An impacted tooth simply means that it is stuck and cannot erupt into proper 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. Since there is rarely a functional need for wisdom teeth, they are usually extracted if they develop problems.
The maxillary canine is the second most common tooth to present as an impaction. The canine tooth is a particularly important tooth in the dental arch and plays an important role in your bite. The canine teeth are extraordinarily strong biting teeth and have the longest roots of any human teeth. 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.
The maxillary canine teeth are the last of the front teeth to erupt into place. They usually erupt around age 13 and cause any space left between the upper front teeth to close tighter together. If a canine tooth is impacted, every effort is made to get it to erupt into its proper position in the dental arch. Nearly two-thirds impacted canines are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted canines 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 side of the dental arch.
EARLY RECOGNITION OF IMPACTED CANINES IS THE KEY TO SUCCESSFUL TREATMENT
Early diagnosis and intervention will increase the likelihood of successful treatment and long-term dental arch form and stability. 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 count the teeth and determine if there are problems with eruption of the adult teeth. It is important to determine whether all the adult teeth are present or if there are some adult teeth missing. Are there extra teeth present or unusual growths that are blocking the eruption of the canine? Is there extreme crowding or too little space available causing an eruption problem with the canine?
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 over-retained baby teeth and/or selected adult teeth that are blocking the eruption of the all-important canines.
Dr. Matthew Hilmi 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 space is opened by age 11-12, there is a good chance the impacted canine will erupt with natures help alone. If the canine can develop further (age 13-14), the impacted canine will not erupt by itself even with the space cleared for its eruption. If the patient is too old (over 40), there is a much higher chance the tooth will be fused in the position perhaps requiring extraction and a more extensive treatment plan.
GUIDED CANINE ERUPTION
In cases where the canines will not erupt spontaneously, the orthodontist and oral surgeon work together to allow eruption to occur. Each case is unique must be evaluated individually. The most common scenario will call for the orthodontist to place braces on the teeth (at least the upper arch). Space will be opened to provide room for the impacted tooth to be moved into its proper position in the dental arch. If the primary canine (baby tooth) has not exfoliated, it is usually left in place until the space for the adult canine is ready. Once space is ready, the orthodontist will refer the patient to the oral surgeon to have the impacted canine exposed and an orthodontic bracket affixed.
In a simple surgical procedure performed in the oral and maxillofacial surgeon’s office, the gum tissue on top of the impacted tooth will be lifted 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 to the exposed tooth. The bracket will have a small gold chain attached to it. The doctor will guide the chain back to the orthodontic arch wire where it will be temporarily secured. 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 (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.
Within two weeks of the surgical procedure, 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 anatomic position. This is a carefully controlled, slow process that may 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 to last for a lifetime of chewing and tooth brushing. In some circumstances, especially those where the tooth had to be moved a long distance, there may be some minor periodontal surgery required to add bulk to the gum tissue over the relocated tooth, so it remains healthy during normal function.
WHAT TO EXPECT FROM SURGERY TO EXPOSE AND BRACKET AN IMPACTED TOOTH
The surgery to expose and bracket an impacted tooth is a very straightforward and otherwise simple surgical procedure routinely performed in our oral and maxillofacial surgery practice. It can be performed under local or general anesthesia, based on consultation with Dr. Hilmi and the patient and/or parent(s).