As with wisdom teeth, the term “impacted” refers to a permanent tooth being stuck in the jaw and not erupting through the gum tissue into function. Impacted wisdom teeth are usually removed. However, other permanent teeth can become impacted due to abnormal developmental positon and other mechanical barriers to normal eruption. When this occurs, a surgical procedure, coupled with orthodontic treatment can bring an impacted permanent tooth into normal position and function.
The most commonly impacted permanent tooth, other than wisdom teeth, is the upper (maxillary) canine, or “eye” tooth. The canine tooth in the lower jaw can become impacted as well, as can some incisor and bicuspid teeth in both the upper and lower jaw. Usually, an impacted permanent tooth is discovered on a routine dental x-ray by the family dentist, orthodontist or pediatric dental specialist (pedodontist). If the impacted permanent tooth is left untreated, it usually will not erupt into full function on its own, and may need to be removed in later years.
In order to bring an impacted tooth into full function, a surgical procedure termed “expose and bond” is usually required. During this procedure, the impacted tooth crown is surgically uncovered and an orthodontic bracket, with an attached gold chain, is bonded to the crown of the impacted tooth. The gold chain is exited through the gum tissue and attached temporarily to the orthodontic appliances in place, or is ligated to an adjacent tooth. The gum tissue is sutured closed and after a week or so of healing, the orthodontist activates the gold chain with a small amount of tension. The tension applied to the chain and bracket, which is renewed periodically, causes the impacted tooth to gradually erupt through the gum tissue. The orthodontist then moves the tooth into its proper position and function.
The greatest likelihood of a successful “expose and bond “procedure is in the early teens, when the impacted tooth is supposed to be erupting into function. In young patients, the tooth will move more predictably and further over a shorter period of time. Adults with impacted permanent teeth can also be successfully treated, but the outcomes take longer and are less predictable. If an “expose and bond” procedure in an adult is not successful, the impacted tooth is usually removed, the site grafted, and a dental implant and crown placed.
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