Impacted Canines

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 cuspid (upper eyetooth) 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 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 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. Sixty percent 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 side of the dental arch.

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 natures 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 panorex 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 or are some adult teeth missing. 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? 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 extraction of over-retained baby teeth and/or selected adult teeth that are blocking the eruption of the all-important eyeteeth. The oral surgeon will also need to remove any extra teeth (supernumerary teeth) or growths that are blocking 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 natures help alone. If the eyetooth is allowed to develop too much (age 13-14), the impacted eyetooth will 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 will not budge despite all the efforts of the orthodontist and oral surgeon 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).

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What Happens If The Eyetooth Will Not Erupt When Proper Space Is Available?

In cases where the eyeteeth will not erupt spontaneously, the orthodontist and oral surgeon work together to get these unerupted eyeteeth to erupt. Each case must be evaluated on an individual basis but treatment will usually involve a combined effort between the orthodontist and the oral surgeon. The most common scenario will call for the orthodontist to place braces on the teeth (at least the upper arch). A space will be opened to provide room for the impacted tooth to be moved into its proper position in the dental arch. If the baby eyetooth has not fallen out already, it is usually left in place until the space for the adult eyetooth is ready. Once the space is ready, the orthodontist will refer the patient to the oral surgeon to have the impacted eyetooth exposed and bracketed.

In a simple surgical procedure performed in the surgeons office, the gum on top of the impacted tooth will be lifted up to expose the hidden tooth underneath. If there is a baby tooth present, it will be removed at the same time. Once the tooth is exposed, the oral surgeon will bond an orthodontic bracket to the exposed tooth. The bracket will have a miniature gold chain attached to it. The oral surgeon will guide the chain back to the orthodontic arch wire where it will be temporarily attached. Sometimes the surgeon will leave the exposed impacted tooth completely uncovered by suturing the gum up high above the tooth or making a window in the gum covering the tooth (on selected cases located on the roof of the mouth). Most of the time, the gum will be returned to its original location and sutured back with only the chain remaining visible as it exits a small hole in the gum.

Shortly after surgery (1-14 days) the patient will return to the orthodontist. A rubber band will be attached to the chain to put a light eruptive pulling force on the impacted tooth. This will begin the process of moving the tooth into its proper place in the dental arch. This is a carefully controlled, slow process that may take up to a full year to complete. Remember, the goal is to erupt the impacted tooth and not to extract it! 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 surgery required to add bulk to the gum tissue over the relocated tooth so it remains healthy during normal function. Your dentist or orthodontist will explain this situation to you if it applies to your specific situation.

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These basic principals can be adapted to apply to any impacted tooth in the mouth. It is not that uncommon for both of the maxillary cuspids to be impacted. In these cases, the space in the dental arch form will be prepared on both sides at once. When the orthodontist is ready, the surgeon will expose and bracket both teeth in the same visit so the patient only has to heal from surgery once. Because the anterior teeth (incisors and cuspids) and the bicuspid teeth are small and have single roots, they are easier to erupt if they get impacted than the posterior molar teeth. The molar teeth are much bigger teeth and have multiple roots making them more difficult to move. The orthodontic maneuvers needed to manipulate an impacted molar tooth can be more complicated because of their location in the back of the dental arch.

Recent studies have revealed that with early identification of impacted eyeteeth (or any other impacted tooth other than wisdom teeth), treatment should be initiated at a younger age. Once the general dentist or hygienist identifies a potential eruption problem, the patient should be referred to the orthodontist for early evaluation. In some cases the patient will be sent to the oral surgeon before braces are even applied to the teeth. As mentioned earlier, the surgeon will be asked to remove over-retained baby teeth and/or selected adult teeth. He will also remove any extra teeth or growths that are blocking eruption of the developing adult teeth. Finally, he may be asked to simply expose an impacted eyetooth without attaching a bracket and chain to it. In reality, this is an easier surgical procedure to perform than having to expose and bracket the impacted tooth. This will encourage some eruption to occur before the tooth becomes totally impacted (stuck). By the time the patient is at the proper age for the orthodontist to apply braces to the dental arch, the eyetooth will have erupted enough that the orthodontist can bond a bracket to it and move it into place without needing to force its eruption. In the long run, this saves time for the patient and means less time in braces (always a plus for any patient!).

What To Expect From Surgery To Expose and bracket An Impacted Tooth?

The surgery to expose and bracket an impacted tooth is a very straightforward surgical procedure that is performed in the oral surgeons office. For most patients, it is performed with using laughing gas and local anesthesia. In selected cases it will be performed under IV sedation if the patient desires to be asleep, but this is generally not necessary for this procedure. The procedure is generally scheduled for 75 minutes if one tooth is being exposed and bracketed and 105 minutes if both sides require treatment. If the procedure only requires exposing the tooth with no bracketing, the time required will be shortened by about one half. These issues will be discussed in detail at your preoperative consultation with your doctor. You can also refer to Preoperative Instructions under Surgical Instructions on this website for a review of any details.

You can expect a limited amount of bleeding from the surgical sites after surgery. Although there will be some discomfort after surgery at the surgical sites, most patients find Tylenol or Advil to be more than adequate to manage any pain they may have. Within two to three days after surgery there is usually little need for any medication at all. There may be some swelling from holding the lip up to visualize the surgical site; it can be minimized by applying ice packs to the lip for the afternoon after surgery. Bruising is not a common finding at all after these cases. A soft, bland diet is recommended at first, but you may resume your normal diet as soon as you feel comfortable chewing. It is advised that you avoid sharp food items like crackers and chips as they will irritate the surgical site if they jab the wound during initial healing. Your doctor will see you seven to ten days after surgery to evaluate the healing process and make sure you are maintaining good oral hygiene. You should plan to see your orthodontist within 1-14 days to activate the eruption process by applying the proper rubber band to the chain on your tooth. As always your doctor is available at the office or can be beeped after hours if any problems should arise after surgery. Simply call Summit Implants & Oral Surgery at Burien Office Phone Number 206-248-3035 if you have any questions.

Summit Implants & Oral Surgery

5 out of 5 stars based on 7 Bonding Impacted Canine reviews

Patient Review

I highly recommend this place to any and everyone. Everyone was so friendly, from the receptionist, Wendy, to the nurse, and the Dentist, Dr. Beatty. I was so nervous to get my wisdom teeth pulled and I was expecting the worse. They did such an awesome job though, I haven't experienced any pain afterward and even Dr. Beatty called to check on me afterward. This couldn't have gone any better than what it did. Very pleased and satisfied.

- Raven

5 out of 5 stars on

Patient Review

I am no stranger to difficult extractions. My nightmares started with the removal of four stubborn wisdom teeth when in my twenties. On one particular occasion, the dentist had all but given up: Sweating profusely, he announced that if he wasn't successful in the next five minutes, he was going to put me in a cab and send me across town to an oral surgeon colleague for an emergency procedure. This was shaping up to be a very bad day. In a desperate, last ditch attempt, the dentist grabbed the tooth and pulled one way; I grabbed the opposite armrest and pulled the other way. A crunch and a snap later, the tooth came out, sending the dentist flying across the room, arms akimbo, and causing us both a bit of a laugh over having actually experienced the kind of dental procedure usually seen only in a Marx Brothers movie. So when my dentist announced that two of my molars had to be surgically removed, I was not a happy man. Off to Summit I went, ready for the worst. What I got instead was the very best oral surgery experience one could hope to have ... EVER! Dr. Cottam and Dr. Beatty are rare birds in the business: both are fully qualified dental surgeons and are also medical doctors. If that's not enough to inspire confidence, Dr. Cottam's charming smile, undauntable positive regard for his patients, and sheer enthusiasm for his work will win over even the most fearful of patients. I had less than five minutes wait before I was guided by one of Summit's very professional staff into a comfortable dental chair. In another five minutes, my medical and dental history were thoroughly reviewed (I had submitted the patient registration form online beforehand), and the most gentle of IV therapists had me ready to go for full sedation. Dr. Cottam administered the medications, and ... the next thing I knew I was awake, totally pain-free, wondering when the procedure was going to get started. It had already happened. I'm not sure what had me more awestruck: the fact that it was over and I felt so good, or that I didn't have even a glimmer of a memory of any aspect of the procedure. With prescriptions in hand, I returned home, and it wasn't but two hours later that I received a call from Dr. Cottam himself inquiring how I was doing. Now when's the last time that happened to you? I'm one day post-op now, and the healing is already well-advanced. Whatever Dr. Cottam did whilst I slept, it must have been gentle, thorough, and as atraumatic as possible. I'm still amazed. I'm also certain that Summit is the one and only place I will ever go for any future advanced dental procedures. Even their procedure pricing is remarkable. My out-of-pocket expense was literally a tenth of what I had expected, especially with full sedation. -- This page doesn't allow paragraphing, so I'm just going to end by offering my sincerest gratitude to Dr. Cottam, Beth, Brion, the IV therapist (whose name just flew right out of my head), and the rest of the staff. They somehow have a way of making you feel like you're the only patient there, and Dr. Cottam's jovial and dedicated demeanor engenders an instant, trusting rapport. Believe me when I tell you, you couldn't find better than this oral surgery practice. I'm almost enthusiastic about the possible necessity of returning for additional work ... well, not that enthusiastic, of course. Nonetheless, if the need should arise, I know where to go. All the verbiage in this review is insufficient to convey the full praise these sincere and superb professionals deserve. If you are in need of oral surgery or implants, your search ends here, and the best dental experience of your life begins. On a scale of 1 to 5, Summit gets a 10!

- Antonio D

5 out of 5 stars on

Patient Review

Best extraction ever!

- Bill R

5 out of 5 stars on

Patient Review

I am an extremely nervous dental patient, enough so that I put off getting my wisdom teeth out for a long time. I also have a fear of anesthesia so I decided to have them out one at a time, under local anesthesia and my dentist started the process. My final tooth was fully impacted so I was referred to Dr. Cottam and I am so happy I was! He was absolutely incredible from my consult to my procedure, very reassuring and completely willing to do whatever would make me comfortable. The procedure ended up going better than I could have ever hoped for. He was very calm and friendly and let me go at my own pace. His assistant was awesome too! He called that evening to check on me, and I was even given his personal cell phone number to call or text with any questions over the weekend. I would recommend Dr. Cottam to everyone I know!

- Katie D

5 out of 5 stars on

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definitely will be back for any other dental work!

- Monica N

5 out of 5 stars on

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My son was very nervous, they made him feel at ease. Seemed like as soon as we got to the waiting room they were coming to get us saying he was done. He had no complications at all! Highly recommended!

- Nicole H

5 out of 5 stars on

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I really liked everything about my visit. They were all very informed and kept me comfortable the whole time.

- Janell G

5 out of 5 stars on