Exposure and Orthodontic Bracketing of an Impacted Tooth

An impacted tooth means that it is “stuck” and can not erupt into function in the mouth. Some teenagers and even adults have impacted teeth other than their wisdom teeth. The maxillary canine (upper eye tooth) is the second most common tooth to become impacted. The canine is a critical tooth in the bite and plays an important role in your chewing and appearance. They are supposed to be the first teeth that touch when your jaws close together so they guide the rest of the teeth into the proper bite. There are other teeth that can also be impacted and Dr. Noren can discuss this if it applies in your case.

The upper canine teeth are the last of the “front” teeth to move into place. They usually move into place around age 13 and cause any space left between the upper front teeth to close tight together. If a canine tooth gets impacted, every effort is made to get it to erupt into its proper position in the “bite” or arch. 60% of these impacted eye teeth are located on the palatal (roof of the mouth) side. The remaining impacted eye teeth are found in the middle of the bone but stuck in an elevated position above the roots of the adjacent teeth or out to the cheek side of the teeth.

As patients’ get older, 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 bite. 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 see whether all the adult teeth are present or if some adult teeth missing.

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 normal eruption of 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. Dr. Noren 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 will not erupt by itself even with the space cleared for its eruption. If the patient is older (not old; over 40!), there is a much higher chance the tooth will be stuck in position. Many times, the only option at this point is to extract the impacted tooth and consider an alternate treatment to replace it with a crown on a dental implant or a fixed bridge).

The usual procedure performed in the oral surgeon’s office involves exposing the hidden tooth underneath delicately. If there is a baby tooth present, it will be removed at the same time. Once the tooth is exposed, Dr. Noren will bond an orthodontic bracket to the exposed tooth. The bracket will have a miniature gold chain attached to it. Dr. Noren will secure the chain back to the orthodontic arch wire where it will be temporarily attached. Sometimes we 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 hole in the gum.

After surgery (1-14 days) the patient will return to the orthodontist. Often, a rubber band 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 can take up to a year in some cases, but also needs to be stabilized with time after that. 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. Call us at (607) 273-0327 with any questions.