An impacted tooth simply means that it is “stuck” and cannot erupt into function. Patients frequently develop problems with impacted third molar (wisdom) teeth. The maxillary cuspid (upper eyetooth) is the second most common tooth to become impacted. Because of its critical role, when a cuspid tooth gets impacted, every effort should be made to get it to erupt into its proper position in the dental arch.
Early Recognition Of Impacted Eyeteeth Is The Key To Successful Treatment
The American Association of Orthodontists recommends that all dental patients at the age of seven to be evaluated whether all the adult teeth are present or if some adult teeth missing.
If any potential eruption problem has been identified, an orthodontist may suggest 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 all-important eyeteeth. The oral surgeon will also need to remove any extra teeth (supernumerary teeth) or growths that are blocking the eruption of any adult teeth. If the eruption path is cleared and the space is opened up by certain age, there is a good chance that the impacted eyetooth will erupt with nature’s help.
Exposure & Bracket Placement
In some cases, the patient will be referred to the oral surgeon to have impacted tooth to be exposed and place a bracket. The bracket will have a miniature gold chain attached to it. The oral surgeon will guide the chain back to the orthodontic arch wire where it will be temporarily attached. Sometimes the surgeon will leave the exposed and impacted tooth completely uncovered by suturing the gum up high above the tooth, or making a window in the gum covering the tooth. Most of the time the gum will be returned to its original location and sutured back with only the chain remaining visible as it exits a small hole in the gum.
Shortly after surgery, the patient will return to the orthodontist and a rubber band will be attached to the chain to put a light eruptive pulling force on the impacted 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.
Each case must be evaluated on an individual basis, but treatment will usually involve a combined effort between the orthodontist and the oral surgeon.
What To Expect From Exposure Surgery
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 using laughing gas and local anesthesia. In selected cases it will be performed under IV sedation if the patient desires to be asleep. The procedure is scheduled for approximately 45 minutes for exposure and bracket placement. These issues will be discussed in detail at your preoperative consultation with your doctor.
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