Exposure of Impacted Teeth

Oral Surgery Norwood, MA | Mansfield, MA

An impacted tooth simply means that it is stuck and cannot erupt into the proper position. Wisdom teeth are the most frequently impacted teeth in the mouth. Because they are the last teeth to erupt, there is usually insufficient space to accommodate them and they remain impacted in the jaw bone. Patients often develop problems with impacted third molar (wisdom) teeth (see Impacted wisdom teeth). Since most wisdom teeth are nonfunctional, they are usually extracted; preferably before they develop problems.

The maxillary cuspid (upper eye tooth or canine tooth) is the second most commonly impacted tooth in the mouth. The cuspid tooth is a critical tooth in the dental arch and plays an important role in your occlusion (bite) and esthetic appearance. The cuspid teeth are very strong biting teeth that 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 a proper occlusion (bite). The maxillary cuspids are also extremely important in helping to maintain proper alignment of the other maxillary anterior (front) teeth.

Normally, the maxillary cuspid teeth are the last of the anterior (front) teeth to erupt into place. They usually erupt around age 12-13.

As they erupt, the maxillary cuspids exert pressure on the other anterior teeth which often helps to close any space left between the teeth. If a cuspid tooth becomes impacted, every effort should be made to promote its eruption into proper position in the dental arch.

Early Recognition of Impacted Teeth is Crucial

The older the patient, the less likely an impacted cuspid tooth will erupt on its own even if there is adequate space to accommodate the tooth in the dental arch. Therefore, early evaluation and intervention are recommended. The American Association of Orthodontists recommends that all patients at the age of seven receive a panoramic (panorex) radiographic screening and dental examination to determine that all adult teeth are present and evaluate for potential eruption problems of the adult teeth.

An initial screening examination is usually performed by the general dentist who will refer the patient to an orthodontist if a problem is identified. The importance of early intervention cannot be overemphasized with regard to the management of eruption problems. Failure to identify and treat tooth eruption problems in a timely manner can complicate treatment, increase the risk for orthodontic and surgical complications and produce less than optimal results.

There are several reasons why a tooth may not erupt at the proper time. Extra teeth (supernumerary teeth) or abnormal growths may be present which can block the eruption of the permanent teeth. Extreme crowding or lack of space will frequently obstruct the eruption of the cuspid or other permanent teeth. Deciduous (baby) teeth that do not exfoliate (fall out) in a timely manner can prevent the eruption of permanent teeth.

Crowding problems may necessitate orthodontic treatment to create space for proper eruption of the adult teeth. Treatment may also require a referral to an oral surgeon for extraction of over-retained deciduous teeth. Occasionally selected adult teeth to need to be extracted to relieve crowding and create space for the cuspid teeth. The oral surgeon will need to remove any supernumerary teeth (extra teeth) or growths that may block the eruption of adult teeth. In these cases, oral surgical treatment is always closely coordinated with orthodontic therapy. If the eruption path is cleared and there is adequate space to accommodate the cuspid tooth by age 11 or 12, there is a good chance it will erupt without additional surgical intervention. If the cuspid tooth has not erupted by age 13-14, it is unlikely that it will erupt without surgical intervention.

What if the Cuspid Tooth Does Not Erupt?

In cases where the cuspid tooth does not erupt spontaneously, the orthodontist and oral surgeon work together to promote its eruption. The orthodontist will place braces on the teeth and create space to accommodate the impacted tooth at its proper position in the dental arch. If the deciduous (baby) cuspid has not previously fallen out, it is usually left in place until sufficient space has been established for the permanent cuspid. When adequate space has been created, the orthodontist will refer the patient to the oral surgeon to have the impacted cuspid tooth surgically exposed and bracketed.

Sixty percent of impacted cuspid teeth are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted cuspids are positioned in the middle of the ridge often stuck above the roots of the adjacent teeth or out to the facial side of the dental arch. The surgical and orthodontic techniques employed to aid the eruption of impacted teeth can be applied to any impacted tooth in the mouth.

The gum above the impacted tooth is opened to expose the hidden tooth underneath. If there is a deciduous cuspid present, it is removed at this time. An orthodontic bracket is bonded to the exposed tooth. The bracket is attached to a miniature gold chain which will be temporarily secured to the orthodontic archwire. Often the exposed impacted tooth is left completely uncovered. Occasionally the gum is returned to its original position above the impacted tooth with only the fine gold chain remaining visible as it exits a small hole in the gum.

A post-operative visit will be made with Dr. Turesky approximately one week after surgery. The patient will return to the orthodontist approximately 10 to 14 days after surgery. The orthodontist will use the chain to apply a light eruptive force on the impacted tooth. This will begin the process of moving the tooth into its proper place in the dental arch. Orthodontic eruption of an impacted tooth is a carefully controlled process that may take a few months to a full year to complete. Once the tooth is moved into its final position in the arch, 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, minor gum surgery may be required to add bulk to the gum tissue over the repositioned tooth so it remains healthy during normal function.

It is not uncommon for both of the maxillary cuspids to be impacted. In these cases, the orthodontist will prepare space on both sides of the dental arch simultaneously. When sufficient space has been established, Dr. Turesky will expose and bracket both teeth in one visit. Since anterior teeth (incisors and cuspids) have single roots, they are easier to erupt if they become impacted than the multi-rooted posterior molar teeth. The orthodontic mechanics required to erupt impacted molar teeth are more complicated due to their multiple roots and location in the back of the dental arch.

Surgical exposure and bracketing impacted teeth to aid eruption is a very common procedure with an extremely high success rate. Surgical exposure of impacted teeth can be performed with complete comfort in our office under local anesthesia, intravenous general anesthesia (asleep), intravenous conscious sedation, nitrous oxide gas anesthesia with local anesthesia, oral sedation with local anesthesia. Dr. Turesky will review these anesthetic options with you during your consultation appointment.