Impacted Canines

The "canine" or "cuspid" tooth is a critical tooth in the dental arch and plays an important role in your “bite”. They were also commonly called "eye" teeth. The canine 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.

Normally, the maxillary canine 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. As with impacted wisdom teeth, an impacted canine tooth simply means that it is “stuck” and cannot erupt into function. Situations occasionally arise where surgical exposure of an impacted canine tooth is necessary in order to attach an orthodontic bracket and a small chain, so that the Orthodontist can move this tooth into the proper position in the arch. Although this can occur with many different teeth, the canine teeth are frequently the ones that require this as they sometimes fail to erupt, and may remain in a horizontal position on the palate. When these teeth remain impacted, they are on the palatal (roof of the mouth) side approximately 60% of the time.  Sometimes the canines can be impacted on the lip side of the ridge as well.  The surgical procedure required to expose and bracket a tooth such as this, is usually performed under intravenous sedation, although in certain circumstances, local anesthesia may be all that is needed.

Early Recognition of Impacted Canine Teeth Is The Key To Successful Treatment

The older the patient, the more likely an impacted eyetooth will not erupt by nature’s forces alone even if the space is available for the tooth to fit in the dental arch. 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 whether some adult teeth may be missing.

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 the Orthodontist placing braces in order 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 canine teeth.

The Oral Surgeon may also need to remove any extra teeth (supernumerary teeth) or cysts that are blocking 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 canine tooth will erupt spontaneously without any assistance. If the canine tooth is allowed to develop too much (age 13-14), it is not likely that the impacted canine will not erupt by itself even with the space cleared for it's 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 try to make erupt it into it's proper place.  Unfortunately, the only option at this point is to extract the impacted tooth and consider an alternate treatment to replace it in the dental arch (usually either a dental implant or a fixed bridge).

What Happens If The Canine Tooth Will Not Erupt When Proper Space Is Available?
In cases where the eyeteeth will not erupt spontaneously, the Orthodontist and Oral Surgeon work together to get these unerupted Canine teeth to erupt. The most common scenario will call for the Orthodontist to place braces on the teeth (at least the upper arch). A space will then be opened to provide room for the impacted tooth to be moved into its proper position in the dental arch. If the baby canine has not fallen out already, it is usually left in place until the space for the adult canine is ready. Once the space is ready, the Orthodontist will refer the patient to the Oral Surgeon to have the impacted canine 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 then attach the chain 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). 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 surgery, 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 an extended time to complete. 

It is not that uncommon for both of the maxillary canines to be impacted. In these cases, the space in the dental arch form will be prepared on both sides at once. When the orthodontist is ready, the surgeon will expose and bracket both teeth in the same visit so the patient only has to heal from surgery once.

What To Expect From Surgery To Expose & Bracket An Impacted Tooth?
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 with intravenous sedation

You can expect a small amount of bleeding from the surgical sites after surgery. Although there will be some discomfort after surgery at the surgical sites, most patients find Tylenol or Advil to be adequate to manage any pain they may have. A prescription will be written in the event that the discomfort is greater than anticipated.  Within two to three days after surgery there is usually little need for any medication at all.

If the impacted canine is on the lip side, there may be slight swelling from holding the lip up to visualize the surgical site.  This can be minimized by applying ice packs to the lip for the afternoon after surgery. If the surgery is on the palatal side, no external ice packs are necessary. A soft, bland diet is recommended at first, but you may resume your normal diet as soon as you feel comfortable chewing. It is advised that you avoid sharp food items like crackers and chips as they will irritate the surgical site if they contact the wound during initial healing.  You should find out when your orthodontist wants to see you again after the surgery so that he or she can activate the eruption process by applying the proper rubber band to the chain on your tooth.