If the impacted tooth does not erupt by itself, the oral surgeon and orthodontist must perform procedures to help.
Each case is unique and should be examined individually; however, the treatment usually involves both the orthodontist and oral surgeon collaborating to resolve the issue.
Usually, the treatment plan will include the orthodontist placing braces on the patient’s teeth. This will create space for the impacted tooth to move to its expected position all by itself.
Dentists leave the baby canine untouched if it has not come out yet until the required space is created. Once it is, the oral surgeon will expose and bracket the impacted canine. It is a simple procedure performed by surgeons in their offices.
During the impacted canine surgery, the gum that conceals the impacted eye tooth will be lifted to expose the tooth. If the baby tooth is still there, it will also be removed at that time.
After the impacted tooth has been exposed, the oral surgeon ties the exposed tooth with an orthodontic bracket. This bracket has a small gold chain attached to it.
The surgeon will then guide this chain to where the orthodontic archwire is, attaching it temporarily. In some cases, the oral surgeon may uncover the exposed impacted canine by:
- Making a ‘window’ to reveal the impacted tooth through the gum (which is sometimes on the palatal side)
- Using sutures to pull the gum above the tooth
Usually, the gum returns to its original place and is sutured up, while the chain is visible through a tiny hole made in the gum.
The patient is then required to revisit the orthodontist within fourteen days. They will attach a rubber band to the chain so that there is a subtle pulling force created to aid the eruption of the impacted tooth.
This procedure will help move the impacted tooth to its proper position. The whole process is prolonged and controlled, so it usually takes about a year to complete.
Keep in mind that the goal of this process is to aid the tooth’s eruption process, not extraction!
Once the tooth has moved to its final place in the dental arch, the dentist will evaluate the gum surrounding it to make sure it is healthy enough to last a lifetime worth of brushing and chewing.
Sometimes, in cases that involve the impacted tooth being moved a long way down, minor surgery may be required on the gum so that the surgeon can bulk up the gum tissue on top of the erupted tooth. This is done to avoid issues with standard tooth functionality.
These procedures can be performed on impacted teeth located anywhere in the mouth. Usually, the upper eye teeth are the ones that get affected the most.
And if they are both impacted at the same time, your orthodontist will create the space needed in your dental arch on both impacted teeth together.
Once the orthodontist gives the green signal, the oral surgeon will use the required methods to expose the impacted teeth and bracket them during the same appointment, meaning that you will only have to go through the impacted canine surgery once.
Keep in mind that the bicuspid and anterior teeth (cuspids and incisors) are smaller, having singular roots, making it easier for them to erupt even if they are impacted.
On the other hand, the posterior molar teeth are bigger, having multiple roots, making it more challenging to erupt.
It is a lot more complicated for an orthodontist to operate on impacted molar teeth because they are located at the back of the mouth. Studies have shown that with early recognition of impacted canines, the treatment should begin with haste.
As soon as a hygienist or general dentist identifies potential eruption problems, patients should see an orthodontist to be evaluated. Sometimes, patients are even referred to an oral surgeon before they get braces.