Procedures
Impacted Canines
An impacted tooth simply means that it is “stuck” under gum and bone 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 Impacted Wisdom Teeth under Procedures). Since there is rarely a functional need for wisdom teeth, they are usually removed, especially if impacted. The maxillary cuspid (upper eyetooth) 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 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 cuspid 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 cuspid tooth becomes impacted, every effort is made to force it to erupt into its proper position in the dental arch. Sixty percent of these impacted eyeteeth 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.
Early Recognition of an Impacted Canine (eyetooth) 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 radiograph, along with a dental examination, be performed on all patients at the age of seven 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 or are some adult teeth missing. Are there extra teeth present or unusual growths that are blocking the eruption of the eyetooth? Is there extreme crowding or too little space available causing an eruption problem with the eyetooth? This exam is usually performed by your general dentist or hygienist who will then refer you to an orthodontist if a problem is identified.
The treatment may require a visit to the orthodontist or oral surgeon for braces or extraction of baby teeth or any extra teeth. If the eruption path is cleared and the space is opened up by age 11-12, there is a good chance the impacted eyetooth will erupt with nature’s help alone. If the eyetooth is allowed to develop too much (age 13-14), the impacted eyetooth will 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 – a bridge or implant.
What Happens If The Eyetooth Will Not Erupt When Proper Space Is Available?
In cases where the eyeteeth will not erupt spontaneously, the orthodontist and oral surgeon work together to solve the problem. 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. 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 eyetooth has not fallen out already, it is usually left in place until the space for the adult eyetooth is ready. Once the space is ready, the orthodontist will refer the patient to the oral surgeon to have the impacted eyetooth surgically exposed and bracketed.
The procedure involves moving the gum on top of the impacted tooth 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, the oral surgeon will bond an orthodontic bracket to the exposed tooth. The bracket will have a miniature gold chain attached which will connect it to the archwire. The gum will be returned to its original location and sutured back with only the chain remaining visible as it exits a small hole in the gum.
About 2 weeks after surgery the patient will return to the orthodontist. A rubber band will be attached to the chain to put a light eruptive pulling force on the impacted tooth and 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. Your dentist or orthodontist will explain this situation to you if it applies to your specific situation.
These basic principals can be adapted to apply to any impacted tooth in the mouth. It is not that uncommon for both of the maxillary canines to be impacted. In these cases, the space in the dental arch form will be prepared on both sides at once. When the orthodontist is ready, the surgeon will expose and bracket both teeth in the same visit so the patient only has to undergo surgery once.
If molar teeth are impacted and need to be guided back into position, it is typically more difficult. The molar teeth are much bigger teeth and have multiple roots making them more difficult to move. The orthodontic maneuvers needed to manipulate an impacted molar tooth can be more complicated because of their location in the back of the dental arch.
Recent studies have revealed that early identification and treatment of impacted teeth leads to greater success.
What to Expect From Surgery To Expose & Bracket An Impacted Tooth?
The surgery to expose and bracket an impacted tooth is a very straightforward procedure that is performed in the oral surgeon’s office. For most patients, it is performed with intravenous (IV) sedation to assist with patient comfort. This will be discussed in detail at the preoperative consultation with Dr. Pennington. You can also refer to Preoperative Instructions under Surgical Instructions on this website 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 at the surgical sites, most patients find Tylenol or Advil to be more than adequate to manage any pain they may have. Within two to three days after surgery there is usually little need for any medication at all. Swelling can be minimized by applying ice packs to the lip for 24 hours after surgery. A soft, bland 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 if they jab the wound during initial healing. Your doctor will see you approximately 2 weeks after surgery to evaluate the healing process and make sure you are maintaining good oral hygiene. You should also plan to see your orthodontist about 2 weeks after surgery to activate the eruption process.
As always, Dr. Pennington is available at the office or after hours if any problems should arise. Simply call 912-673-6545 with any questions.