An impacted tooth is one that is simply buried beneath mucosa (gum tissue) and/or bone and cannot erupt into function. Patients frequently develop problems with impacted third molar (wisdom) teeth. These teeth remain buried in the back of the jaw and can develop painful infections and other problems (see Wisdom Teeth under Procedures). Since there is rarely a functional need for wisdom teeth, they are usually extracted whether they do or do not develop problems. The maxillary cuspid (upper “eyetooth”) is the second most common tooth to become impacted. Most often, when one is impacted, they both are impacted. The cuspid tooth plays an important functional role in your “bite”. These teeth are very strong teeth and have the longest roots of any of the teeth. They function to protect the other teeth from excessive forces during normal chewing motion. Thus they prolong the life and health of ALL of the other teeth.
The maxillary cuspid teeth are the last of the “front” teeth to erupt into place. They usually come into place around age 13 and help close any of the spaces left between the upper front teeth. If a cuspid tooth remains impacted beyond this age then every effort is made to assist its eruption into its proper position in the dental arch. The techniques utilized to aid eruption can be used with any impacted tooth. Surgical exposure is performed by an oral surgeon to partially expose the crown of the impacted tooth, bond a bracket and chain to it and give a gentle nudge to it. The orthodontist then attaches the chain to the “braces” and slowly guides the tooth into its normal position.
Sixty percent of these impacted cuspids are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted cuspids lie either between the adjacent teeth or are labial (towards the lip side) of the dental arch.
The older the patient becomes, the more likely it is that an impacted cuspid will not erupt naturally into the dental arch. The American Association of Orthodontists recommends that a panoramic screening x-ray and a dental examination be performed on all dental patients at age seven. The dentist can then determine the number of permanent teeth (adult teeth) and whether there is room for these teeth to erupt normally into the dental arches. It is important to determine whether extra (supernumerary) or missing teeth exist. An over crowded arch will most commonly lead to impacted cuspids. This exam is usually performed by your general dentist who will refer you to an orthodontist if a problem is identified. Treating such a problem may involve an orthodontist placing braces to create spaces to allow for proper eruption of the adult teeth.
Treatment may require referral to an oral surgeon for extraction of retained baby teeth and/or selected adult teeth that are blocking the eruption of the all-important “eyeteeth”. The oral surgeon may also need to remove any supernumerary teeth that are blocking 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 “eyetooth” will erupt with naturally. If the impacted “eyetooth” develops too long (past age 13-14), it will not erupt by itself even if ample space exists. After the age of 14 there is a much higher chance that the tooth will be ankylosed (fused) in position and will require surgical exposure to aid in its eruption. In such cases, the tooth may not budge despite all the efforts of the orthodontist and oral surgeon to assist with its eruption into place. Any impacted tooth which cannot be coaxed into its eruptive path may ultimately need to be removed.
When the “eyeteeth” will not erupt spontaneously, the orthodontist and oral surgeon work together to facilitate eruption. Each case must be evaluated and treated on an individual basis. Most commonly, the orthodontist will place braces on the teeth. A space will be created between the adjacent teeth to provide room for the impacted tooth to move or be moved into its proper position in the dental arch. If the baby cuspid has not been lost, it is usually left in place until the space for the adult cuspid is ready.
Once the proper space for eruption has been gained, the orthodontist will refer the patient to the oral surgeon to have the baby tooth removed and to have the impacted cuspid surgically exposed and bracketed. The opening in the gum tissue is shaped to enhance both short term and longterm healing. This can greatly enhance the gum contours around the cuspid once it erupts into position.
Surgical exposure of impacted canines is an out-patient procedure performed in the surgeon’s office with IV sedation or general anesthesia. The gum tissue overlying the impacted tooth will be lifted up to expose the hidden tooth underneath. The bone surrounding the tooth crown will be partially removed. The impacted tooth is then given a gentle nudge with an instrument to ensure that it will move. The oral surgeon will then bond a bracket to the exposed tooth and the fine gold chain attached to it will be temporarily attached to the orthodontic arch wire (braces). Small sutures are placed for stabilization of the gum tissue. Gauze packs rare placed and the patient is dismissed to home. Oral wounds normally heal very quickly. Chewing through foods with the front teeth is avoided for 4 - 6 weeks.
The patient returns to the orthodontist within 2 weeks where a guiding spring or band will be attached to the chain to put a light eruptive 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 year to complete. The gum tissue contours will be carefully evaluated as healing progresses around the cuspid once it has assumed its normal position in the dental arch. You will be notified if any additional gum tissue grafting or shaping will be necessary. Dr. Perry is well qualified to provide these services where and when they are needed.
Other adult teeth that remain in an impacted position may require surgical/orthodontic intervention to aid in their eruption. Once a space is created orthodontically, the impacted tooth may respond to surgical exposure alone, or it may require a bonded bracket and chain with traction. Certain teeth (especially molars) may not respond to such treatment and may require extraction. The restoration of any missing tooth may require bone grafting plus implant and crown placement. Your dentist, orthodontist and oral surgeon can confidently guide you through such unique treatment needs.