Exposure of Impacted Teeth

Impacted Canines

The upper canine teeth normally erupt when a patient is about 11 to 12 years old. In some cases, these teeth do not erupt properly and become dislodged and impacted in the roof of the mouth. In order to expose these teeth and help them come down into position, we can perform exposure surgery. This particular surgery simply cuts the gum around the impacted tooth so that it has room to grow down and into the mouth.

Early Recognition and Treatment

The American Association of Orthodontists recommends that a panorex screening x-ray, along with a dental examination, should be performed on all dental patients around the age of seven years to count the teeth and determine if there are problems with eruption of the adult teeth. It is important to determine whether all the adult teeth are present or if some adult teeth are missing.

Early screening can help determine:

  1. Are there extra teeth present or unusual growths that are blocking the eruption of the eyetooth?

  2. Is there extreme crowding or too little space available causing an eruption problem with the eyetooth?

Watch our AAOMS video to learn more about impacted canines!

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This exam is usually performed by your general dentist or hygienist who will refer you to an orthodontist if a problem is identified. Treating such a problem may involve an orthodontist placing braces to open spaces to allow 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 important eyeteeth. The oral surgeon will also need to remove any extra teeth (supernumerary teeth) or growths that are blocking the eruption of any of the adult teeth.

If the eruption path is cleared and the space is opened up by age 11-12, there is a good chance the impacted canine will erupt by itself into the mouth. If the canine develops too much (age 13-14) before the path to eruption is created, then the impacted eyetooth will not erupt by itself even with the space cleared for its eruption. This would require a simple surgical procedure (see below). 

What does the surgery involve?

In cases where the canine will not erupt spontaneously, the orthodontist and oral surgeon work together to get these unerupted canines to erupt. The most common scenario will call for the orthodontist to place braces on the teeth and create space so the impacted canine can be moved into its proper position in the dental arch. If the baby eyetooth has not fallen out already, it is usually left in place until the space for the adult eyetooth is ready. Once the space is ready, the orthodontist will refer the patient to the oral surgeon to remove the baby canine tooth and have the impacted adult canine tooth exposed and bracketed.

In this procedure, 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 surgeon will bond an orthodontic bracket to the exposed tooth. The bracket will have a small gold chain attached to it and 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). Most of the time, the gum tissue 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.

We recommended seeing your orthodontist within 7-14 days after surgery. Your orthodontist will then attach a rubber band 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.