In some cases, the adult teeth do not appear because they are trapped beneath bone of the jaw (impacted). These impacted teeth usually require surgical exposure to help them erupt. While the upper canines are the second most common teeth to become impacted (after wisdom teeth), incisor teeth and premolar teeth can also become impacted and require exposure.
The surgical options include:
- Surgical exposure– option of choice if the impacted tooth is in reasonable alignment and the patient is prepared to have orthodontic treatment.
- Removal of the tooth– treatment of choice if the impacted tooth is in a poor position for the orthodontic repositioning or shows signs of causing problems to adjacent teeth. The resultant gap is filled with a false tooth such as an implant or bridge.
Before the procedure, x-rays are required to indicate the position of the tooth. In some cases, a 3-dimension x-rays (CT-scan) will be taken to determine the exact position of the tooth to insure that the surgery is the least invasive possible.
The Exposure Procedure
Treatment usually involves a team effort between the orthodontist and Dr. Bouclin.
First, the orthodontist places braces on the teeth and a space is opened to provide room for the impacted tooth to be moved into the proper position. Once the teeth have reached their intended position, the orthodontist refers the patient to Dr. Bouclin to have the impacted tooth exposed.
The exposure of the tooth involves the removal of some gum tissue and bone overlying the tooth, resulting in the crown of the tooth being exposed. Dr. Bouclin bonds an orthodontic bracket and gold chain onto the exposed tooth which is then attached to the orthodontic wire.
The patient then returns to their orthodontist to begin treatment for repositioning the tooth in the dental arch. The orthodontic repositioning process is a slow and carefully controlled maneuver that may take up to 1 year to complete.
Surgical exposure treatment is done in our office under local anesthesia, usually combined with IV conscious sedation.