Exposure of Impacted Teeth
What is an impacted tooth?
An impacted tooth simply means that it is “stuck” and cannot erupt into function. Patients frequently develop problems with impacted third molar (wisdom) teeth. These teeth get “stuck” in the back of the jaw and can develop painful infections, among a host of other problems (see Wisdom Teeth under Procedures). Since there is rarely a functional need for wisdom teeth, they are usually extracted if they develop problems. The maxillary canine or cuspid (sometimes call an upper eyetooth) is the second most common tooth to become impacted. The canine tooth is a critical tooth and plays an important role in your “bite”. These teeth are very strong biting teeth and 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 canine teeth are the last of the “front” teeth to erupt into place. They usually come into place around age 13 and cause any space left between the upper front teeth to close tighter together. If a canine gets impacted, every effort is made to get it to erupt into its proper position. 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 canine teeth. Sixty percent of these impacted teeth are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted teeth are found in the middle of the supporting bone, but are stuck in an elevated position above the roots of the adjacent teeth, or are out to the facial side of the dental arch.
Early Recognition of Impacted Eyeteeth Is the Key to Successful Treatment
The older the patient is, the more likely an impacted tooth will not erupt by natural forces alone, even if the space is available for the tooth to fit in the dental arch. A panoramic x-ray, along with a dental examination, will help determine whether all the adult teeth are present or if some adult teeth are missing.
Treatment may require referral to an oral surgeon for extraction of retained baby teeth and/or selected adult teeth that are blocking the eruption of the important canine teeth. The oral surgeon will also need to remove any extra teeth (supernumerary teeth) or growths that are blocking the eruption of any adult teeth.
Impacted tooth success by patient’s age:
- 11-12 years old – with space opened for eruption, good chance for success.
- 13-14 years old – the impacted tooth will probably not erupt by itself, even with the space cleared for its eruption.
- Over 40 years old – much higher chance that the tooth will be fused in position (ankylosed). The only option is to extract the impacted tooth and replace it with a crown on a dental implant or a fixed bridge.
What happens if the tooth will not erupt when proper space is available?
In cases where the canine teeth will not erupt spontaneously, the orthodontist and oral surgeon will work together to get try to get these teeth to erupt. 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 oral surgeon will expose and bracket the impacted tooth, and the orthodontist will guide it into position with an orthodontic chain, rubber band, or other device.
The goal is to erupt the impacted tooth and not to extract it. Once the tooth has moved into its final position, the gum around it will be evaluated. In some circumstances, there may be some minor “gum surgery” required.
Exposure and Bracketing of an Impacted Cuspid
What to expect from surgery to expose & bracket an impacted tooth
The surgery to expose and bracket an impacted tooth is performed in the oral surgeon’s office, usually in less than an hour. Although it is not a painful procedure, it is usually performed under general anesthesia. Every patient is unique, and the exact procedure necessary will be discussed in detail at your preoperative consultation with your doctor.
Refer to Preoperative Instructions under Surgical Instructions on this website for a review of any details. Simply call Harlan Oral and Maxillofacial Surgery Associates at (405) 632-9726 if you have any questions.