Exposure of Impacted Teeth

When a tooth is simply “stuck”, which is preventing it from growing and functioning normally, it is called an impacted tooth. The most affected impacted teeth are the third molar teeth or the wisdom teeth. When these teeth get stuck at the end of the jaw, it causes severe pain and infection for the patient along with other issues. As there is hardly any function of wisdom teeth, it is generally extracted to relieve pain and do away with the problem of infection. The second most common tooth causing problems is the maxillary cuspid or the upper eyetooth. In your dental arch, cuspid teeth are critical and play a pivotal role when you bite. It is a strong biting tooth with the longest root than any other human teeth.  When you close your jaws together, these teeth are the first to meet and then they guide the other teeth to bite.

The maxillary cuspid teeth are the last front teeth that grow into place. When a person is around 13 years old, these teeth come out. It closes the space tightly between the upper front teeth. For an impacted cuspid tooth, we make every attempt to get it to erupt into the proper place in the dental arch. The techniques that are used for this are most commonly used for cuspid teeth but they can be applied in the case of other impacted teeth of the upper and lower jaw as well. In 60% cases, the impacted eyeteeth are located on the palatal side of the dental arch or the roof of the mouth. At times, it is also found in the middle of the supporting bone, stuck in an elevated position, out of the facial side of the dental arch or over the roots of the teeth around it.

If the Impacted Teeth are Recognized Early, the Treatment Can Be Successful

If the patient is older, it is more likely that the teeth will remain stuck and will need an external force to make it erupt even when there is enough space for it to erupt naturally. According to the recommendation of the American Association of Orthodontists, all dental patients, at the age of seven years, should get a panorex screening x-ray which will be able to count the teeth and also determine whether any adult teeth are stuck or impacted, or not. This x-ray can determine whether all the adult teeth have erupted or there is any tooth stuck or impacted. It will also determine the unusual growth that might block the adult teeth from being erupted normally. This way, you will know if there is enough space or not to let the eyeteeth erupt normally. This procedure of exam is performed by your dentist who can refer you to an orthodontist if there is any problem. The treatment can involve placing braces in order to provide the space for the eruption of the eyeteeth. The treatment will require the referral of the dentist about the extraction of the over-retained baby teeth and/or selected adult teeth that are blocking the natural eruption. The oral surgeon can also remove supernumerary teeth or the extra teeth that are blocking the growth and eruption of an adult tooth. When the path of eruption is clear by the age of 11 or 12, the eyeteeth will erupt naturally. However, if it is allowed too much to develop until the age of 13-14, the impacted eyetooth won’t erupt even if there is enough space for it. In the case of older patients, with almost 40 years of age, the tooth is most likely fused in its position. In this case, even after many efforts from the orthodontists and the oral surgeons, it won’t erupt anyway. In a situation like this, the only option is to extract the impacted tooth and go for some alternative treatment like a crown on a dental implant, or fixed bridge for replacing it in the dental arch.

What Will Happen if the Eyetooth Doesn’t Erupt Despite Having the Proper Place?

In the cases where the eyeteeth are prevented from erupting naturally, oral surgeons and orthodontists work together to make it happen. They will individually evaluate the case to see and consider every factor of the case. And after that, they will collaborate and work together. In most number of cases, the orthodontist will use the braces to manage the upper dental arch, providing enough space for the un-erupted teeth to erupt. If the patient has not lost the baby eyetooth naturally, it is more likely to be there waiting to come out until the space of adult eyetooth is there. After completing this process, the orthodontist will refer the patient to the oral surgeon for getting the impacted eyetooth exposed and bracketed.

With a simple surgical procedure, the surgeon will lift the gum of the impacted tooth to reveal the hidden tooth underneath. Now the oral surgeon will bond an orthodontic bracket on the exposed tooth. The miniature gold chain attached to the bracket will be now guided back to the orthodontic arch wire for temporary attachment. There are also cases where the surgeon leaves the impacted teeth completely exposed while suturing the gum up high above the tooth, leaving a window in the gum or on the roof of the mouth. Most of the time, the gum will return to the normal position and will be sutured while only the chain will remain visible for exiting the small hole in the gum.

After the surgery, the patient will come back again within 14 days and the orthodontist will place a rubber band on the chain for creating a light eruptive pulling force for the impacted tooth. With this, the process of moving the teeth in its proper place in the dental arch will begin. This slow process can take around one year to be complete. The aim is to make the impacted tooth erupt without risking for extraction. Once the tooth erupts, the surrounding gum will be tested to see if it is healthy and strong enough to withstand the impact of a lifetime of chewing and brushing. In case the tooth is moved a long distance, the oral surgeon will perform a gum surgery for adding bulk to the gum tissue over the relocated tooth in order to provide it with a healthy foundation for functioning normally. If you need this procedure to be done, your oral surgeon or orthodontist will explain it to you.

These basic principles can be applied to other impacted teeth as well. Often both the maxillary cuspids can be affected. In that case, the space needs to be created from both sides of the dental arch, all at once. It will be done with one surgery where the oral surgeon will expose and bracket both teeth when the orthodontist is done. This way the patient will only have to heal from one surgery. Both anterior teeth and bicuspid teeth can be easy to erupt even if they are impacted, as they are small and have a single root. The posterior molar teeth are difficult to erupt while impacted as they are bigger with multiple roots. That is why orthodontists need to work with the surgeon for dealing with this issue.

Recent studies show that it is not just the early detection of the impacted teeth but also the early treatment that is necessary for treating this issue. The moment the dentist identifies the problem, it needs to be immediately forwarded to the orthodontist for early evolution. In some cases, the oral surgeon needs to get involved before the braces are placed for removing the over-retained baby teeth and/or the adult teeth that are blocking the natural eruption of the impacted eyeteeth. Finally, the surgeon might be asked to expose the impacted teeth without bracketing it which is a much easier process than that of bracketing the impacted teeth. This way a part of the teeth can erupt even if it is stuck. By the time the patient will be old enough to get the braces, the orthodontist will have to simply move the teeth to its place instead of forcing the eruption first. This way, patients will have to spend less time with braces.

What can You Expect from Surgery to Expose and Bracket the Impacted Teeth?            

This needs a very straightforward procedure that can be carried out at the clinic of the oral surgeon. Generally, this is done with the help of laughing gas or general anesthesia. If the patients want to be sedated and asleep, the procedure is done with IV sedation. However, this is not always necessary. The time the procedure requires is 75 minutes for one tooth and 105 minutes if both sides need to be exposed or bracketed. If the procedure needs only exposing the teeth but not bracketing, then the time will come down to half. You can get more details about the procedure once you come for your appointment with the surgeon at Rolle Oral & Facial Surgery.

There will be some natural bleeding from the surgical site after the procedure is done. There will be some discomfort and pain too, which most of the patients can bear with Tylenol or Advil. In two or three days post the surgery, the pain will be under control and hardly any medication will be needed. As during the surgery, the lips will be stretched to keep the surgical site visible, it might cause some bruising. For this, you can use ice packs on the lips. Bruising is not uncommon for the patients who go through this procedure. Initially, just after the surgery, you can go for a soft bland diet. But with time, once you become comfortable, you can resume your normal diet. Crackers, chips and similar sharp food items should be avoided so that they don’t jab the surgical site and cause unnecessary pain. The patient will be asked to see the doctor after seven to ten days of the surgery. The doctor will evaluate your healing process as well as your overall oral hygiene. The patient needs to plan to see the orthodontist in 14 days for attaching the rubber band to the chain and to activate the eruption process. If you find any further issues or need to consult the doctor, you can call us at Rolle Oral & Facial Surgery at 704-892-9500 right away.