Impacted Canines

An impacted tooth means that it is “stuck” and cannot erupt into function. The most commonly impacted teeth are wisdom teeth. However, any tooth in the mouth can become impacted and steps may be taken to try to bring the tooth into function. Management of an impacted canine tooth is explained below.

Impacted Canine Tooth

The maxillary canine (also called an upper cuspid or eye tooth) is the second most common tooth to become impacted. 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 that they guide the rest of the teeth into the proper bite.

Normally, the maxillary canine teeth erupt into place around age 13 and cause any space left between the upper front teeth to close tighter together. If a canine tooth gets impacted, every effort is made to get it to erupt into its proper position in the dental arch.

Early Recognition Of An Impacted Canine Is Important

The American Association of Orthodontists recommends that a panorex screening x-ray, along with a dental examination, be performed on all dental patients around the age of seven years to count the teeth and determine if there are problems with eruption of the adult teeth. This exam is usually performed by your general dentist who will refer you to an orthodontist if a problem is identified.

If the canine tooth is impacted, an orthodontist may place braces to open spaces between the teeth to allow for proper eruption of the canine. Treatment may also require referral to an oral surgeon for extraction of retained baby teeth, extra teeth (supernumerary teeth) and/or adult teeth that are blocking the eruption of the canine.

The older the patient, the more likely an impacted canine will not erupt by itself even if the space is available. If the eruption path is cleared and the space is opened up by age 11-12, there is a good chance the impacted canine will erupt by itself. By age 13-14, it is less likely that the impacted canine will erupt by itself even with the space cleared for its eruption. The treatment for this problem is explained in the next section. If the patient is over 40, there is a much higher chance the tooth will be fused in position. Unfortunately, the only option in this case is to extract the impacted tooth and replace it with a dental implant, or leave the impacted tooth and replace it with a fixed bridge or removable partial denture.

What Happens If The Canine Will Not Erupt When Proper Space Is Available?

In cases where the canine will not erupt spontaneously, the orthodontist and oral surgeon will work together to treat this problem. Each case must be evaluated on an individual basis but treatment will usually involve the orthodontist placing braces on the teeth (at least the upper arch). The braces will be used to open a space between the teeth to provide room for the canine to be moved into its proper position. 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.

The surgeon will lift the gum on top of the impacted tooth to expose the hidden tooth underneath. If there is a baby tooth present, it will be removed at the same time. The oral surgeon will bond an orthodontic bracket to the exposed tooth. The bracket will have a miniature chain attached to it. The chain will then be temporarily attached to the orthodontic arch wire. Sometimes the surgeon will leave the exposed impacted tooth uncovered. 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 pull 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. Once the tooth is moved into the arch in its final position, the gum around it will be evaluated. In some circumstances, minor “gum surgery” may be required to add bulk to the gum tissue over the relocated tooth so it remains healthy during normal function.

Other Impacted Teeth

The basic principles described above for the management of an impacted canine tooth can be applied to other impacted teeth in the mouth (except wisdom teeth, which are generally removed). Consultation with your orthodontist and oral surgeon will provide you an individualized treatment plan based on your circumstances.

Exposure and Bracketing of an Impacted Cuspid