An impacted tooth is one that does not erupt into its expected position in the upper or lower jaw at its expected age (of the patient) of eruption, leading to a gap between two adjacent teeth (or in the back of the mouth, such as with wisdom teeth), drifting of adjacent teeth, deformation of the dental arch and/or damage to adjacent roots. The most common succedaneous tooth (a tooth taking the place of a baby tooth) affected is the upper canine (i.e. eye or cuspid) tooth. The cause of impacted canine teeth is varying and debatable, but the list would include: crowded teeth in the upper jaw, a narrow upper jaw, trauma to the primary (baby) canine or a cyst on the permanent canine.
Depending on the research study referenced, the incidence of impacted canines in the general population is between 1 and 3%. That is an extremely high incidence for a significant dental problem, considering the deleterious effects it can have on the functioning of the dentition and the esthetics of a smile. An orthodontist or general dentist often finds these misplaced teeth on an x-ray and realizes that they will not erupt appropriately due to the direction in which the teeth are oriented or the age of the patient (we expect these teeth to erupt by approximately age 11-13yrs).
It is approximately two to three times more common to see these teeth oriented ￼or pointing in the direction of the roof of the mouth (pictured to the left) rather than the cheek-side of the dental arch, but regardless of location, procedures have been developed to access these teeth and use orthodontics to direct them into their appropriate position in the dental arch.
It is beyond the scope of this webpage to go into the details of how these teeth are surgically accessed by a periodontist or oral surgeon and the controversies surrounding the various methods of “uncovering” these teeth. It is Dr. Fishel's personal priority to uncover these teeth in a fashion that leaves minimal long-term scarring of the gums surrounding the teeth, gives long-term periodontal health for these teeth and makes the orthodontist’s job of directing these teeth into the dental arch as easy as possible, with little chance of failure of the bonding of the orthodontic brackets or need for further periodontal procedures.
To the right is an example of an upper left canine that was uncovered for a 16 year-old female patient using the apically positioned graft technique.
As you can see￼ in the first picture,
the orthodontist created space for the canine tooth using a spring between the two adjacent (lateral incisor and first premolar) teeth. A bracket was placed on the canine 10 days after uncovering the tooth, and 4 months later the tooth had been positioned into the dental arch where you see it in the second photograph.
Although not perfect, this result is very acceptable. Minimal scarring of the gums is present, the root of the tooth is completely covered with gum tissue and, overall, the tooth appears to fit￼ well with the surrounding teeth (it doesn’t look out of the ordinary). The patient is very pleased with the result and, following completion of the orthodontic treatment, will undoubtedly have many years of functioning with that tooth and a very pretty smile!
AN IMPACTED CANINE IS A CHALLENGE FOR THE ORTHODONTIST AND PERIODONTIST TO ACCESS AND PROPERLY POSITION WITHIN THE DENTAL ARCH. REGARDLESS OF THE PROCEDURE USED TO UNCOVER THESE TEETH, CERTAIN COMPROMISES MUST BE EXPECTED AND ACCEPTED. SCARRING OF THE GUMS, FUTURE NEED FOR GINGIVAL GRAFTING PROCEDURES AND POSSIBLE RECESSION OF THE GUMS ON THESE TEETH ARE DEFINITE POSSIBILITIES. IT IS OUR GOAL, HOWEVER, TO MINIMIZE THESE OUTCOMES BY SOUND PERIODONTAL SURGERY TECHNIQUE AND ORTHODONTIC MECHANICS.