Impacted Canines

What is an Impacted Canine?

An impacted tooth simply means it is “stuck” and unable to erupt into its proper position. Patients often experience problems with impacted third molars (wisdom teeth). These teeth can become “stuck” in the back of the jaw and may develop painful infections, along with other complications. Since wisdom teeth seldom serve a functional purpose, they are typically extracted when problems arise. The maxillary cuspid (upper eye tooth) is the second most common tooth to become impacted. The cuspid is a critical tooth in the dental arch and plays an important role in your bite. Cuspid teeth are strong and have the longest roots of any human teeth. They are designed to be the first teeth that make contact when your jaws close, guiding the rest of the teeth into the proper alignment.

Normally, maxillary cuspid teeth are the last of the “front” teeth to erupt, usually coming into place around age 13. This helps close any remaining space between the upper front teeth. If a cuspid tooth becomes impacted, every effort is made to help it erupt into its correct position. Techniques used to assist eruption can be applied to any impacted tooth in the upper or lower jaw, though they are most commonly used for maxillary cuspid teeth. Approximately 60% of impacted eye teeth are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted eye teeth are either positioned in the middle of the supporting bone but elevated above the adjacent teeth’s roots, or positioned toward the facial side of the dental arch.

Early Recognition of Impacted Eye Teeth is the Key to Successful Treatment:

The older the patient, the less likely an impacted eye tooth will erupt on its own, even if there is sufficient space in the dental arch. The American Association of Orthodontists recommends that all dental patients undergo a panorex screening x-ray and dental examination around the age of 7 to assess the presence of adult teeth and identify any potential eruption issues. This exam helps determine whether all adult teeth are present and if there are any extra teeth or usual growth that are obstructing the eruption of the eye tooth. It also helps assess whether there is severe crowding or insufficient space for the eyetooth to erupt properly.

Typically, this examination is performed by your general dentist or hygienist, who will refer you to an orthodontist if any issues are identified. If a problem is detected, treatment may involve an orthodontist using braces to create space for the adult teeth to properly erupt. In some cases, a referral to an oral surgeon may be necessary for the extraction of over-retained baby teeth or adult teeth blocking the eruption path of the eye tooth. The oral surgeon may also need to remove any extra (supernumerary) teeth or growths preventing the eruption of the adult teeth.

If the eruption path is cleared and space is created by the age of 11 or 12, there is a high likelihood that the impacted eye tooth will erupt naturally. However, if the tooth is left untreated until ages 13-14, it is much less likely to erupt on its own, even with the space cleared. For patients over 40, the likelihood of the impacted eye tooth being fused in place increases, and despite efforts from the orthodontist and oral surgeon, the tooth may not budge. In these cases, the only option may be to extract the impacted tooth and consider alternative treatments, such as a crown on a dental implant or a fixed bridge, to replace it in the dental arch.

What to Expect from Surgery to Expose and Bracket an Impacted Tooth:

The surgery to expose and bracket an impacted tooth is a straightforward procedure, which is usually performed using laughing gas (Nitrous Oxide) and local anesthesia. In some cases, IV sedation may be used if the patient prefers to be asleep, depending on the patient’s anxiety level and the complexity of the case. The procedure generally takes 30 minutes if one one tooth is being exposed and bracketed, and 60 minutes if both sides require treatment. If the surgery only involves exposing the tooth without bracketing, the procedure time will be about half as long. These details will be further discussed during your preoperative consultation with Dr. Gadler.  

After the surgery, minor bleeding from the surgical sites is to be expected. Although there may be some discomfort at the surgical sites, most patients find that over-the-counter pain relievers like Tylenol or Advil are sufficient to manage the pain. Within 2-3 days after surgery, most patients experience little to no pain. Some swelling may occur due to the lip being held up during the procedure to access the surgical site. Applying ice packs to the lip for a few hours after surgery can help minimize swelling. Bruising is uncommon in these cases. A soft, bland diet is recommended initially, but you can return to your normal diet as soon as you feel comfortable chewing. It’s best to avoid sharp foods like crackers and chips, as they may irritate the surgical site during the initial healing period.

Dr. Gadler will see you 7-14 days after surgery to evaluate your healing and ensure you’re maintaining good oral hygiene. You should also 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. If you have any questions or encounter problems after surgery, call us at Fletcher Hills Dental Implant & Oral Surgery Center Phone Number (619) 334-8880 for assistance.