An impacted tooth simply means that it is “stuck” underneath bone and/or gum tissue and cannot erupt into the mouth. 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 extracted if they develop problems. The maxillary canine tooth (upper cuspid) is the second most common tooth to become impacted. The canine tooth is a critical tooth in the dental arch and plays an important role in your “bite”. The canine teeth have the longest roots of any human teeth and as such are incredibly strong and play an integral part in our ability to bite and shear off food. They are also 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 11-13 and cause any space left between the upper front teeth to close tighter together. If a canine tooth remains impacted, every effort should be made to get 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 mouth, but aside from wisdom teeth the teeth most likely to be impacted are the maxillary canines. 80% percent of these impacted canines are located on the palatal (roof of the mouth) side of the dental arch. The remaining 20 % of impacted canine 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 (front) side of the dental arch.
Early Recognition of Impacted Eyeteeth is the Key to Successful Treatment
The older the patient, the more likely an impacted canine will not erupt spontaneously even if the space is available for the tooth to fit in the dental arch. The American Association of Orthodontists recommends that a panorex x-ray, along with a dental examination, be performed on all dental patients at around the age of 7 years to evaluate the teeth and determine if there may be problems with eruption of the adult teeth due to crowding or malposition. It is important to identify potential problems while they can be corrected or prevented in a predictable fashion.
- 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 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 Dr. Spanganberg for extraction of retained baby teeth and/or selected adult teeth that are blocking the eruption of the all-important canine teeth. There may also be extra teeth (supernumerary teeth) or growths that are blocking eruption of any of the adult teeth. If the eruption path within the bone is cleared and the space between the other teeth is opened up by age 11-12, there is a good chance the impacted canine will erupt spontaneously. If the canine is allowed to fully develop (age 13-14), they tend not erupt even with the space cleared for its eruption. If the patient is too old (over 25), there is a much higher chance the tooth will be fused in position. In these cases the tooth will not move despite all the efforts of the orthodontist and Dr. Spanganberg to guide the canine tooth into place. Sadly, the only option at this point is to extract the impacted tooth and consider an alternate treatment to replace it in the dental arch (ideally 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 will not erupt spontaneously, the orthodontist and Dr. Spanganberg will work together to make a plan to guide the unerupted canine into its proper position. Each case must be evaluated on an individual basis but treatment will usually involve a combined effort between the orthodontist and Dr. Spanganberg. The most common scenario will call for the orthodontist to place braces on the teeth (at least the upper arch). 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 tooth has not fallen out already, it is usually left in place until the space for the adult canine is ready. Once the space is ready, the orthodontist will refer the patient to Dr. Spanganberg to have the impacted canine exposed and a bracket and chain placed that will then be used to guide the tooth into its proper position.
In a simple surgical procedure performed in Dr. Spanganberg’s office, the gum over top of the impacted tooth will be lifted up to expose the impacted tooth underneath. If there is a baby tooth present, it will be removed at the same time. Once the impacted tooth is exposed, Dr. Spanganberg will bond an orthodontic bracket to the now exposed tooth. The bracket will have a miniature gold chain attached to it. Dr. Spanganberg will guide the chain back to the orthodontic arch wire where it will be temporarily attached. Sometimes Dr. Spanganberg will leave the exposed impacted tooth uncovered by suturing the gum tissue up above the tooth or by making a window in the gum tissue covering the tooth (on selected cases located on the roof of the mouth). Most of the time, the gum tissue will be repositioned to its original location and sutured with only the chain remaining visible as it exits a small hole in the gum tissue.
Shortly after surgery (1-14 days) the patient will return to the orthodontist. A rubber band (power chain) will be attached to the chain to put a light pulling force on the impacted tooth. This will 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. 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 newly relocated tooth so it remains healthy long term. Dr. Spanganberg will explain this situation to you if it applies to your specific situation.
Exposure and Bracketing of an Impacted Cuspid
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 cuspids 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 heal from surgery once. Because the anterior teeth (incisors and cuspids) and the bicuspid teeth are small and have single roots, they are easier to erupt if they get impacted than the posterior molar teeth. 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 with early identification of impacted eyeteeth (or any other impacted tooth other than wisdom teeth), treatment should be initiated at a younger age. Once the general dentist or hygienist identifies a potential eruption problem, the patient should be referred to the orthodontist for early evaluation. In some cases the patient will be sent to the oral surgeon before braces are even applied to the teeth. As mentioned earlier, the surgeon will be asked to remove over-retained baby teeth and/or selected adult teeth. He will also remove any extra teeth or growths that are blocking eruption of the developing adult teeth. Finally, he may be asked to simply expose an impacted eyetooth without attaching a bracket and chain to it. In reality, this is an easier surgical procedure to perform than having to expose and bracket the impacted tooth. This will encourage some eruption to occur before the tooth becomes totally impacted (stuck). 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. In the long run, this saves time for the patient and means less time in braces (always a plus for any patient!).
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. It can be performed using either laughing gas (Nitrous oxide), and local anesthesia, or with IV sedation, if the patient desires to be asleep. During your consultation visit, you can discuss with Dr. Spanganberg which type anesthesia will best suit you. You can 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 localized 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. There may be some swelling from holding the lip up to visualize the surgical site; it can be minimized by applying ice packs to the lip for the afternoon after surgery. Bruising is not a common finding after this type of procedure. A soft, bland diet is recommended at first, but you may resume your normal diet as soon as you feel comfortable. It is advised that you avoid sharp food items like crackers and chips, as they will irritate the surgical site during initial healing. You will be rescheduled to our office seven to ten days after surgery to evaluate the healing process. You should plan to see your orthodontist within 14 days to activate the eruption process by applying the proper rubber band to the chain on your tooth. As always your doctor is available at the office or can be called after hours if any problems should arise after surgery. Simply call at Gilbert Office Phone Number 480-279-3113 if you have any questions.
Sonoma Oral and Facial Surgery
Our Latest Patient Testimonial
My son was really worried about his procedure but the staff was so kind, they made him feel really comfortable. Dr. Spanganberg took the time to explain everything and answer his questions. The procedure went incredibly smoothly, much better than we anticipated. We've already referred friends to this office. Thank You!
- Angelica L
Our Latest Patient Testimonial
They made my daughter's experience stress free.
- Julie J