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Orthodontics And Impacted Teeth

An impacted tooth is simply a tooth that is blocked or ‘stuck’ under the gum and cannot erupt or grow into the correct position. Any tooth can become impacted but the most frequent tooth to be impacted is a wisdom tooth. Wisdom teeth become impacted due to a lack of space or because they grow in a poor position. As these teeth normally do not have a chewing or cosmetic purpose they are often removed when they start to cause problems.

  • impacted canine video from Belur Orthodontics on Vimeo.

  • Canine teeth are important for chewing and for the appearance of a pleasing smile. As a result, every effort is made to try and align impacted canine teeth but sometimes this is not always possible or advisable.
  • The upper canine teeth usually come into place between the ages of 11-13 years and your dentist will play an important role in detecting if there is an early problem with their development and, if this is the case, may refer you to a specialist.  Usually 4 percent of the population are affected by impacted canines. Many of the canine impactions can be intercepted by seeking a consultation with an Orthodontist by age of 10yrs of age. The below video shows, how an canine tooth gets impacted and early referral means, the upper canine impaction can be intercepted by early diagnosis.
  • 0122 Canines becoming impacted (panoramic) (Converted) from Belur Orthodontics on Vimeo.

  • There may be a genetic element and another family member may have had a similar problem.
  • Over crowding.
  • Missing or odd shaped adjacent teeth resulting in lack of guidance for the canine.
  • Extra teeth impeding their pathway.

Treatment options depend on:

  1. Severity of the impaction
  2. The condition of your teeth adjacent to the impacted tooth
  3. How old you are
  4. Your opinions and wishes
The main options are:
  1. Uncover the tooth +/- have an attachment (a gold chain) placed onto the tooth and align the tooth with a brace.

    A fixed orthodontic brace will be placed onto your teeth and then a gentle force will be applied, usually via the gold chain, to the un-erupted canine tooth, to align the tooth into the correct position. You may also need to have an additional permanent tooth removed to allow space for the canine tooth.

  2. Create space for the impacted canine tooth and await eruption.

    Space may be created by the removal of the baby canine tooth and/or brace treatment. This treatment option is more successful in younger patients and for those teeth that are almost in the correct position.

  3. Remove the impacted tooth plus a course of orthodontic treatment to improve the position and appearance of the remaining teeth.
  4. If an impacted tooth is not treated it can remain buried and cause no problems.

a.Usually not advisable, as the covering tooth follicle can transform into a cyst.

b.Alternatively it can continue to develop on the wrong path and may lead to root damage of the adjacent teeth, particularly the upper incisor teeth. This can result in the shortening of the incisor roots which may be a small to very severe amount. This is unlikely to happen after the age of 14.

c.The baby canine tooth may be left in place and it could last a long time if it has a good root length. The baby canine is smaller and lighter in colour and its appearance is not quite as good as the adult tooth. The enamel of the baby canine tooth is softer and it therefore wears down or may become loose with time. If you decide to leave the baby canine tooth in place, you should be prepared that at some point in your life it may become so loose that it falls out and you will be left with a gap.

d. A rare consequence of an impacted tooth is that a cyst may develop around it. If a canine tooth is left under the gum your dentist may check it from time to time to see if there are any problems with it.

  5.Leave the impacted tooth in its place.
  6.Remove the impacted tooth with no further need for orthodontic treatment.

These treatments are multi-disciplinary treatments involving Oral surgery and Orthodontic teams. The above treatments carry a complexity index of 3b, which is the highest complexity and can only be treated on the NHS in a hospital setup. However, there is usually long waiting list of 3yrs+ at the hospital. Once the treatment starts it can take up to 3-31/2yrs for the treatment and innumerable visits to the hospital. This means missing days’ worth of school every month until treatment is completed.

However, Dr. Belur has immense expertise and experience in both the Specialities of Orthodontics and Oral Surgery, he can undertake the above treatments at a specialist practice on a private basis and at your doorstep, without having to be on the waiting list and  also have shorter treatment period (2-21/2yrs), means fewer visits and less time of school.

Sometimes this can be undertaken on the Private medical/dental insurance at the practice as we are also registered with many insurance companies as a preferred provider, thereby minimizing further costs of private treatments.

You can see some of the before and after of treatment carried out in the case gallery section of the website.

In order to determine the correct treatment for you, Mr V Belur, Specialist Orthodontist, will examine your teeth and take x-rays to determine the position of the impacted tooth.

Regardless of whether it is decided to uncover the canine tooth and align it, or extract it, you will be seen by the Oral Surgery team. They will meet with you so that you can discuss with them how your surgical treatment will be done.

Depending on your individual case, you may have your brace fitted before your surgery or this may be delayed for a few weeks until your surgery is completed.

 

You will have the opportunity to discuss with the surgical team your preference of going to sleep or being awake for uncovering the canine tooth or having it extracted. The decision will depend on how anxious you are about the procedure, the level of difficulty of the surgery and whether you need any other treatment carried out at the same time, such as extraction of other teeth. Generally, for removing impacted teeth you would be put to sleep, but it depends on how difficult the surgeon assesses the removal of the teeth would be.

If the impacted tooth is to be aligned orthodontically and it is very close to the gum, the surgical team may just remove the skin overlying the tooth. If the tooth is deeper the surgeon would normally glue a gold chain onto the tooth. Once the gold chain has been stuck onto the tooth the overlying gum is then stitched back over and the gold chain will be secured to the outside gum with a black stitch. Your Orthodontist will remove this stitch 1-2 weeks after the operation. If the stitch drops out, resulting in the gold chain “dropping down,” it is not a problem and we will still see you at your next routine appointment.

Even if you are put to sleep for the surgery, immediately after the procedure your mouth will feel numb as a result of the local anaesthetic. As it wears off, your mouth is likely to feel tender for a few days and before you leave hospital the staff will give you advice on pain relief.

It is important to keep your teeth and gums clean and healthy, especially around where you have had the procedure done. You will be advised to rinse your mouth with warm salty water and/or Chlorhexidine mouthwash and brush your teeth well with a small headed soft toothbrush. You may require a couple of days off school or work.

If you have not been seen by the orthodontic team within 10 days, following the exposure of an impacted tooth, then you need to contact the department at the hospital or Dr.Belur at the practice to make an appointment.

The risks of canine surgery, whether to remove it or expose it, are very similar:

General risks of surgery:

  • Bleeding, bruising and swelling
  • Infection– the area around the exposed teeth may become red, swollen and tender after the operation. It is important you keep the area clean to prevent this from getting worse. If you do experience these symptoms you should contact the Oral & Maxillofacial Department or your Dentist for advice.

General Anaesthetic risk- all procedures carried out under General Anaesthetic pose a potential risk to life.

Specific risks of canine exposure surgery:

  • It is possible that the gold chain may fall off the canine tooth before it has erupted into the mouth. This may mean that the procedure needs to be repeated.
  • The blood supply to the teeth near the area of the operation may be disrupted. This can result in the nerves of these teeth dying. If the nerve of a tooth dies it can cause the tooth to discolour and/or become infected, and the tooth would require a root filling to be carried out by your dentist.
  • There is always a possibility that the roots of the adjacent teeth could be damaged when the Oral surgeon is gaining access to the impacted tooth.
  • There is a risk that the exposed canine tooth will not move when orthodontic force is applied. This can be a result of the tooth being fused to the jawbone. It is a rare complication and is more likely to occur in older patients.
  • The teeth near the site of the operation may become loose after the operation. You should avoid eating hard or chewy foods until the teeth feel normal again.

In most situations, Dr.Belur likes to place a Glass ionomer block on the exposed tooth, to prevent the adjacent gums growing on the uncovered tooth and this forms a tunnel for the impacted tooth to come through vertically, thereby minimizing the time duration needed to have braces treatment. This option avoids complications that can happen with the gold chain attachments. However, if the block comes of the tooth, the same needs to be put back and need to contact the practice, at the earliest.

Alternatively, When a gold chain is glued onto the impacted tooth the surgeon will usually stitch the chain to the gum to keep it out of the way. Sometimes the black stitch can become detached from the chain before your appointment and the chain hangs down in your mouth. There is no reason to panic as the chain has not come off the tooth. All that we would do is cut the chain a little shorter so that it does not flap around as much. Providing that the chain is not hurting you this can wait until your review appointment which is 2-3 weeks after you have had the gold chain or Glass ionomer cement block placed. You are not likely to swallow the gold chain as it is glued to the tooth.

Yes, other teeth can get impacted, particularly the lower second molars or premolars and sometimes the incisors. These can also be uncovered in a similar way and treatment carried out as the impacted canines. Dr. Belur would be happy to discuss treatment options for all the different variations of impacted teeth.

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