Exposure and Bracketing of an Impacted tooth
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An impacted tooth simply means that it is “stuck” and cannot erupt into function. The maxillary cuspid (upper eye tooth) is the second most common tooth to become 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, which have the longest roots of any human teeth. They are designed to be the first teeth that touch when your jaws close together. As such, 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 at about the age of twelve (12) and cause any space left between the upper front teeth to close tightly together. If a cuspid tooth becomes impacted, every effort is made to get it to erupt into its proper position in the dental arch. The techniques involved to aid eruption can be applied to any impacted tooth in the upper or lower jaw, but most commonly they are applied to the maxillary cuspid (upper eye) teeth.
Early recognition of impacted cuspid teeth is the key to successful treatment
The older the patient, the more likely an impacted cuspid tooth will not erupt by nature’s 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 screening x-ray along with a dental examination be performed on all dental patients by the age of seven (7) in order to count the teeth and determine if there are problems with eruption of the adult teeth.
It is important to determine whether all the adult teeth are present or if some adult teeth are missing. Are there extra teeth present or unusual growths that are blocking the eruption of the cuspid tooth? Is there extreme crowding or too little space available causing an eruption problem with the cuspid tooth? This exam is usually performed by your general dentist or hygienist 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 to allow for proper eruption of the adult teeth.
Treatment may also require a referral to an oral surgeon for extraction of over retained baby teeth and/or selected adult teeth that are blocking the eruption of the all important cuspid teeth. The oral surgeon will also need to remove any extra teeth (supernumerary teeth) or growths that are blocking eruption of any of the adult teeth. If the eruption path is cleared and the space is opened up by age eleven or twelve (11 or 12), there is a good chance the impacted cuspid tooth will erupt naturally.
If the cuspid tooth is allowed to develop too much and remain impacted (age thirteen to fourteen 13-14), the impacted cuspid tooth will not erupt by itself even with the space cleared for its eruption. If the patient is too old, there is a much higher chance the tooth will be embedded in its position. In these cases the tooth will not budge despite all the efforts of the orthodontist and oral surgeon to encourage it to erupt into position. Sadly, the only option at this point is to extract the impacted tooth and consider an alternate treatment to replace it in the dental arch (crown on a dental implant or a fixed bridge).
What happens if the cuspid tooth will not erupt when proper space is available?
In cases where the cuspid teeth will not erupt spontaneously, the orthodontist and oral surgeon work together to get these unerupted cuspid teeth to erupt. Each case must be evaluated on an individual basis but treatment will usually involve a combined effort between the orthodontist and the oral surgeon.
In a surgical procedure performed 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 impacted 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. Sometimes the surgeon will leave the exposed impacted tooth completely uncovered by suturing the gum up high above the tooth or making a window in the gum covering the tooth. Shortly after surgery (approximately fourteen (14) days) 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.