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Exposure of Impacted Canine Teeth

An impacted tooth simply means that the tooth cannot erupt into the mouth or in to function. Patients frequently develop problems with impacted wisdom teeth . These teeth get “stuck” in the back of the jaw and can develop painful infections among a host of other problems (see “Impacted wisdom teeth” under Procedures). Since there is rarely a functional need for wisdom teeth, they are usually extracted in early adulthood or if they develop problems. The maxillary cuspid or canine (upper “eye” tooth) is the second most common tooth to become impacted. The cuspid tooth is a critical tooth in the dental arch and plays an important role in your “bite”. The cuspid teeth are very strong biting teeth, which have the longest roots of any human teeth. They are designed to be the first teeth that touch when your jaws close together so they guide the rest of the teeth into the proper bite.

Normally, the maxillary cuspid teeth are the last of the “front” teeth to erupt into place. They usually come into place around age 12-13 and cause any space left between the upper front teeth to close tightly together. If a cuspid tooth becomes impacted, every effort is made to get it to erupt into its proper position in the dental arch. The techniques involved to aid eruption can be applied to any impacted tooth in the upper or lower jaw, but most commonly they are applied to the maxillary cuspid (upper eye) teeth. 80% of these impacted eye teeth are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted eye teeth are found in the middle of the supporting bone but stuck in an elevated position above the roots of the adjacent teeth or out to the facial side of the dental arch (towards your lips).

Early recognition of impacted canine teeth is the key to successful treatment

The older the patient, the more likely an impacted canine will not erupt by nature’s forces alone, even if the space is available for the tooth to fit in the dental arch. The American Association of Orthodontists recommends that a panorex screening x-ray along with a dental examination be performed on all dental patients at around the age of 7 years to count the teeth and determine if there are problems with eruption of the adult teeth. It is important to determine whether all the adult teeth are present. Are there extra teeth present or unusual growths that are blocking the eruption of the eye tooth? Is there extreme crowding or too little space available causing an eruption problem with the eye tooth?

This exam is usually performed by your general dentist or hygienist who will refer you to an orthodontist if a problem is identified. Treating such a problem may involve an orthodontist placing braces to open spaces to allow for proper eruption of the adult teeth. Treatment may also require a referral to an oral surgeon for extraction of over retained baby teeth and/or selected adult teeth that are blocking the eruption of the all important eye teeth. The oral surgeon will also need to remove any extra teeth (supernumerary teeth) or growths that are blocking eruption of any of the adult teeth. If the eruption path is cleared and the space is opened up by age 11 or 12, there is a good chance the impacted eye tooth will erupt naturally. If the eye tooth is allowed to develop too much (age 13-14), the impacted eye tooth may not erupt by itself, even with sufficient space available. As a patient becomes older, there is a much higher chance the tooth will be fused in position. In these cases the tooth will not move despite the efforts of the orthodontist and oral surgeon. The only option at this point is to extract the impacted tooth and consider an alternate treatment to replace it in the dental arch (crown on a dental implant or a fixed bridge).

What happens if the canine tooth will not erupt when proper space is available?

In cases where the eye teeth will not erupt spontaneously, the orthodontist and Dr. Engel work together to bring these un erupted eye teeth into place. Each case must be evaluated on an individual basis, but treatment will usually involve a combined effort between the orthodontist and the oral surgeon. The most common scenario will call for the orthodontist to place braces on the teeth (at least the upper arch). A space will be opened to provide room for the impacted tooth to be moved into its proper position in the dental arch. If the baby eye tooth has not fallen out already, it is usually left in place until the space for the adult eye tooth is ready. Once the space is ready, the orthodontist will refer the patient to the oral surgeon to have the impacted eye tooth exposed and bracketed.

In a simple surgical procedure performed in our office, the gum on top of the impacted tooth will be lifted up to expose the hidden tooth underneath. If there is a baby tooth present, it will be removed at the same time. Once the tooth is exposed,  Dr. Engel   will bond an orthodontic bracket to the exposed tooth. The bracket will have a miniature gold chain attached to it. He will guide the chain back to the orthodontic arch wire where it will be temporarily attached. Sometimes Dr. Engel   will leave the exposed impacted tooth completely uncovered by suturing the gum up high above the tooth or making a window in the gum covering the tooth (on selected cases located on the roof of the mouth). Most of the time, the gum will be returned to its original location and sutured back with only the chain remaining visible as it exits a small opening in the gum.

Some time after surgery (2-6 weeks) the patient will return to the orthodontist. An elastic will be attached to the chain to put a light eruptive pulling force on the impacted tooth. This will begin the process of moving the tooth into its proper place in the dental arch. This is a carefully controlled, slow process that may take up to a full year to complete. Remember, the goal is to erupt the impacted tooth and not to extract it! Once the tooth is moved into the arch in its final position, the gum around it will be evaluated to make sure it is sufficiently strong and healthy to last for a lifetime of chewing and tooth brushing. In some circumstances, especially those where the tooth had to be moved a long distance, there may be some minor “gum surgery” required to add bulk to the gum tissue over the relocated tooth so it remains healthy during normal function. Dr. Engel   or your orthodontist will explain this situation to you if it applies to your specific situation.

What to expect from surgery to expose and bracket an impacted tooth

The surgery to expose and bracket an impacted tooth is a very straightforward surgical procedure that is performed in Dr. Engel ‘s office. Most patients prefer this procedure with I.V. (intravenous) sedation along with local anesthesia. For some patients, the use of laughing gas and local anesthesia is adequate. The procedure is completed within 35 to 60 minutes. If the procedure only requires exposing the tooth, without the bonding of a bracket, the time required will be shortened by about one half. These issues will be discussed in detail at your preoperative consultation with your doctor. You can also refer to ” Preoperative Instructions ” under Surgical Instructions on this web site for a review of any details.

You can expect a limited amount of bleeding from the surgical sites after surgery. Although there will be some discomfort after surgery, most patients find Tylenol or Advil to be adequate to manage any pain. Within 4-5 days after surgery there is usually little need for any medication. There may be some minor swelling. This can be minimized by applying ice packs to the area after surgery. Bruising is not a common finding after this surgery. A soft diet is recommended at first. You may resume your normal diet as soon as you feel comfortable chewing. It is advised that you avoid sharp food items like crackers and chips, as they will irritate the surgical site. Dr. Engel   will see you one week after surgery to evaluate the healing process and make sure you are maintaining good oral hygiene. You should plan to see your orthodontist within 2-6 weeks to start the eruption process by activating the chain/bracket on your exposed tooth. Be sure to call Dr. Engel   at (860) 739-3133 if you have any questions.

Oral and maxillofacial surgeons and orthodontists work together to provide the best possible orthodontic results. 

The information presented in this video is intended for educational purposes only. It is meant to help you better understand dental health conditions and procedures. For specific orthodontic or oral surgery advice, please consult an orthodontist who is a member of the American Association of Orthodontists or an oral and maxillofacial surgeon who is a fellow or member of the American Association of Oral and Maxillofacial Surgeons.

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