Exposure of unerupted teeth

An impacted tooth simply means that it is stuck under the gum line and cannot erupt into function. Patients frequently develop problems with impacted third molar (wisdom) teeth. These teeth get stuck in the back of the jaw causing painful infections among other problems (see Impacted Wisdom Teeth under “Procedures” section). Since there is rarely a functional need for wisdom teeth, they are usually extracted if they cause problems. The maxillary cuspid (upper eyetooth) 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 and have the longest roots of any human teeth. They are designed to be the first teeth that touch when your jaws close together, so they can guide the rest of the teeth into the proper alignment.

Normally, the maxillary cuspid teeth are the last of the front teeth to erupt into place. They usually come into place around age 13 and cause any space left between the upper front teeth to close tighter together. If a cuspid tooth gets 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. Commonly, they refer to the maxillary cuspid (upper eye) teeth. Sixty percent of these impacted eyeteeth are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted eye teeth are found in the middle of the supporting bone, stuck in an elevated position above the roots of the adjacent teeth or out to the facial side of the dental arch.

Early Recognition of Impacted Eyeteeth is the Key to Successful Treatment:

The older the patient, the more likely an impacted eyetooth will not erupt naturally, even if space is available for the tooth to fit in the dental arch. The American Association of Orthodontists recommends that a panorex screening x-ray along with a dental examination, be performed on all dental patients around age seven, to count the teeth and determine if there may be problems with eruption of the adult teeth. Are extra teeth present or unusual growths that are blocking the eruption of the eyetooth? Is there extreme crowding or too little space available causing an eruption problem with the eyetooth?

This exam is usually performed by your general dentist or hygienist, who will refer you to an orthodontist if a problem is identified. Treatment may involve an orthodontist placing braces to open spaces to allow for proper eruption of the adult teeth. Treatment may also include a referral to one of our doctors at Northeast Oral Surgery and Dental Implant Center, for extraction of over-retained baby teeth and/or selected adult teeth that are blocking the eruption of the all-important eyeteeth.

Our doctors may need to remove any extra teeth (supernumerary teeth) or growths that are likely blocking the eruption of any of the adult teeth. If the eruption path is cleared and the space is opened up by age 11-12, there is a good chance the impacted eyetooth will erupt with natures help alone. If the eyetooth is allowed to develop too much (age 13-14), the impacted eyetooth will not erupt by itself even with the space cleared for its eruption. If the patient is too old (over 40), there is a much higher chance the tooth will be fused in position. In these cases, the tooth will likely not budge, despite all the efforts of the orthodontist or our doctors. The only viable 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 Eyetooth will not Erupt when Proper Space is Available?

When eyeteeth do not erupt spontaneously, an orthodontist and our doctors at Northeast Oral Surgery and Dental Implant Center work together to get these unerupted eyeteeth to erupt. Each case must be evaluated on an individual basis, but treatment usually involves a combined effort between an orthodontist and one of our doctors. The most common scenario requires the orthodontist to place braces on the teeth (at least the upper arch). A space will be opened to provide room for the impacted tooth to be moved into its proper position in the dental arch. If the baby eyetooth has not fallen out already, it is usually left in place until the space for the adult eyetooth is ready.

Once the space is ready, the orthodontist will refer the patient to our office to have the impacted eyetooth exposed and bracketed. Shortly after surgery (1-14 days), the patient will return to the orthodontist. A rubber band is 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. This is a carefully controlled, slow process that may take up to a full year to complete. Remember, the goal is to erupt the impacted tooth and not to extract it!


Exposure and Bracketing of an Impacted Cuspid


These basic principals can be adapted to apply to any impacted tooth in the mouth. It is not uncommon for both of the maxillary cuspids to be impacted. In these cases, space in the dental arch form will be prepared on both sides at once. When the orthodontist is ready, one of our doctors will expose and bracket both teeth in the same visit, so the patient only has to heal from one surgical procedure. Because the anterior teeth (incisors and cuspids) and the bicuspid teeth are small and have single roots, they are easier to erupt if they become impacted, than the posterior molar teeth. The molar teeth are much bigger and have multiple roots, making them more difficult to move. The orthodontic maneuvers needed to manipulate an impacted molar tooth can be more complicated because of their location in the back of the dental arch. Recent studies have revealed that with early identification of impacted eyeteeth (or any impacted tooth other than wisdom teeth), treatment should be initiated at a younger age.

Once the general dentist identifies a potential eruption problem, the patient should be referred to an orthodontist for early evaluation. In some cases, patients will be sent to Northeast Oral Surgery and Dental Implant Center before braces are even applied to the teeth. One of our doctors will be asked to remove baby teeth and/or selected adult teeth, as well as extra teeth or growths that are blocking eruption of the developing adult teeth. Our doctors may also be asked to simply expose an impacted eyetooth, without attaching a bracket and chain to it. This is an easier surgical procedure to perform than having to expose and bracket the impacted tooth. It encourages eruption to occur before the tooth becomes totally impacted (embedded in the jaw bone). By the time the patient is at the proper age for the orthodontist to apply braces to the dental arch, the eyetooth will have erupted enough so that the orthodontist can bond a bracket to it and move it into place without needing to force its eruption. In the long run, this saves time for the patient and means less time in braces.

What to Expect from Surgery to Expose and Bracket an Impacted Tooth:

Surgery to expose and bracket an impacted tooth is a very straightforward procedure that is performed in our office. For most patients, it is performed using nitrous oxide (laughing gas) and local anesthesia. In selected cases, it may be performed under IV sedation if the patient desires to be asleep, but it is generally not necessary for this procedure. The procedure takes approximately 75 minutes to expose and bracket one tooth and slightly longer if both sides require treatment. If the procedure only requires exposing the tooth without bracketing, the time required is significantly less. These issues will be discussed in detail at your pre-operative consultation with your doctor at Northeast Oral Surgery and Dental Implant Center.

You can expect a limited amount of bleeding from the surgical sites after surgery. Although there will be some discomfort after surgery, at most patients use Tylenol or Advil to manage any pain they may have. Within two to three days after surgery, there is usually little need for any medication at all. There may be some swelling from holding the lip up at the surgical site; it can be minimized by applying ice packs to the lip following surgery. A soft diet is recommended at first and you may resume your normal diet as soon as you feel comfortable chewing.

It is advised that you avoid sharp food items like crackers and chips, since they could irritate the surgical site if they jab the wound during initial healing. Your doctor will see you approximately one week after surgery to evaluate the healing process. Make sure you are maintaining good oral hygiene. You should plan to see your orthodontist within 1-14 days to activate the eruption process by applying the proper rubber band to the chain on your tooth. Our doctors are available after hours if any problems should arise following your surgical procedure.