Although we often think of the third molars, or “wisdom teeth,” when we think of impacted teeth, any of the permanent teeth can fail to erupt properly. This lack of normal tooth eruption can be due to a variety of factors such as failure of the developing tooth follicle to have the correct orientation, improper developmental timing of the tooth bud, or ankylosis of the developing adult tooth to the surrounding alveolar bone. The wisdom teeth can just be extracted and removed, but other teeth that are impacted will have a more noticeable effect on the smile’s appearance and also on a patient’s occlusion and function.
This is especially true of the upper canines, which are the last of the front teeth to emerge and sometimes do become impacted. Usually, they are completely obscured by the bone and visible only in x-rays.
Patients who are facing this issue can benefit from a collaborative treatment between an oral surgeon and an orthodontist. The oral and maxillofacial surgeon performs a procedure to uncover the impacted tooth, and the orthodontist moves it into place using specific appliances.
This treatment is known as a surgical tooth uncovering and chain-and- bracket procedure. The orthodontist begins the course of treatment, attaching the orthodontic appliances to the visible teeth, creating room for the unerupted tooth. Then, the patient is referred to the oral surgeon for surgical exposure of the impacted tooth and placement of an orthodontic appliance to facilitate its eruption. Sometimes the maxillofacial surgeon may need to also luxate or mobilize the tooth as well, which makes the movement required easier for the orthodontics to achieve in a more efficient manner.
That surgery involves lifting the gum tissue overlying the unerupted tooth and removing any bone that may obstruct it from being moved into place. A bracket and chain are bonded to the tooth, and the chain is later connected to the rest of the braces. When everything is in place on the tooth, the gum tissue is then repositioned and sutured. This is all performed under the comfort of sedation and typically can be completed within an hour.
After taking a few weeks to heal from the procedure, patients return to the orthodontist to get the adjustments that will put tension and rotation on the tooth in order to bring it properly into position. This process may require considerable patience, as it can take up to a year for everything to be complete.
Please click on the informative video below, which was produced by the AAOMS (American Association of Oral and Maxillofacial Surgeons), and explains in detail the process involved in a tooth exposure with the attachment of an orthodontic bracket and chain.
