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Impacted Canines

Canines, also known as “eye teeth”, sometimes get stuck in the bone and are prevented from correctly erupting into function. An impacted tooth can cause painful infections as well as many other problems. Eye teeth are the second most common tooth to become impacted, next to wisdom teeth.  While wisdom teeth can be extracted, canines play an important role in eating, esthetics, and proper bite. Therefore, oral surgeons attempt to guide these teeth to correctly erupt rather than remove them. Eye teeth usually come into place around age 13 and cause any space between the front teeth to close tighter together. If it gets impacted, every effort should be made to allow it erupt into proper function. The older the patient, the less likely an impacted eye tooth will erupt by nature’s forces alone. The surgical treatment for impacted canines doesn’t fully erupt the tooth, but brings it to a point of exposure and brackets it to give it the best chance possible for proper eruption. Each case must be evaluated individually, but treatment will usually include the combined efforts of an orthodontist and oral surgeon.

Who should have impacted canine surgery?

Candidates for impacted canine surgery are those who have one or more adult canine teeth that have been prevented from erupting properly. However, less invasive measures can treat the problem if detected early in a child’s development.

Early Detection

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? 

If the eruption path is cleared through orthodontics and the space is opened up by age 11-12, the impacted canine has a good chance to erupt naturally.

By age 13-14, eyeteeth have likely already developed significantly. By this time, the impacted tooth is less likely to erupt naturally even if space is cleared for it. In these cases, the orthodontist and oral surgeon work together to guide the eye teeth to erupt.

If the patient is over 40 with a tooth that has been fused into position and cannot be guided into eruption, it must be extracted and replaced with a dental implant.

Treatment

An orthodontist will take an X-ray of your mouth to determine the exact situation of your canine teeth. If an impacted tooth is still early in its development, they will likely place braces to create space for the tooth to erupt.

In some cases, the patient will be referred to the oral surgeon to remove over-retained baby teeth or obstructions before braces are even placed. 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!).

For procedures that require bracketing, the orthodontist will refer the patient to the oral surgeon to have the tooth exposed and bracketed once the space is ready.

Before the procedure, our oral surgeon will provide local anesthesia to numb your mouth. IV sedation is available but is usually not necessary for this procedure.

The gum on top of the impacted tooth will be opened to expose the hidden tooth underneath. If there is a baby tooth present, it will be removed.

The surgeon will surgically bring your canine tooth to the point of exposure, then bracket it in position.  The tooth will be equipped with a small chain and rubber band that gently pull it into place over time. 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.

Eye tooth eruption is a carefully controlled process that may require up to a full year to complete. 

Once the tooth has moved into final position, the gum surrounding it will be examined to make sure it is strong and healthy enough to last a lifetime of chewing and brushing. In some cases, there may be a minor gum surgery required to add bulk gum tissue for it to remain healthy and function properly. Your dentist or orthodontist will notify you if this situation applies to you.

Limited amounts of bleeding and slight discomfort are expected after surgery. Most patients find Tylenol or Advil to be more than adequate to manage any pain. Within two or three days pain medication will usually not be necessary. Any swelling can be minimized by applying ice packs to the lip for the afternoon after surgery.

It is advised that you avoid sharp foods such as crackers and chips as they will irritate the surgical site during healing. Your doctor will see you for a checkup seven to ten days after the surgery to evaluate your healing process and oral hygiene.

You should plan to see your orthodontist within 1-14 days after surgery to activate the eruption process by applying a rubber band to the chain on your tooth.

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