Canine Exposure (For Braces)
What is an Impacted Tooth?
An impacted tooth simply means that the tooth is “stuck” in the jaw and cannot erupt into function. The canine tooth is the second most common tooth to become impacted. Ths tooth is critical in the dental arch and plays an important role in your chewing function. The canine teeth are the strongest teeth and have the longest roots in our mouth. Normally, canine teeth are the last of the “front” teeth to erupt into place and usually come into place around age 13. If a canine tooth is impacted, every effort is made to get it to erupt into its proper position. 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 canine teeth.
Early Recognition Of Impacted Teeth Is The Key To Successful Treatment
The older the patient the more likely an impacted canine will not erupt by natural forces alone, even if the space is available for the tooth to fit in the dental arch. Your dentist or orthodontist often times will determine through examination and x-rays if there are impacted teeth requiring exposure. It is important to determine whether all the adult teeth are present, if a tooth is impacted or if some adult teeth are missing.
This examination is usually performed by your dentist 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 allowing 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 very important canine teeth. The oral surgeon will also need to remove any extra teeth (supernumerary teeth) or sometimes even growths that are blocking the eruption of any adult teeth.
If the eruption path is cleared and the space is opened up by age 11-12, there is a chance that an impacted canine tooth will erupt with on its own. If the canine tooth is allowed to fully develop under gum and bone (by age 13-14), the impacted canine tooth will not likely erupt by itself, even with the space cleared for its eruption. If the patient is older (between the ages of 18 and 40), there is a much higher chance that the tooth will be fused in position. In these cases, it is possible that the tooth will not move into position despite orthodontic and surgical efforts to erupt it into place. The only option at this point may be to extract the impacted tooth and consider an alternate treatment to replace it in the dental arch.
What Is Involved With Exposure Procedures:
In cases where the impacted tooth will not erupt spontaneously, the orthodontist and oral surgeon will work together to get these teeth to erupt. Each case must be evaluated on an individual basis with a pre-operative consultation. During the consultation, additional x-rays and possible CT images may be obtained. Surgical protocols with be described and anesthetic options will be reviewed.
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 baby eyetooth has not fallen out already, it may be removed early to try to facilitate eruption of the impacted Canine, or it may be removed at the time of the exposure procedure. Once the space is ready, the orthodontist will refer the patient to the oral surgeon to have the impacted tooth exposed and bracketed.
In an office procedure, gum tissue and bone will be managed to expose the impacted tooth. Once the tooth is exposed, the oral surgeon will bond a specialized orthodontic bracket with an attached miniature gold chain. The oral surgeon will guide the chain back to the orthodontic arch wire where it will be temporarily attached.
Either on the same day as surgery or up to 14 days after surgery, the patient will return to the orthodontist so the elastics can be placed to start the process of erupting the 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. Once the tooth has 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 a need to evaluate the area for gum grafting or adding healthier stronger gum tissue. Your oral surgeon, orthodontist or dentist will identify this issue if it applies to your specific situation and possibly refer you to a gum specialist.
In summary, management of impacted teeth with a team approach using your orthodontist and your oral surgeon is often highly successful when timed properly and provides long-term stability of the dental complex for proper function and appearance.