Expose and Bond of impacted teeth


Impacted teeth refer to instances where teeth fail

to erupt into the mouth appropriately. An impacted tooth remains stuck in gum tissue or bone for various reasons. The area may be overcrowded, leaving no room for the teeth to emerge. For example, the jaw may be too small to fit the wisdom teeth. Teeth may also become twisted, tilted, or displaced as they try to emerge.


The most commonly impacted teeth are third molars or wisdom teeth. A canine tooth is the second most common tooth to become impacted and also some incisors or bicuspids.


A canine is an important tooth of the dentition because it is placed strategically in the mouth. It makes the transition between the anterior teeth (central and lateral incisors) and the posterior teeth, which are the first and second premolars. This tooth has a very long root; the longest of all teeth, and therefore, its position is unique in the dental arch. It erupts around age 12-13 after the premolars in the maxillary arch. Being the last one to arrive, it often has to put up with limited space. As it is a big sharp tooth, it is not uncommon to observe its prominence and its malposition. The canine usually erupts before the first premolar in the mandibular arch, but it sometimes happens that the order is reversed and, like its counterpart in the maxillary arch, it puts up with the remaining space.


Sixty five percent or more of these impacted canines are located on the roof of the mouth (palatal area) in the upper arch compare to vestibular impaction but if a canine tooth becomes impacted, every effort is made to get it to erupt into its proper position in the dental arch.


Early detection of an impacted canine is important because the dentist, orthodontist or oral surgeon will be able to determine the best method to help the tooth fit into place. Usually your general dentist or orthodontist will take an X-ray to determine if any teeth are impacted and to make sure growth is normal. If the oral surgeon needs to be involved, it is usually because the tooth is not positioned to erupt normally.


There are several different approaches to treatment for impacted canine teeth. The most conservative of treatments is to observe the tooth normally accompanied by extraction of the overlying baby canine tooth. The most aggressive form of treatment for impacted canines is surgical extraction of the tooth and, in some cases; this is the only appropriate choice for treatment.


The most common decision regarding orthodontic surgery is to undergo a procedure called canine exposure and bonding of traction device to the tooth. A 3D scan is usually required for exact localization of impacted tooth. The traction device will be bonded directly onto the tooth using typical dental composite materials. This device will normally incorporate a chain that will allow force to be applied to the tooth to help pull it into position in the jaw by attachment of the chain to the braces.


The surgery to expose and bracket an impacted tooth is a very straightforward surgical procedure; for most patients, the procedure will be performed under IV sedation. In selected cases it is performed with using laughing gas and local anesthesia. These issues will be discussed in detail at your preoperative consultation with your doctor.