Exposure of Impacted Teeth

What is an impacted tooth?

An impacted tooth simply means the tooth is “stuck” and therefore cannot erupt into function. Patients frequently develop problems with impacted third molar (wisdom) teeth, as these teeth are commonly “stuck” in the back of the jaws, leading to painful infections amongst a number of other potential problems. (Please refer to “Wisdom Teeth” under “Procedures” for additional information.) Since there is rarely a functional need for wisdom teeth, extraction is generally recommended when problems develop or are anticipated. The maxillary cuspids (upper eyeteeth) are the second most commonly impacted teeth. The cuspid teeth have the longest roots and are very strong biting teeth. They are the first teeth that touch when the jaws close together, and they guide the rest of the teeth into the proper bite. The cuspids are therefore critical teeth, playing a very important role overall in one’s “bite”.

Normally, the maxillary cuspid teeth are the last of the “front” teeth to erupt into place, usually about 13 years of age. Their eruption will often cause any space left between the upper front teeth to close tighter together. If there is inadequate space for all of the teeth to erupt and/or if teeth are angled in unfavourable positions, a cuspid tooth may be impacted. If this is the case, every effort is made to facilitate eruption of the cuspid 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 maxillary cuspid (upper eye) teeth. Sixty percent of impacted eyeteeth are located on the palatal (roof of the mouth) side of the dental arch. Eyeteeth may also be impacted in the middle of the supporting bone in an elevated position above the roots of the adjacent teeth, or are otherwise impacted on the facial side of the dental arch.

Early Recognition of Impacted Eyeteeth Is the Key to Successful Treatment

A panoramic x-ray, in combination with an oral examination, will reveal whether all of the teeth are present, if any of them are impacted, or if any teeth are missing altogether. If a patient is found to have an impacted adult eyetooth, the older the patient is, the more likely an impacted eyetooth will not erupt by natural forces alone, even if the space is available for the tooth to fit within the dental arch.

Treatment may 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 other impediments that are blocking the eruption of any adult teeth.

Probability of eruption success of an impacted tooth according to a patient’s age:

  • 11-12 years old – with space opened for eruption, good chance for success.
  • 13-14 years old – the impacted eyetooth will usually not erupt on its own, even with space cleared for its eruption.
  • Over 40 years old – much higher probability that the tooth will be fused in position, in which case the only option is to extract the impacted tooth and consider replacement options, such as a dental implant retained crown or a fixed bridge.

What happens if the eyetooth will not erupt when proper space is available?

For cases in which the eyeteeth will not erupt spontaneously, the Orthodontist and Oral Surgeon will work together to facilitate eruption, following individual evaluations by each Specialist. Dr. Özcan will perform a surgical procedure to expose the impacted eyetooth, and then place a bracket on the impacted eyetooth. In combination with the efforts of the Orthodontist, this treatment provides a mechanism for moving the tooth in a gradual manner through the bone, until it reaches its proper position within the tooth arch. 

The goal is to encourage eruption of the impacted tooth – not to extract it. Once the tooth has successfully moved into its final position, the gingiva (gum tissue) around the tooth will be evaluated. In some circumstances, minor “gum surgery” may be required, which would be performed by a Periodontist (who specializes in the treatment of the gums and other supportive tissues of the teeth).

Exposure and Bracketing of an Impacted Cuspid

What to expect from surgery to expose & bracket an impacted tooth

The surgery to expose and bracket an impacted tooth is a very straightforward surgical procedure routinely performed in the Oral Surgeon’s office. For most patients, it is performed under local anesthesia and possibly under intravenous sedation. In some cases, the impacted tooth requires only surgical exposure without subsequent bracketing, in which case a shorter procedure time is required. Such details will be discussed at the preoperative consultation with Dr. Özcan.

Please refer to “Preoperative Instructions” under “Surgical Instructions” for more information. Feel free to contact us at Prince George Phone Number (250) 614-1828 should you have any further questions.