Any tooth can become impacted which means that it will not erupt into the mouth, it may sit completely underneath the gum, or it may partially erupt leaving part of the tooth visible on clinical examination. It commonly affects wisdom teeth, second premolar teeth and upper canine teeth. The cause is often unknow, but it can be linked to overcrowding, dental trauma, or early extraction of baby teeth.
At your orthodontic consultation appointment your orthodontist will assess your teeth and bite and may request X-rays to confirm the presence, location, and severity of the impacted tooth. We will then discuss all your treatment options with you and begin to formulate a treatment plan.
If an impacted tooth is identified in a child, the first strategy may be a conservative plan. Sometimes it is enough just to create sufficient space for the impacted tooth either by removing a baby tooth, removing an adult tooth or by using braces to open a space. Once the space has been created, we will give the impacted tooth a chance to erupt by itself. We will agree on a time frame and if after that specified period of time there has been no progress, we may move onto more invasive measures such as a surgical exposure.
This conservative approach works best in younger children and may not be an option for older teenagers or adults where a tooth’s potential to erupt all by itself diminishes.
If the conservative approach has not worked or if it is not appropriate, we may recommend surgical exposure of the tooth. This involves a small surgical procedure to uncover the impacted tooth and place an attachment onto the tooth which can be incorporated onto the brace so we can pull the tooth into the correct position. Sometimes the surgeon will leave the wound open, so the impacted tooth remains visible. Sometimes they will close the wound up with stitched, leaving a gold chain attached to the impacted tooth which remains visible in the mouths. Your orthodontist can use the chain to pull the tooth into position.
This minor surgical procedure is often done under general anaesthetic in a hospital setting although you may have the option to have the tooth exposed in a dental chair. When surgical exposures are carried out in a dental practice setting, we can avoid long hospital wait times, however general anaesthetic will not be an option. You would need to remain awake either with local anaesthetic or a combination of local anaesthetic and sedation.
This surgical approach is only necessary if the tooth is completely hidden underneath the gum. In some cases an impacted tooth may be partially erupted and some of the tooth may be visible. These teeth can usually be aligned with braces without the need for surgical exposure.
In some instances, if the impaction is severe, or if there’s a severely ectopic tooth (a tooth developing in the wrong place) alignment may be unrealistic and extraction of the at topic tooth may be recommended as part of your orthodontic treatment plan.
In the case of wisdom teeth, the impaction is usually caused by a lack of available space and extraction is the only sensible course of action.
Aligning impacted teeth can be slow going and upsettingly, for a small minority of people, impacted teeth become ankylosed (fused to the bone) and cannot be moved. These teeth will ultimately need extracting. Unfortunately, we won’t know if a tooth is ankylosed until we start trying to move the tooth.
Aligning impacted teeth should always be carried out by a specialist, and our experienced orthodontist at Neyo will be happy to talk through your options with you.