Background <p>The traction of an impacted canine is complicated and challenging due to its position, direction, relationship to adjacent teeth and anchorage design. This study describes a customized device for the three-dimensional traction of complex maxillary impacted canines (MICs).</p> Case presentation <p>This article reports two cases of young patients with complex MICs (Case Ⅰ: the MIC has high horizontal impaction without enough adjacent anchorage teeth, and Case II: the crown of the MIC is entirely embedded between the roots of adjacent incisors). A digitally customized device was developed to optimally resolve impaction management challenge in both patients. The therapeutic effects are evaluated by comparing the pretreatment, during-treatment and posttreatment results, including those from clinical and imaging examinations. After traction using the customized device, the impacted canines were successfully repositioned in the dental arch, and both the anchoring teeth and adjacent teeth were in good condition, which established a robust foundation for subsequent stage. Then, after fixed orthodontic treatment, both patients exhibited good dental alignment.</p> Conclusions <p>The satisfactory clinical outcome demonstrated that the customized device is convenient, comfortable, safe, and excellent in 3D control for the traction of MIC; in conjunction with fixed orthodontic techniques, it can effectively accomplish comprehensive orthodontic treatment for MIC.</p>