Surgical Exposure of Impacted Teeth
Any tooth can be impacted. This means something is preventing its normal eruption into the mouth, such as bone, another tooth or dense soft tissue. Impacted teeth can damage the adjacent teeth making treatment more complicated.
Commonly the eye teeth or cuspids will be mal-aligned and not erupt. These teeth will generally need both orthodontic and surgical treatment. Since the cuspid normally erupts into the mouth around age 12, the orthodontist is the first to see the problem. Once the problem is identified, braces and initial orthodontic treatment are begun. The patient is then referred for surgical evaluation. In more complicated cases, a surgical consult may be required before orthodontic treatment is begun.
Consultation and surgical procedure
At consultation, special radiographs will be taken to determine the relative position of the impacted tooth to the adjacent teeth (shift-sketch study). Occasionally a CT scan is necessary. Surgical exposure will involve making a flap or window in the tissue to expose the crown of the tooth. Next a gold bracket and chain are attached to the crown and the chain attached to the patient’s orthodontic wires. We do not forcefully move the tooth; your orthodontist will slowly move the tooth and slowly pull the tooth into the mouth using the gold chain.
These procedures are very delicate and require a very cooperative patient; therefore intravenous anesthesia with supplemental local anesthesia is preferred.
Removal of the eye tooth
Occasionally the eye tooth is in such a bad position, we suggest removal of the eye tooth. In these cases, the tooth is extracted and the socket filled with a graft material. When the patient is an early adult, 17 – 20 years of age, an implant can be placed. In other cases, the space may be closed by orthodontic treatment. Also occasionally (1 patient in 200-300) the exposed tooth will not erupt despite exposure and traction. These teeth are removed and the site grafted. The space is then either closed orthodontically or left for an implant at a later date.
Duration of treatment and post operative care
Your office visit will be approximately 1 – 1 ½ hours. Total treatment time for eruption of an impacted tooth will vary from weeks to a year. The actual procedure causes soreness, but generally not significant pain. We usually give samples of pain medicine. Antibiotics are often not required. Most patients will return to the orthodontist in about 2-3 weeks following exposure.
Post operatively, patients should refrain from contact sports and running for 2-4 days. This will vary according to your particular treatment. Students should not return to school following surgery and generally are able to return to classes the following day.
Hard, crunchy foods will need to be avoided. Soup and foods like pasta are recommended for 2-3 days. Popcorn should be avoided for 6 weeks. You can refer to Post Operative Instructions on this website.
Other teeth
The surgical principles of exposure and bracketing can be applied to other teeth as well. Each situation will need to be evaluated both surgically and orthodontically. For more information, a specialty consult can be made with Dr. Cameron.