A tooth is referred to as impacted when it is unable to erupt to function properly, in other words the tooth is stuck. A tooth that is commonly impacted is the third molar otherwise known as a wisdom tooth. They tend to be prevented from erupting correctly by the back of the jaw, which can cause infections and a wide variety of other issues. Take a look at our impacted wisdom teeth section under procedures to learn more. Wisdom teeth tend to be more or less unnecessary so they are usually extracted if any issues arise. The upper eyetooth otherwise known as a the maxillary cuspid is the next most commonly impacted tooth. These teeth play a critical role in the formation of your bite, as well as the dental arch. They are exceptionally strong and feature the longest roots of any teeth in the human mouth. They are meant to be the first teeth to make contact when your jaw closes. They will also guide your jaw into the correct bite, making them very important.
Under normal circumstances these teeth are the last of the front teeth to erupt. This tends to happen around the age of 13. They will cause any space that is left over between the upper front teeth to close. If a cuspid tooth is unable to erupt correctly it is important to make it erupt in the right location in the dental arch. The methods utilized to help eruption can be used on any tooth that is impacted on either the upper or lower jaw. They do tend however, to be used predominantly on the maxillary cuspid teeth. Around sixty percent of these impacted teeth end up on the palatal side of the dental arch, which is to say on the roof of the mouth. The remaining forty percent can be located in the middle of the supporting bone but are stuck in an elevated location above the roots of neighbouring teeth or they are out of the facial side of dental arch itself.
Recognizing early on that these teeth are impacted is essential to treating the problem successfully. With an older patient it is more and more likely that the tooth that is impacted will not erupt on its own, even if there is space available for it along the dental arch. It is recommended that a panorex screening x-ray be taken in conjunction with a dental examination around the age of seven. This will allow predictions to be made regarding potential issues that may be avoidable. This x-ray will help us determine if there are any adult teeth that are missing or whether there are extra teeth blocking the tooth from erupting correctly. It will also show us if there is too much crowding causing an eruption issue. This examination tends to be completed by your general dentist or a hygienist who can refer you to an orthodontist if there is an issue. Treatment can consist of orthodontic work such as a brace to open spaces to free up room for the teeth to erupt properly. An oral surgeon may need to be referred to treat the issue as well. Some over-retained baby teeth or certain adult teeth may need to be removed to make room for the eyeteeth. Surgery may also be necessary to remove any extra teeth or growths blocking the eruption route.
If the eruption route is clear and there is enough space freed up by the ages of eleven or twelve then it is likely that the impacted tooth will be to able erupt correctly. If this space is not cleared and the tooth develops too much, around the ages of thirteen and fourteen, then it will not erupt properly even if there is space for it to do so. If the patient is too old, over forty years old, then it is much more likely that the tooth itself will be fused into position. In both of these instances the tooth will unfortunately not be able to be moved regardless of the efforts of the orthodontist or oral surgeon. If this is the case then the only option is to extract the impacted tooth and investigate other treatment options to replace the tooth in the dental arch. This can consist of a crown with a dental implant or even a fixed bridge.
What will happen if the maxillary cuspid does not erupt properly when there is space for it to do so?
In instances such as these then your orthodontist and oral surgeon will work with one another to get any un-erupted teeth to erupt correctly. This is done on a case by case basis, but treatment will generally involve both professionals. The typical situation will be for the orthodontist is apply braces to the teeth in order to free up the necessary space. If the baby maxillary cuspid has yet to fall out then it will be left until the space for the adult version is available. Once this space is free then the orthodontist will typically refer the patient to an oral surgeon to have the impacted tooth exposed and bracketed.
The oral surgeon will then perform a straightforward procedure. This entails lifting the gum on the top of the impacted tooth to expose it, if there is a baby tooth there it will be extracted. When the tooth is exposed there will be a bracket bonded to it. This bracket has a very small gold chain connected to it, the surgeon will use it to attach to the orthodontic arch where it will be attached, temporarily. In some cases the exposed tooth will be left uncovered by using sutures to hold the gum up above the tooth creating a window in the gum tissue. There are even some cases where this is done to the roof of the mouth. In the majority of cases the gums will be placed back to its original location with only the chain staying in sight as it is visible through a small hole in the gums.
Soon after the surgical procedure the patient will need to visit the orthodontist again. During this appointment a rubber band will be affixed to the chain to put a light force on the tooth to help it erupt. This is the start of the slow movement of the tooth into the right location on the dental arch. This is a well controlled slow technique designed to help erupt the tooth. Once the tooth has reached the right location the surrounding gum tissue will be examined to ensure that it is strong and healthy enough to handle the chewing and brushing that it will be subjected to. In certain cases, mostly where the tooth has had to shift a long area, there may need to be a minor gum surgery to rebuild the gum tissue over the tooth so it can stay healthy and strong.
These procedures can be modified and applied to any impacted tooth. It is not very unlikely that both of the eyeteeth are impacted. In these instances the space required in the dental arch will be made at the same time. The surgeon will uncover the bracket on both teeth during the same appointment, that way the patient only has to heal from one surgery. Since bicuspid and anterior teeth are small and only have one root, they are much easier to erupt if they are impacted than posterior molars. The larger size and more routes makes the molars harder to relocate. They can also be much harder to access since they are further back on the jaw, and the dental arch.
New studies have suggested that if impacted teeth are detected early, with the exception of wisdom teeth, then treatment should be started at an earlier age to increase the likelihood of success. As soon as the problem is identified the patient ought to be referred to an orthodontist to be evaluated and treated as soon as possible. An appointment with an oral surgeon can happen even before braces are placed.
The oral surgeon will remove any over-retained baby teeth or certain problematic adult teeth. They will also extract any extra teeth or growths that stop a tooth from erupting correctly. They may also need to uncover an impacted maxillary cuspid and bracket it. This will help eruption to occur before the tooth is able to become fully impacted or stuck. This way by the time the patient is ready for braces the maxillary cuspid will have erupted sufficiently enough to be bonded to a bracket and be moved into the right place. This bypasses the need to force an eruption. In the grand scheme of things this will save time and require less braces for the patient.
What can be expected from the surgery to expose and bracket the problematic impacted tooth?
The surgery is actually fairly straightforward and is completed in the oral surgeon’s own office. For the vast majority of patients it uses laughing gas and a local anesthetic. Under certain conditions it is completed using IV sedation if the patient prefers to be asleep, but it is not usually necessary. Surgery tends to last about 75 minutes for one tooth or 105 minutes if there are two that require attention. If the tooth only needs to be uncovered then the surgery only requires half that time. The specific details of your surgery will be discussed prior to surgery during a consultation appointment. You may also look to preoperative instructions under the surgical instructions portion of this website if you need to review the specifics.
A small amount of blood is to be expected around the surgical sites post surgery. Most patients only need mild painkillers like tylenol or Advil to regulate the pain and discomfort after the surgery. After two or three days there ordinarily will be little to no need for any medication. There may however be some inflammation from keeping the lip up to look at the surgical site, which can be remedied by icing the site after surgery. It is not likely that there will be any bruising. your regular diet may have to be slightly altered to accommodate softer and more bland foods until you feel comfortable chewing again. It is recommended that you do not consumed foods with sharp edges as they will aggravate the surgical site by poking at the wounds. After a week to ten days you will see your doctor to examine how well the recovery is going. You should then see your orthodontist at the appropriate time so they can start the eruption process by placing the rubber band to the chain bonded to your tooth. Don’t forget that your doctor is available at the office or at anytime after hours if there are any complications after surgery. Feel free to call if you have any questions.
Martindale Dental provides both general and specialty dentistry under one roof. For more than 20 years, our dentists have been advocates for their patients oral health care needs. Our dental offices are conveniently located in Toronto, North York, St Catharines, North York, Burlington, Milton East and Milton West, Ontario. We offer convenient before & after work and weekend appointments.