Exposure of Impacted Teeth

An impacted tooth simply means that it is “stuck” and cannot erupt into function.  The maxillary cuspid (upper eyetooth) is the second most common tooth to become impacted next to wisdom teeth. The cuspid tooth is a critical tooth and plays an important role in your “bite” and smile esthetics. The cuspid teeth are very 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.

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 tighter together.    It is not uncommon that these upper canines cannot erupt and get blocked out by the adjacent teeth.    Although upper canines are the most common teeth we see for exposure, we frequently see others as well.   

Exposure and bond of a bracket on an impacted tooth is a procedure performed in coordination with an orthodontist.  Often, the orthodontist will perform some basic alignment and create sufficient space for the canine prior to referring a patient to our practice.   The exposure and bonding procedure is simply to surgically access the tooth and the placement of a gold bracket on the impacted tooth surface and extend a gold chain to the arch wire (gold is very well tolerated and causes less tissue irritation).  The bracket and chain are often below the gum line and not visible until the tooth is near eruption.   The chain allow the orthodontist access to place gentle traction forces guiding the eruption of the impacted tooth.   As the tooth erupts slowly toward the tissue surface, links are removed from the chain. 

Although this treatment may take many months, depending upon the position of the impacted tooth, this procedure has an excellent success rate.    The brackets are placed on the impacted tooth surface with a bonding agent similar to other orthodontic brackets.   Occasionally, these brackets can come off the tooth surface and need to be replaced.    If this occurs, they will be replaced at no charge to the patient. 

What to expect

This routine procedure is usually tolerated very nicely by patients with minimal post-operative pain usually controlled by medications like Ibuprofen.    The procedure can be performed with local anesthesia alone, intravenous sedation, or nitrous oxide.     We will review the procedure in detail at the consultation visit, provide insight into your individual situation, and help explore which anesthetic option would be best suited for your needs.   Often this procedure is performed for pre- and early teens and we make special effort to make this procedure the best experience possible. 

Exposure and Bracketing of an Impacted Cuspid