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Impacted canines and other impacted teeth other than third molars

Impacted tooth is a tooth that has simply “stuck” to the jaws and has not erupted in the mouth. Often patients have problems with closed third molars. These teeth can stick to the back of the jaws and cause painful inflammation and many other problems (see impacted third molars). Because there is no functional need to hold the wisdom tooth, when they cause a problem, we surgically remove them.

The canines of the upper jaw are the most common teeth that stick to the jaw immediately after the wisdom tooth. Canines are very important teeth and play a key role in how we bite. The canines are also very strong teeth and have the longest root of all teeth. They are designed to be the first teeth that come into contact when the jaws are closed and thus lead the other teeth to the correct closure.

Normally canines are the last of the front teeth to rise. They usually rise to the age of 13 and close any space between the front teeth by squeezing them. If a canine is enclosed then every effort must be made to get it right in the dental arch.

Techniques that help tooth eruption can be applied to any closed upper and lower jaw teeth but most commonly applied to the upper jaw canines. 60% of enclosed canines are on the roof of the mouth (palate).

Early diagnosis of impacted canines  is the key to successful treatment.

The older the patient is, the less likely it is for the canine to normalize, even if the space required is there. We recommend radiographic (panoramic) examination at the age of 7 to measure all teeth and determine if there are problems with their sunrise.

It is very important to see if all the permanent teeth are present or if one is missing. Are there any extra teeth or other causes that prevent the canine’s east? Is there a crowding of teeth or is there too little space to prevent the canine’s eruption?

The orthodontist places brackets to create the proper space for the permanent tooth eruption. If necessary, the maxillofacial surgeon may remove the neonate (child tooth) and / or a selected permanent tooth that prevents the eruption of very important canines. The maxillofacial surgeon may need to remove any extra tooth (supernumerary) or some other obstacle that blocks normal tooth orientation. If the path to the eruption is “clean” and enough space is opened by the age of 11-12 years, then the canine can naturally rise. If canines are allowed to grow up to the age of 13-14 it is difficult to erect them normally, even if there is space.

If the patient is old enough (over 40 years) then there is a high chance that the canine will be anchored to the bone. In these cases, the tooth, despite all efforts, cannot move. Unfortunately, the only solution left is to extract the enclosed tooth and replace it in some other way (e.g. implant or bridge).

What happens when the canines do not erupt despite the space available?

In cases where the canines do not erupt spontaneously, the maxillofacial surgeon works with the orthodontist to ‘put’ the tooth into the dental barrier. Each case has to be evaluated separately but the treatment usually involves this maxillofacial-orthodontic collaboration.

The most common treatment scenario begins with the orthodontist placing braces. This creates the right place for the canine eruption. If the newborn canine is still there, it usually stays on until the appropriate space is created. When the appropriate space is created, the orthodontist will refer the patient to the maxillofacial surgeon to reveal the impacted tooth and attach it through a bracket to the other teeth.

Revelation surgery is usually performed under local anesthesia. Essentially the gums covering the tooth enclosed are lifted to reveal the tooth. If there is also a tooth (child) tooth this is extracted in the same procedure. Then a bracket is placed on the enclosed tooth, which, through a chain, is attached to the other braces.

Soon, (1-14 days) after surgery, the patient visits the orthodontist again, who places the appropriate forces on the tooth to move it. It is usually a slow process that takes almost a year. Remember, the point is to make the tooth lift and not to remove it!! When the tooth takes its place in the dental  arch, the final assessment is made.

If they are not thick enough then you may need a plastic surgery to get it. These basic principles apply in all cases of impacted teeth. In cases where both canines are closed then the revelations are made in a surgical procedure. Thus, the patient has to wait only once for the healing period.

What can I expect from the exposure and placement of brackets on a impacted tooth?

The exposure of an impacted tooth is usually performed under local anesthesia in the maxillofacial surgery. It lasts up to about 60 minutes (above if it is two impacted teeth). The details of the procedure are something we can discuss in an appointment and answer any questions you may have.