Impacted Teeth

Exposure and Bracketing of an Impacted tooth

An impacted tooth basically means that it is “stuck” and will not erupt into function. The maxillary canine or the upper eye tooth is a 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 and have the longest roots of all your dentition. 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.

Early recognition of impacted eye teeth: key to successful treatment: The older the patient, the more likely an impacted eye tooth will not erupt by nature’s forces alone even if the space is available for the tooth to fit in the dental arch. It is important to determine whether all the adult teeth are present or are some adult teeth missing or if there are extra teeth present or possible growths that are blocking the eruption of the eye tooth. Extreme crowding or too little space available may cause an eruption problem with the eye tooth in the future. An exam is usually performed by a general dentist who will refer you to a dental specialist 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 an oral surgeon for extraction of teeth that are blocking the eruption of the 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 with nature’s help alone. If the eye tooth is allowed to develop too much (age 13-14), the impacted eye tooth may not erupt by itself even with the space cleared for its eruption. If the patient is too old (over 40), there is a much higher chance the tooth will be fused in position. In these cases the tooth will not budge despite all the efforts of the orthodontist and oral surgeon to erupt it into place. Unfortunately, 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 eye tooth will not erupt when proper space is available?

In some cases where the eye teeth have not erupted spontaneously, an orthodontist and oral surgeon can work together to get these eye teeth to erupt. Each case will be evaluated on a case by case basis. Treatment will usually involve a combined effort between the orthodontist and 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 by the oral surgeon, the impacted tooth will be exposed. If there is a baby tooth present, it will be removed at the same time. Once the tooth is exposed, an orthodontic bracket will be bonded to the exposed tooth. The bracket will have a miniature gold chain attached to it. The oral surgeon will guide the chain back to the orthodontic arch wire where it will be temporarily attached. Sometimes the surgeon will leave the exposed impacted tooth completely uncovered. Within two weeks of surgery, the patient will return to the orthodontist to begin light traction forces on the impacted tooth. This will begin the process of moving the tooth/teeth into their proper place in the dental arch. This process can take up to a full year to complete. 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 strong and healthy. In some circumstances, especially those where the tooth had to be moved a long distance, there may be need of some minor gum surgery. Your dentist or orthodontist will explain this situation to you if it applies to your specific situation.

Recent studies have revealed that with early identification of impacted eye teeth (or any other impacted tooth other than wisdom teeth), treatment should be initiated at a younger age.

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

The surgery to expose and bracket an impacted tooth is a very straight forward surgical procedure. You can expect a limited amount of bleeding from the surgical sites after surgery. Although there will be some discomfort after surgery at the surgical sites, most patients find Tylenol or Advil to be more than adequate to manage any pain they may have. Within 2-3 days after surgery there is usually little need for any medication at all. There may be some swelling from holding the lip up to visualize the surgical site; it can be minimized by applying ice packs to the lip for the afternoon after surgery. Bruising is not a common finding at all after these cases. A soft diet is recommended at first, but 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. Your should have a follow up visit 7-10 days after surgery to evaluate the healing process and make sure you are maintaining good oral hygiene. You should plan to see your orthodontist within 1-14 days to activate the eruption process. Should you have any questions or concerns after surgery, simply call Pearlmax (619)-29 PEARL.