Impacted Canines

What Is An Impacted Canine?

An impacted tooth simply means that it is “stuck” and cannot erupt into function. 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 have applied to the maxillary cuspid (upper eye) teeth. Sixty percent of these impacted canines are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted canines 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. The maxillary cuspid (upper eyetooth) is the second most common tooth to become impacted.

How Do You Prepare For Impacted Canines?

Typically, patients are referred to an oral surgeon from an orthodontist. The orthodontist starts treatment by placing brackets first. During the surgical consultation, a 3D scan may be obtained to determine the exact position of the impacted tooth. All the details of the procedure will be discussed. In that appointment, the patient will decide if they need IV sedation or local anesthesia (staying awake) for the procedure. If local anesthesia is chosen, the patient can drink and eat prior to surgery. If under the age of 18, they need to be accompanied by a parent/guardian. Avoid any blood thinning medication such as ibuprofen 10 days prior to any procedure.

Why Is Impacted Canine Surgery Performed?

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.

Maxillary canines also support the lips and to some extent the midface area. If canines are missing, there is a good possibility that this area would look weaker as the patient grows up.

It is important to determine whether all the adult teeth are present or 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 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 eye tooth will naturally erupt. If the eyetooth is allowed to develop too much (age 13-14), the impacted eye tooth 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).

What Can You Expect During Impacted Canine Surgery

In cases where the eye teeth will not erupt spontaneously, the orthodontist and oral surgeon work together to get these unerupted eye teeth 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). 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 space is ready, the orthodontist will refer the patient to the oral surgeon to have the impacted eye tooth exposed and bracketed.

In a simple surgical procedure performed in the surgeon’s 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). Often times, 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.

The surgery to expose and bracket an impacted tooth is a very straightforward surgical procedure that is performed in the oral surgeon’s office. For most patients, it is performed 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 60 minutes if one tooth is being exposed and bracketed. If both sides require treatment, the procedure is typically 90 minutes. If the procedure only requires exposing the tooth with no bracketing, the time required will be shortened by about a half. These issues will be discussed in detail at your preoperative consultation with your doctor.

What Is The Followup And Recovery Like For Impacted Canines?

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. Always take the pain medication before the pain starts. Antibiotics will most likely not be needed. 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 uncommon.

The wound should not be disturbed. If surgical packing was placed, leave it alone. The pack helps to keep the tooth exposed. If it gets dislodged or falls out, do not get alarmed.

Bleeding:

You can expect a limited amount of bleeding or redness in the saliva for 24 hours. Excessive bleeding, which results in your mouth filling rapidly with blood, is very rare with this procedure. We do not recommend placing gauze in the area as this may dislodge the stitches. If bleeding continues, please call for further instructions.

Swelling:

Swelling is a normal occurrence after any surgery. To minimize swelling, use a plastic bag or towel filled with ice cubes on the cheek in the area of surgery. Apply the ice continuously as much as possible for the first 24 hours.

Diet:

Drink plenty of fluids. Avoid hot liquids or food for the first 24 hours. Soft food and liquids should be eaten on the day of surgery and continued for the following 10 days. Return to a normal diet after 10 days unless otherwise directed.

Pain:

You should begin taking pain medication prior to the local anesthetic wears off. Ibuprofen is a preferred medication in our practice. Most likely a Rx will be given to you. For moderate to severe pain, 1 or 2 tabs of Tylenol or Extra Strength Tylenol may be taken every 6 hours in addition to Ibuprofen.

Oral Hygiene:

Mouth cleanliness is essential to good healing. Clean your mouth thoroughly after each meal beginning the day after surgery. Brush your teeth as best you can. Rinse with warm salt water (1/2 teaspoon of salt in a cup of warm water) 1-2 times a day. Continue this procedure until healing is complete. REMEMBER: A clean wound heals better and faster.

Activity:

Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.

What Are The Potential Costs For Impacted Canines?

The cost ranges anywhere between $500-$900. Your insurance company most likely will cover a portion of this. Our office staff will assist you with your questions at the time of consultation.

What Are The Potential Risks For Impacted Canines?

The risks involved with this procedure are rare. The most common occurrence is the separation of the bracket from the tooth. If this occurs, the tooth would need to be rebonded again. Damage to adjacent teeth is extremely rare. Opening of the sutures may happen but should not occur if the instructions are followed carefully. As the tooth erupts, it may be missing gingiva around it. This can be corrected by a periodontal procedure.