Impacted Canines

An impacted tooth simply means that it is “stuck” and cannot erupt into function.  The maxillary cuspid (upper eyetooth) is a common tooth that is impacted.  The cuspid tooth is a critical tooth in the dental arch and plays an important role in your “bite”. The cuspid teeth are very strong biting teeth and have the longest roots of any human teeth. 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.

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. If a cuspid tooth gets impacted, every effort is made to get it to erupt into its proper position in the dental arch. Sixty percent of these impacted eyeteeth are located on the palatal (roof of the mouth) side of the dental arch.

Early Recognition Of Impacted Eyeteeth Is The Key To Successful Treatment

The older the patient the more likely an impacted eyetooth will not erupt by natural forces alone, even if the space is available for the tooth to fit in the dental arch. The American Association of Orthodontists recommends that a panoramic x-ray, along with a dental examination, be performed on all dental patients at the age of seven to determine if there are problems with eruption of the adult teeth.

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 open spaces allowing for proper eruption of the adult teeth. Treatment may also require an oral surgeon to extract over-retained baby teeth and/or selected adult teeth that are blocking the eruption of the eyeteeth.

If the eruption path is cleared and the space is opened up by age 11-12, there is a good chance that the impacted eyetooth will erupt with nature’s help.  If the patient is older, there is a much higher chance that the tooth will be fused in position. In these cases, the tooth will not budge despite all the efforts of the orthodontist and oral surgeon to erupt it into place. At this point, the only option is to extract the impacted tooth and consider an alternate treatment to replace it.

What Happens If The Eyetooth Will Not Erupt When Proper Space Is Available?

In cases where the eyeteeth will not erupt spontaneously, the orthodontist and oral surgeon will work together to get these teeth to erupt. Each case must be evaluated on an individual basis. 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 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 have the impacted eyetooth exposed and bracketed.

The surgical procedure will be done 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 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. 

A few days after surgery, the patient will return to the orthodontist. A rubber band will be attached 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. Remember, the goal is to erupt the impacted tooth and not to extract it. In some circumstances, especially those where the tooth had to be moved a long distance, there may be some minor “gum surgery” required to add bulk to the gum tissue over the relocated tooth so that it remains healthy during normal function. Your dentist or orthodontist will explain this procedure to you if it applies to your specific situation.


Exposure and Bracketing of an Impacted Cuspid


These basic principals can be adapted to apply to any impacted tooth in the mouth. It is not that uncommon for both of the maxillary cuspids to be impacted. In these cases, the space in the dental arch will be prepared on both sides at once. When the orthodontist is ready, the surgeon will expose and bracket both teeth in the same visit so that the patient only has to heal from one surgery. 

What To Expect From Surgery To Expose & Bracket An Impacted Tooth

The surgery to expose and bracket an impacted tooth is a very straightforward surgical procedure that is performed in the oral surgeon’s office. It is usually performed using I.V. Sedation or general anesthesia. The procedure usually takes about an hour.  If the procedure only requires exposing the tooth with no bracketing, the time required will be a little shorter. These issues will be discussed in detail with the patient and parent on the consultation visit. 

You can expect a limited amount of bleeding from the surgical sites after surgery. Although there will be some discomfort after surgery, most patients find that Ibuprofen or Tylenol are adequate to manage their discomfort.  Within two to three days after surgery, there is usually little need for any medication at all. There may be some swelling for a few days after the procedure that can be minimized by applying ice packs to the lip for 36 hours after surgery.  A soft, bland diet is recommended for a week after the procedure. 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. Dr. Kilkuts will see you 7 to 10 days after surgery to evaluate the healing process.  You should plan to see your orthodontist a few days later to activate the eruption process.