Orthodontic Exposure of Impacted Teeth

Lutherville, MD Oral Surgeon

An impacted tooth simply means that it is “stuck” and cannot erupt into the mouth. Most frequently patients develop problems with impacted third molar (wisdom) teeth. Since there is rarely a functional need for wisdom teeth, they are usually extracted if they develop problems. The upper cuspid (eyetooth) is the second most commonly impacted tooth. The cuspid is a critical tooth in the dental arch and plays an important role in your “bite”. They are the first teeth that touch when your jaws close together and guide the rest of the teeth into a functional bite.

Normally at around age 13 the upper cuspids are the last of the “front” teeth to erupt into your mouth. Upon eruption they cause any space left between the upper front teeth to close together. If a cuspid is impacted, every effort is made to assist its eruption into the dental arch

The Key to Successful Treatment is the Early Recognition of Impacted Canines

The American Association of Orthodontists recommends that all patients by seven years old receive a panoramic screening x-ray to determine if there are potential problems with eruption of the adult teeth, if any adult teeth are missing, if extra teeth are present, or unusual growths are blocking the eruption of teeth. The amount of crowding is assessed to determine if there is enough space available for the eruption of the canines. An orthodontist routinely addresses these problems by placing braces to open spaces and allow for the eruption of the adult teeth. If the eruption path is cleared and the space is opened by age 11-12, it is likely the impacted canine will erupt on its own. If the impacted canine develops too much (age 13-14), then it may not erupt even with the space opened for its eruption.

What Happens if the Cuspid Will Not Erupt?

In cases where the cuspid does not erupt, an orthodontist places braces on the teeth and opens a space for the impacted tooth. If the primary cuspid is still present, it is usually left in place until the space for the adult cuspid is ready. Once the space is ready, the orthodontist will refer the patient to us to have the primary tooth removed and the impacted cuspid surgically exposed and bracketed.

The surgical procedure involves lifting the gum that is on top of the impacted tooth to expose the hidden tooth underneath. Once the tooth is exposed, an orthodontic bracket is bonded to the exposed tooth. The bracket has a miniature brass-colored chain attached to it. We then attach the chain to the orthodontic arch wire.

Shortly after surgery (1-14 days) the patient returns to the orthodontist. A rubber band is attached to the chain thereby placing a light eruptive pulling force on the impacted tooth. Slowly during the next few months the tooth moves into its proper position in the dental arch.

What To Expect From Surgery To Expose & Bracket An Impacted Tooth?

The surgery to expose and bracket an impacted tooth is routinely performed in our office. It is typically performed with laughing gas and local anesthesia, and in selected cases it is performed under IV sedation. The surgery and pre-operative and post-operative instructions will be discussed in detail at your preoperative consultation with Dr. Spector.