Procedures
Impacted Canines
An impacted tooth simply means that it is “stuck” and cannot erupt into function. The maxillary cuspid (upper eyetooth) is a common tooth to become impacted. The cuspid tooth is a critical tooth in the dental arch and plays an important role in your “bite”. The cuspid teeth are very strong biting teeth and 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. Although, patients frequently develop problems with impacted third molar (wisdom) teeth. These teeth can develop a host of problems (see Impacted Wisdom Teeth under Procedures). Since there is rarely a functional need for wisdom teeth, they are usually removed before they develop problems.
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 together. If a cuspid tooth gets impacted, every effort should be made for 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. Most often these impacted eyeteeth are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted cuspid 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 side of the dental arch.
Early recognition of impacted teeth is the key to successful treatment.
The older the patient, the more likely an impacted tooth will not erupt by nature’s forces alone, even if the space is available for the tooth to fit 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 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 are some adult teeth missing, as well as extra teeth present or unusual growths that are blocking the eruption of the tooth. If there is extreme crowding or too little space available an eruption problem may exist. 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 cuspids, or eyeteeth. The oral surgeon 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 at an early age, there is a good chance the impacted eyetooth will erupt with nature’s help alone. If the cuspid tooth is allowed to develop too much, the impacted tooth will not erupt by itself even with the space is available. If the patient is too old, there is a much higher chance the tooth will be fused in position. In these cases the tooth will not budge despite the efforts of the orthodontist and oral surgeon to erupt it 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.
What happens if the cuspid tooth will not erupt when proper space is available?
In cases where the cuspid will not erupt spontaneously, the orthodontist and oral surgeon work together to get these unerupted cuspid to erupt. Each case must be evaluated on an individual basis but treatment will usually involve a combined effort between the orthodontist and the oral surgeon. The most common scenario will call for the orthodontist to place braces on the teeth. 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 corresponding baby tooth has not fallen out already, it is usually left in place until the space for the adult tooth is ready. Once the space is ready, the orthodontist will refer the patient to the oral surgeon to have the impacted cuspid exposed and bracketed.
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. For most patients, it is performed with using nitrous oxide gas and local anesthesia. In select cases it will be performed under IV sedation if the patient desires to be asleep or the surgical case is technically involved. These issues will be discussed in detail at your preoperative consultation with your doctor. You can also 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 discomfort after surgery at the surgical sites, most patients find Tylenol or Advil to be adequate. For others a prescription for pain medication may be provided. Dr. Fox will see you seven to ten days after surgery to evaluate the healing process and make sure you are maintaining good oral hygiene. You should plan to see your orthodontist within 1-14 days to activate the eruption process by applying the proper rubber band to the chain now attached to your tooth. Simply call our practice at (706) 265-1700 if you have any questions.