Exposure & Bracketing of an Impacted Tooth


The maxillary cuspid (upper eye tooth) is the second most common tooth to become impacted. This tooth is a critical one in the dental arch, and it plays an important role in bite alignment. Cuspid teeth are very strong biting teeth and have the longest roots of any human teeth. They’re designed to be the first teeth that touch when your jaws close together, and they guide the rest of the teeth into proper alignment.

Normally, the maxillary cuspid teeth are the last of the “front” teeth to erupt into place. They usually come in around age 13 and cause any space left between the upper front teeth to close tightly together. If a cuspid tooth becomes impacted, every effort is made to get it to erupt into its proper position in the dental arch.

Early recognition of impacted eye teeth is the key to successful treatment.

The older the patient, the more likely an impacted eye tooth will not erupt unaided, even if space is available for the tooth to fit in the dental arch. The American Association of Orthodontists recommends that a screening x-ray, along with a dental examination, be performed on all dental patients around age 7 to count the teeth and determine potential problems with eruption of the adult teeth.

It’s important to ascertain whether all the adult teeth are present or if some are missing. Are there extra teeth present or unusual growths blocking the eruption of the eye tooth? Is there extreme crowding or too little space available, causing an eruption problem with the eye tooth?

Treating an impacted cuspid may involve an orthodontist placing braces to open spaces to allow for proper eruption of the adult teeth. Treatment may also require a referral to our doctors for extraction of over-retained baby teeth and/or selected adult teeth that are blocking the eruption of the all-important eye teeth. Dr. Sherry and Dr. Wallace will also need to remove any extra teeth (supernumerary teeth) or growths that are blocking eruption of any of the adult teeth.

What Happens if the Eye Tooth won’t Erupt when Proper Space is Available?

In cases where the eye teeth will not erupt spontaneously, Dr. Sherry and Dr. Wallace work closely with orthodontists to get these eye teeth to erupt. In a simple surgical procedure performed in our office, the gum on top of the impacted tooth is lifted to expose the hidden tooth. If a baby tooth is present, it will be removed at the same time. Once the tooth is exposed, the oral surgeon bonds an orthodontic bracket to the exposed tooth. The bracket has a miniature gold chain attached to it. The oral surgeon guides the chain to the orthodontic arch wire, where it is temporarily attached.

Sometimes the surgeon will leave the exposed impacted tooth completely uncovered by suturing the gum high above the tooth or making a window in the gum covering the tooth. 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 oral surgery (1-14 days) the patient will return to the orthodontist. A rubber band will be attached to the chain to put a light 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 for a lifetime of chewing and brushing. In some circumstances, especially those where the tooth had to be moved a long distance, minor gum grafting may be required to add bulk to the gum tissue over the relocated tooth so that it remains healthy during normal function.

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.

Experience exemplary service and world-class care at Dallas Oral Surgery Associates. Call today to schedule an appointment with Dr. Sherry or Dr. Wallace at our Dallas or Plano office.