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 tooth (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”. The canine teeth are very strong biting teeth and have the longest roots in your mouth. 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 tooth 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 maxillary canine teeth. Sixty percent of impacted canine teeth are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted canine 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 lip/cheek 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 canine 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 over-retained baby teeth and/or selected adult teeth that are blocking the eruption of the all-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 eyetooth will not erupt by itself, even with the space cleared for its eruption.
  • Over 30 years old – much higher chance that the tooth will be fused in position. 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 canine 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 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 place a bracket with a chain on the impacted tooth.  The orthodontist then applies elastics to the chain which allow the tooth to gently erupt into position.

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 a very straightforward surgical procedure that is performed in the oral surgeon’s office. For most patients, it is performed using  local anesthesia or IV anesthesia. If the procedure only requires exposing the tooth with no bracketing, the time required will be shortened by about one half.

Your case will be discussed in detail at your preoperative consultation with your doctor. Please call Oral Surgery Associates at Chicago Office Phone Number 773-761-7171 in Chicago or Skokie Office Phone Number 847-676-9300 in Skokie if you have any questions.