gold button and chains with orthodontic elastic traction. Since the teeth do not appear to be on the palatal side of the arch, the surgical access should be excellent to accomplish this procedure. It would be a shame to remove these otherwise perfectly normal teeth and cripple the normal arch form. The surgical approach for extraction is the same for the exposures, so why not attempt the exposures and see if they erupt over the next several months. If the eruption is not successful, the teeth could subsequently be removed.

I am a GP with over 20 years of experience in Orthopedic Jaw development and Functional Orthodontics. I had a number of cases similar to one described above. They all was completed without extraction of neither canines nor bicuspids. None. This was my objectives: 1-none of extractions, because created spaces can never be compensated in arch length Cranio-Mandibular space, tongue and Mandibular posture, and finally damage to the FASCIA.
2- How will the Body compensate the loss of the most important "traffic controllers" (canines)
3- it is Not possible to establish a perfect occlusion guidance and compensate the loss
So, to make a long story short, saving the canines and establish good arch relation and teeth alignment is the best way to go. Especially if you want to recover the silent part of patients breathing problems and posture dysfunctions. Amazing , but the secret to all is in the Mouth. So, this are my recommendations:
1-use any type of arch development appliances for 3-Dimentional maxillary size improvement
2- use full arch bonded braces;
3- exposure of canines, bonding of button with chains for orthodontic guided elastic traction in to the arch.
4-alighment and maintenance
You created a totally Healthy patient with on excellent future.
Good Luck.

It is difficlut to determine without reviewing the full CT series. On the sections shown the position of the impacted cuspids and the surrounding follicles in all likelihood, have damaged the root formation of teeth #'s 5 and 12. If they re not damaged they certainly may be during the surgical removal and subsequent debridement of teeth #'s 6 and 11. I would be more inclined to remove teeth #'s 5 and 12 and proceed with exposure/eruption of teeth #'s 6 and 11.

In fairness to the orthodontist, we do not know to what extent the patient's/parents' desires entered into the decision to remove the cuspids. Perhaps completing treatment in a certain time frame outweighed trying to erupt the cuspids.