Maxillary canine impaction is a common dental anomaly, and identifying its potential causes is crucial. Odontogenic lesions located near the impacted canine may contribute to the occurrence of impaction. This study aimed to determine how frequently odontogenic lesions occur in patients with impacted canines and to explore their relationship with specific impaction characteristics. A cross-sectional study analyzed 93 impacted maxillary canines from cone-beam computed tomography (CBCT) scans obtained at three radiology centers. Inclusion criteria encompassed male and female patients over 12 years of age with unilateral or bilateral maxillary canine impaction, regardless of the presence of odontogenic lesions. Evaluations included the impaction position, sector, presence of dentigerous cysts, odontomas, or follicular enlargements, and lesion size. Statistical analyses were conducted using the χ² test and logistic regression, with significance determined at p < 0.05. Overall, odontogenic lesions near impacted canines were uncommon: dentigerous cysts were present in 7.5% of cases, follicular enlargement in 6.5%, and mesiodens in 3.2%. Dentigerous cysts were significantly more frequent in buccal and mid-alveolar impactions (p = 0.032). Logistic regression revealed that a larger alpha angle increased the likelihood of dentigerous cyst formation (B = 1.22; p = 0.041), whereas a higher beta angle reduced the risk by approximately 18% (p = 0.024). The occurrence of odontogenic lesions in impacted maxillary canines is low, primarily involving dentigerous cysts and follicular enlargements associated with buccal or mid-alveolar impactions. Impaction angles, particularly alpha and beta, appear to influence the development of dentigerous cysts.
