Impacted Canines

What are impacted canines?

An impacted tooth refers to a tooth that is stuck in the gum and cannot erupt. The most common type of impacted teeth are wisdom teeth (third molars), but other teeth can be impacted as well. While impacted teeth can occur in other areas of the mouth, the second most common type of impacted teeth are maxillary cuspids (also called canines or eye teeth). 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. When these impacted teeth will not erupt on their own, surgical intervention may be needed, with a procedure called a surgical exposure. Typically, the oral surgeon will work with an orthodontist to coordinate treatment.

The Role of the Orthodontist:

Identifying teeth that may need to be surgically exposed begins at the general dentist’s office when a patient has their first Panorex X-ray, usually around the age of 7 years old, followed by a referral to an orthodontist. The orthodontist will then identify if a patient has primary (baby) teeth that need extractions and impacted teeth that might need exposures in order to properly erupt. By using braces, the orthodontist will create space, if necessary, for the impacted teeth to erupt. Once the orthodontist feels there is enough space, they will refer the patient to the oral surgeon for the impacted tooth to be exposed. In many cases, the orthodontist will ask the surgeon to place a bracket and chain onto the newly exposed tooth. This will then be used by the orthodontist to guide the tooth into place in the dental arch.

The Role of the Oral Surgeon:

After getting a referral from the orthodontist, the patient will first meet with the oral surgeon for a consultation. At this appointment, the surgeon will review the orthodontist’s treatment request, discuss anesthesia options, and create a surgical plan. Most patients tolerate dental exposures under local anesthesia, although nitrous oxide (laughing gas) and IV sedation can also be discussed.

For most patients, the surgery to expose an impacted tooth and place a bracket is very straightforward; it is performed in our office and usually takes under one hour. The gum on top of the impacted tooth will be lifted up to expose the hidden tooth underneath, and if there is a baby tooth present, it will be removed at the same time. Once the tooth is exposed, the oral surgeon will bond an orthodontic bracket to the exposed tooth. 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 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.

After Surgery:

A limited amount of bleeding from the surgical sites can be expected after surgery. Although there will be some discomfort after surgery at the surgical sites, most patients find Tylenol or Advil to be more than adequate to manage any pain they may have. Within two to three days after surgery, there is usually little need for any medication at all. There may be some swelling from holding the lip up to visualize the surgical site, which can be minimized by applying ice packs to the lip for a few hours after surgery. A soft, bland diet is recommended at first, but a normal diet can be resumed as soon as it is comfortable to chew. It is advised to avoid sharp food items like crackers and chips, as they will irritate the surgical site if they jab the wound during initial healing. Please refer to your postoperative instructions with any questions or call OMSA.

Returning to the Orthodontist:

Your orthodontist will give you instructions on how long to wait after your surgery before seeing them again. Then they will begin the carefully controlled process of moving the tooth into its proper place in the dental arch. Remember, the goal is to erupt the impacted tooth and not to extract it! Once the tooth is 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 toothbrushing.