An impacted tooth cannot erupt and function properly, essentially becoming stuck. The third molar, commonly known as a wisdom tooth, is often affected due to the hindrance from the back of the jaw, leading to potential infections and various complications. Wisdom teeth are typically deemed unnecessary and are commonly extracted if issues arise. Following wisdom teeth, the upper eyetooth or maxillary cuspid is the next most frequently impacted tooth. These strong teeth are crucial in bite formation and dental arch structure, featuring the longest roots in the human mouth.
Usually, these cuspid teeth are the last front teeth to erupt, typically around 13. Proper eruption helps close any remaining space between the upper front teeth and guides the jaw into the correct bite. When a cuspid tooth struggles to erupt correctly, interventions are necessary to ensure its proper location within the dental arch. Techniques aiding eruption can be applied to any impacted tooth on the upper or lower jaw, focusing on the maxillary cuspid teeth.
Approximately 60% of impacted maxillary cuspid teeth are on the palatal side. In comparison, the remaining 40% may be situated in the middle of the supporting bone or on the facial side of the dental arch.
Early recognition of impacted teeth is crucial for successful treatment. Panorex screening x-rays, recommended around age seven, help predict potential issues related to adult teeth missing, extra teeth blocking eruption, or overcrowding hindering proper eruption. General dentists or hygienists often perform this examination and may refer patients to an orthodontist or oral surgeon if needed. Treatment approaches may involve orthodontic work, such as braces, to create spaces for proper eruption. In some cases, removing over-retained baby or specific adult teeth may be necessary to make room for impacted teeth. Surgery might be required to remove extra teeth or growths obstructing the eruption route.
For impacted teeth, a clear eruption route and sufficient space need to be achieved by ages eleven or twelve for successful eruption. If these conditions are not met, improper eruption may occur, especially around ages thirteen to fourteen, when the tooth has developed too much. Beyond forty, there is a higher likelihood that the tooth becomes fused in position, making movement challenging. In such cases, extraction of the impacted tooth is often the only option, followed by exploring alternative treatment options like a crown with a dental implant or a fixed bridge.
In cases where teeth fail to erupt correctly, a collaborative effort between the orthodontist and oral surgeon is often employed to address the issue on a case-by-case basis. Typically, this involves a combination of orthodontic treatment and oral surgery. The orthodontist may significantly use braces to create the necessary space if the baby’s maxillary cuspid (eyetooth) has not fallen out. Once adequate space is available, the orthodontist may refer the patient to an oral surgeon for the exposure and bracketing of the impacted tooth.
The oral surgeon’s procedure involves lifting the gum over the impacted tooth to expose it. If a baby tooth is present, it may be extracted. A bracket is then bonded to the exposed tooth, featuring a tiny gold chain. The surgeon attaches this chain to the orthodontic arch, securing it temporarily. In some cases, the exposed tooth remains uncovered, with sutures holding the gum above the tooth, creating a window in the gum tissue. The gums are usually repositioned to their original location, leaving only the chain visible through a small hole.
After the surgical procedure, the patient revisits the orthodontist, who attaches a rubber band to the chain. This applies a light force to the tooth, initiating a controlled, gradual movement to the correct position on the dental arch. This slow technique aims to facilitate the tooth’s eruption. Once the tooth is correctly positioned, the surrounding gum tissue is examined to ensure it is robust enough for normal function. Sometimes, minor gum surgery may be necessary to rebuild the gum tissue over the tooth.
These procedures can be adapted for any impacted tooth, with both eyeteeth often affected simultaneously. In such cases, the surgeon uncovers the brackets on both teeth during the same appointment, streamlining the healing process for the patient. Bicuspid and anterior teeth are generally easier to erupt if impacted, as they are smaller and have only one root. Molars, being larger and having more roots, can pose more significant challenges due to their size, location, and complexity.
Recent studies suggest that early detection of impacted teeth, excluding wisdom teeth, may warrant initiating treatment earlier for increased success. When you identify the issue, you must be able to refer to an orthodontist, and an appointment with an oral surgeon may occur even before braces are applied. The oral surgeon may address over-retained baby teeth, problematic adult teeth, extra teeth, or growths hindering proper tooth eruption. This proactive approach aims to prevent complications and reduce the need for extensive orthodontic intervention, ultimately saving time and minimizing the duration of orthodontic treatment.
The surgery is relatively straightforward and completed in the oral surgeon’s office. For most patients, it uses laughing gas and a local anesthetic. Under certain conditions, it is constructed using IV sedation if the patient prefers to be asleep, but it is not usually necessary. Surgery lasts about 75 minutes for one tooth or 105 minutes if two require attention. If the tooth only needs to be uncovered, then the surgery only requires half that time. The specific details of your surgery will be discussed before surgery during a consultation appointment. You may also look to preoperative instructions under the surgical instructions portion of this website if you need to review the specifics.
A small amount of blood is expected around the surgical sites post-surgery. Most patients only need mild painkillers like Tylenol or Advil to regulate the pain and discomfort after the surgery. After two or three days, there will ordinarily be no need for any medication. There may be inflammation from keeping the lip up to look at the surgical site, which can be remedied by icing the site after surgery. It is not likely that there will be any bruising. Your regular diet may have to be slightly altered to accommodate softer and more bland foods until you feel comfortable chewing again. It is recommended that you do not consume foods with sharp edges as they will aggravate the surgical site by poking at the wounds. After a week to ten days, you will see your doctor to examine how well the recovery is going. You should then see your orthodontist at the appropriate time so they can start the eruption process by placing the rubber band on the chain bonded to your tooth. Don’t forget that your doctor is available at the office or anytime after hours if there are any complications after surgery. Feel free to call if you have any questions.
