Impacted Teeth / Tooth Exposure
An impacted tooth simply means that it is “stuck” 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 and can develop painful infections among a host of other problems like severe bone loss to the adjacent teeth, or pathology (see Impacted Wisdom Teeth under Oral Surgery Procedures). Since there is rarely a functional need for wisdom teeth, they are usually extracted to prevent these problems.
The maxillary cuspid (upper eyetooth or canine 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 and have the longest roots of any human teeth. They are designed to 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 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, but most commonly they are applied to the maxillary cuspid (upper eye) teeth. The majority 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 but stuck in an elevated position above the roots of the adjacent teeth or out to the facial (cheek side) side of the dental arch.
What happens if the eyetooth will not erupt when proper space is available?
Canine teeth and other teeth are commonly impacted. This means they will not be coming out through your gums by themselves for which a tooth exposure might be necessary. Treatment will involve a combined effort between your orthodontist and Dr. Manuel La Rosa to get these un-erupted eyeteeth to erupt.
In this procedure we create a window on the gum (preserving all the gum tissue) and if needed on the bone that surrounds the crown of your impacted tooth. A small protective disposable crown is placed to protect your tooth or a bracket and a chain is cemented for your orthodontist to be able to bring your tooth in alignment with your adjacent teeth.
Shortly after surgery (1-14 days) you will return to your orthodontist to start light eruptive pulling forces on the impacted tooth.
Once the tooth is moved into the arch in its final position, the gum around it will be evaluated to make sure it is sufficiently strong and healthy to last for a lifetime of chewing and tooth brushing. In some circumstances, especially those where the tooth had to be moved a long distance, there may be some minor gum procedure required to add bulk to the gum tissue over the relocated tooth so it remains healthy during normal function.
Early Recognition of Impacted Eyeteeth is the Key to Successful Treatment
The older the patient, the more likely an impacted eyetooth 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 at around the age of seven years 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. Are there 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?
Treating such problems 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 Dr. Manuel La Rosa for extraction of over-retained baby teeth and/or selected adult teeth that are blocking the eruption of the eyeteeth. Dr. Manuel La Rosa will also need to remove any extra teeth (supernumerary teeth) or growths that are 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 nature’s help alone. If the eyetooth is allowed to develop too much (age 13-14), the impacted eyetooth might 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 is less likely to move despite all the efforts your orthodontist and Dr. La Rosa make to erupt it into place. 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).