Impacted Canines

“Impacted” simply means that the tooth is stuck and cannot erupt into function. Patients frequently develop problems with impacted third molar (wisdom) teeth. Less commonly, canines may also become impacted and require surgical intervention (in conjunction with orthodontics) to guide the tooth into the arch.

Click Here to Watch an Educational Video from the American Association of Orthodontists

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 (see Impacted Wisdom Teeth under Procedures). Since there is rarely a functional need for wisdom teeth, they are usually extracted if they develop problems. The maxillary canine (upper eyetooth) is the second most common tooth to become impacted. The canine tooth is a critical tooth in the dental arch and plays an important role in your bite. They are often called the “cornerstone” of the arch — they 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 guide the rest of the teeth into the proper bite.

Normally, the maxillary canine 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 together more tightly. If a canine tooth gets impacted, every effort is made to get it to erupt into its proper position in the dental arch.

Early Recognition Of Impacted Canines Is The Key To Successful Treatment

The older the patient, the more likely it is that an impacted canine will not erupt naturally, 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 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 or if some are missing. Are there extra teeth present or unusual growths that are blocking the normal eruption patterns? Is there extreme crowding or too little space available for normal eruption? 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 referral to an oral surgeon for any of the following:

  • Extraction of over-retained baby teeth
  • Extraction of selected adult teeth that are blocking the eruption of the canines.
  • Removal of any extra teeth (supernumerary teeth) or growths that are blocking eruption of the adult teeth.

If the eruption path is cleared and the space is opened up by age 11 or 12, there is a good chance the impacted canine will erupt without additional intervention. By age 13 to 14, the canine is not likely to erupt naturally even with sufficient arch space. As a patient reaches an adult age, the likelihood of successful intervention decreases, so time is of the essence in seeking treatment. In these cases the tooth may not erupt despite the combined efforts of an orthodontist and oral surgeon. Sadly, the only option remaining may be to extract the impacted tooth and consider an alternate treatment to replace it in the dental arch (such as a dental implant).

What Happens If The Canine Does Not Erupt When Proper Space Is Available?

In cases where the canine will not erupt spontaneously, an orthodontist and one of our doctors must work together to get the tooth into the arch. Each case must be evaluated on an individual basis but treatment will usually involve a combined effort between the two specialists. The most common scenario will call for the orthodontist to place braces on the teeth. A space will be opened to provide room for the impacted tooth to be moved into its proper position. If the baby canine has not fallen out already, it is usually left in place while the space is opened. Once the space is ready, the orthodontist will refer you to our office to have the baby tooth removed and the impacted canine exposed and bonded with a bracket and gold chain.

In a simple surgical procedure performed in our office, the gum on top of the impacted tooth will be lifted up to expose the hidden tooth underneath. If there is a baby canine present, it will be removed. Once the tooth is exposed, Dr. Smith, Lustig, Banker, or Benson will attach a special bracket with a miniature gold chain attached to it. The chain will be temporarily attached to the orthodontic arch wire. In most cases, the gum will be replaced in its original position with two or three dissolving sutures.  Typically, only the chain remains visible as it exits through the hole in the gum left after removal of the baby tooth.

Roughly two weeks after surgery, the patient will return to your orthodontist. A rubber band or spring will be attached to the chain to put a light guiding force on the impacted tooth. This will begin the process of moving the tooth into its proper place in the arch. This is a carefully controlled, slow process that may take up to a full year to complete. 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 mature and healthy to last a lifetime of function (chewing) and oral hygiene. In some circumstances, especially those where the tooth had to be moved a long distance, there may be some minor gum surgery required to add bulk to the gum tissue over the relocated tooth so it remains healthy during normal function. Your orthodontist will identify the problem and refer for treatment if necessary.

These basic principals can be adapted to any impacted tooth in the mouth. It is not uncommon for both of the maxillary canines to be impacted. In these cases, the space in the dental arch form will be prepared on both sides simultaneously. When the orthodontist is ready, our surgeons will expose, bond, and bracket both teeth during the same visit.

What To Expect From Surgery To Expose, Bond, and Bracket An Impacted Canine?

To expose, bond, and bracket an impacted tooth is a straightforward surgical procedure performed in our office. For most patients, the procedure is performed under intravenous sedation. In selected cases it may be performed under local anesthesia or with an oral sedative. The procedure is generally scheduled for 45 to 60 minutes for one tooth and slightly longer for multiple teeth.

You can expect a very limited amount of bleeding from the surgical sites after surgery. Biting on a piece of gauze for 30 minutes will typically suffice. Post-operative discomfort is mild, with most patients finding Tylenol or Advil more than adequate for management. Within two to three days after surgery there is usually little need for any medication at all. Swelling is minimal, and it can be minimized further by applying ice packs to the lip for the afternoon after surgery. We recommend cycling the use of ice — 20 minutes on, then 20 minutes off. Bruising is uncommon.

A cold, soft, bland diet is recommended at first, but you may resume your normal diet as soon as you feel comfortable chewing. However, it is helpful to isolate food to areas of the mouth away from the surgical site(s). Dr. Smith, Lustig, Banker, or Benson will see you roughly seven days after surgery to evaluate the healing process and reinforce good oral hygiene. You should plan to see your orthodontist approximately two weeks after the procedure to activate the eruption process. As always, we are available around the clock if any problems should arise after surgery.  During office hours, calling the office with questions or concerns is preferred.

After hours, you may contact your surgeon on his personal cell phone.  Our doctors’ cell phone numbers are listed in the post-operative instructions pamphlet you will be given after surgery.  Have you ever received your doctor’s personal cell phone number? Welcome to the ArkLaTex experience!