Impacted Canines

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 result in painful infections among a host of other problems (see Impacted Wisdom Teeth under Procedures). Since ther is rarely a functional need for wisdom teeth, they are usually extracted if they develop problems. The maxillary cuspid (upper eyetooth) is very common to become impacted. The cuspid teeth are very strong biting teeth and have the longest roots of any human teeth.

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 gets impacted, every effort is made to cause it to erupt into its proper position in the dental arch. 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 cuspid (upper eye) teeth.

Early Recognition of Impacted Eyeteeth is the Key to Successful Treatment

The older the patient, the more likely an impacted eyetooth will not erupt naturally even if the space is available in the dental arch. 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 seven years to determine if all the adult teeth are present or are experiencing complications in erupting properly. 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 proper eruption of the adult teeth. Treatment may also require referral to an oral surgeon for extraction of any extra teeth or growths that are blocking the eruption of the eyeteeth. 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 naturally. 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 older (over 40), there is a much higher chance the tooth will be fused in position. 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 Eyetooth Will Not Erupt When Proper Space is Available?

The most common scenario will call for the orthodontist to place braces on the teeth in order to create space to provide room for the impacted tooth to be moved into its proper position. 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 exposed and bracketed.

In a simple surgical procedure, the gum on top of the impacted tooth will be lifted up 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, attached to a miniature gold chain, to the exposed tooth. 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 by suturing the gum up high above the tooth or making a window in the gum covering the tooth. Most of the time, the gum will be returned to its original location and sutured back with only the chain remaining visible.

Shortly after surgery, (1-14 days) 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. This will begin the process of moving the tooth into its proper place in the dental arch. This process could take up to a full year to complete. 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. 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.

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Exposure and Bracketing of an Impacted Cuspid

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The oral surgeon may be asked to simply expose an impacted eyetooth without attaching a bracket and chain to it. This will encourage some eruption to occur before the tooth becomes totally impacted. By the time the patient is at the proper age for the orthodontist to apply braces to the dental arch, the eyetooth will have erupted enough that the orthodontist can bond a bracket to it and move it into place without needing to force its eruption.

What to Expect from Surgery to Expose & Bracket an Impacted Tooth?

• The surgery is preformed in the oral surgeon’s office, using laughing gas and local anesthesia. In selected cases it will be performed under IV sedation if the patient desires to be asleep, but this is generally not necessary for this procedure.
• Expect limited amount of bleeding and discomfort at the surgical sites after surgery.
• Most patients find Tylenol or Advil to be more than adequate to manage any pain. Two to three days after surgery there is usually little need for any medication at all.
• May experience some swelling, which can be minimized by applying ice to the lip after surgery.
• Bruising is not common.
• 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 as they will irritate the surgical site if they jab the wound during initial healing.
• You doctor will see you 7-10 days after surgery to evaluate the healing process.