Exposure of Impacted Canine

The maxillary cuspid (upper eye tooth) is the second most common tooth to become impacted after wisdom teeth. The cuspid tooth is a critical tooth in the dental arch and plays an important role in the way you bite. They are designed to be the first teeth that touch when your jaws close together so they guide the rest of the teeth into the proper bite. < ?xml:namespace prefix = o ns = “urn:schemas-microsoft-com:office:office” /?>

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 tight together. If a cuspid tooth gets impacted, every effort is made to get it to erupt into its proper position in the dental arch. 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.The majority of these impacted eye teeth are located on the palatal (roof of the mouth) side of the dental arch.


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


In cases where the eye teeth do not erupt spontaneously, the orthodontist and oral surgeon work together to help get these teeth into the proper position. Each case must be evaluated on an individual basis but treatment will usually involve a combined effort between the orthodontist and the oral surgeon. The most common scenario will call for the orthodontist to place braces on the teeth (at least the upper arch). A space will be opened to provide room for the impacted tooth to be moved into its proper position in the dental arch. If the baby eye tooth has not fallen out already, it is usually left in place until the space for the adult eye tooth is ready. Once the space is ready, the orthodontist will refer the patient to the oral surgeon to have the impacted eye tooth exposed and bracketed.


In a simple surgical procedure performed in the surgeon’s office, the gum on top of the impacted tooth will be lifted up to expose the hidden tooth underneath. If there is a baby tooth present, it will be removed at the same time. Once the tooth is exposed, the oral surgeonmay 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 (on selected cases located on the roof of the mouth).A dressing to cover the exposed area is usually placed. This helps to shield the surgical site thus making it more comfortable post operatively.Approximately 10 days later, this pack is removed.


Shortly after surgery (1-14 days) the patient will return to the orthodontist.Carefully controlled, gental pressue will applied to the tooth via the attached chain to help guide it into the appropriate position.This is a carefully controlled, slow process that may take up to a full year to complete


What to expect from surgery to expose and bracket an impacted tooth?


The surgery to expose and bracket an impacted tooth is a very straight forward surgical procedure that is performed in the oral surgeon’s office.The option exists to have the procedure performed under IV sedation if the patient desires to be asleep, but this is generally not necessary for this procedure. Occasionally it becomes difficult to attach the chain on the same day of surgery.For these patients it’s best to return for a short appointment approximately 2 weeks later to have the chain placed.This second visit is extremely quick and easy and doesn’t even require anesthesia. All issues will be discussed in detail at your preoperative consultation with your doctor.


You can expect a limited amount of bleeding from the surgical sites 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 2-3 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; it can be minimized by applying ice packs to the lip for the afternoon after surgery. A soft, bland diet is recommended at first, but you may resume your normal diet as soon as you feel comfortable chewing. It is advised that you avoid sharp food items like crackers and chips as they will irritate the surgical site if they jab the wound during initial healing. Your doctor will see you 7-10 days after surgery to evaluate the healing process and make sure you are maintaining good oral hygiene. You should plan to see your orthodontist within 14 days to activate the eruption process by applying the proper rubber band to the chain on your tooth. As always your doctor is available at the office or can be paged after hours if any problems should arise after surgery. Simply call one of our offices if you have any questions