NavigationImpacted Canines − Wilmington DE
Wilmington DE Oral Surgeon, Louis K. Rafetto, DMD, can remove the risk of infection with an Impacted Tooth Exposure Procedure. Wilmington Office Phone Number Wilmington Office Phone Number 302-477-1800
An impacted tooth simply means that it is “stuck” in the jaw and unable to erupt into function. While the most commonly impacted teeth are third molars (wisdom) teeth, other teeth also may become impacted. or example, the maxillary cuspid (canine or eye tooth) is the second most common tooth to become impacted.
About half of impacted cuspids are located on the palatal (roof of the mouth) side of the dental arch with the remaining ones located in the middle or outside of the supporting bone, also stuck in an abnormal position and unable to come into the mouth as intended. Since they and most other non-third molars are important teeth in the dental arch, they should be retained if possible.
Early recognition of impacted teeth is a key to successful treatment. The older the patient is, the more likely an impacted eye tooth 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 7 years to count the teeth and determine if there are problems with eruption of the adult teeth.
Treating such a problem may involve an orthodontist placing braces to open spaces to allow for proper eruption of the adult teeth. Treatment may also require a referral to an oral surgeon for extraction of over retained baby teeth and/or selected adult teeth that are blocking the eruption of teeth in the proper sequence.
If the eruption path is cleared and space opened up by age 11 or 12, there is a good chance the impacted eyetooth will erupt with nature’s help alone. If the eyetooth is allowed to develop too much (age 13-14), it may not erupt by itself even with the space cleared for its eruption.
If the patient is too old (over 25), 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 erupt it into place. Sadly, the only option at this point would be to extract the impacted tooth and consider an alternate treatment to replace it in the dental arch (crown on a dental implant or a fixed bridge).
What happens if the eye-tooth will not erupt when proper space is available?
In cases where the eyeteeth do not come into the mouth spontaneously, your orthodontist and Dr. Rafetto will work together in the effort to help them erupt. While each case must be evaluated, the most common scenario will call for your 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. Once the space is ready, the orthodontist will refer the patient to Dr. Rafetto to have the impacted eyetooth exposed and bracketed.
In a relatively simple office surgical procedure, the gum covering the impacted tooth will be lifted up to expose the hidden tooth underneath. If there is a baby tooth present, it is generally removed at the same time.
Once the tooth is exposed, Dr. Rafetto will bond an orthodontic bracket to it. The bracket will have a miniature gold chain attached to it. He will then guide the chain back 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. At other times, 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 (1-14 days) the patient will return to the orthodontist. A rubber band will be attached to the chain to put a light eruptive 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. Once the tooth is moved into the arch in its final position, the gum around it will be evaluated to make sure it is sufficiently strong and healthy to last for a lifetime of chewing and tooth brushing. These basic principles can be adapted to apply to any impacted tooth in the mouth.
Exposure and Bracketing of an Impacted Cuspid
What to expect from surgery to expose and bracket an impacted tooth
The surgery to expose and bracket an impacted tooth is a relatively straightforward procedure that is performed in the office. For most patients, it is performed using either local anesthesia alone or laughing gas with local anesthesia.
In selected cases it will be performed under I.V. sedation if the patient desires to be asleep, but this is generally not necessary. The procedure is generally scheduled for 45 minutes or so if one tooth is being exposed, longer if both sides require treatment.
You can expect a limited amount of bleeding from the surgical sites after surgery. Although there will be some discomfort after surgery, many patients find Tylenol or Advil to be adequate to manage any discomfort they may experience.
Within 2-3 days after surgery there is usually little need for any medication. There may likely be swelling of the overlying tissues, which can be minimized by applying ice packs to the area.
A soft diet is recommended at first, but you may resume your normal diet as soon as you feel comfortable chewing. It is best to avoid sharp food items like crackers and chips as they will irritate the surgical site if they jab the wound during initial healing.
Your doctor will see you 7-10 days after surgery to evaluate the healing process and make sure you are maintaining good oral hygiene. You should plan to see your orthodontist within 1-14 days to activate the eruption process by applying the proper rubber band to the chain on your tooth. As always your doctor is available at the office or can be beeped after hours if any questions or problems arise after surgery.
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Louis K. Rafetto, DMD, PA
Patient Review by Julie K
Dr. Rafetto, Danielle, and the entire staff are all SO WONDERFUL!! I can't say enough what a great experience I had- which I would think is rare when getting your wisdom teeth removed!! I've been so terrified of any dentistry after a terrible experience in my teens but everyone made me feel so at ease! From the consultation through the wisdom teeth removal procedure everything was communicated so clearly and with such patience.. and the procedure itself was a breeze! I appreciated the information packet and care package for my post extraction recovery. There was hardly any pain during or afterwards--- I will recommend this practice to everyone I know!
- Julie K
Patient Review by Georgia R
Thank you so much to the entire team at Dr. Rafetto’s office. I called this morning as a new patient with concerns about my jaw and was able to be seen just a few hours later. After X-rays and an exam, my concerns were put to rest. And, thanks to a thorough explanation from Dr. Rafetto; I know what I need to further discuss with my dentist about the continuing care of my teeth. If only all doctor’s offices could have such a caring, knowledgeable and helpful team- Thank you again for working me in to today’s schedule and for everyone taking the extra time to explain things so completely, being so incredibly helpful and for answering all of my questions.
- Georgia R
Patient Review by Richard C
Dr. Rafetto & staff exuded dynamic professionalism from the consultation stage through the wisdom 🦷 removal. Dr. Rafetto listened to my concerns and thoroughly explained processes to me. I felt that he genuinely cared about my health. Danielle, 1 of the assistants/ technicians, was kind, patient, and informative as she coached me through the 🦷 removal. Her instructions to breathe deeply, and her descriptions to me of precisely what was transpiring during the surgery, were comforting and helpful.
- Richard C
Patient Review by Richard C
Dr. Rafetto & staff exuded professionalism from the consultation stage through the wisdom 🦷 removal procedure that I experienced. Dr. Rafetto listened to my concerns, explained processes to me thoroughly, and left me feeling that he cared about my health. Danielle, 1 of the assistants/ technicians was kind and patient as she coached me through the 🦷 removal. Her instructions to breathe deeply deceptions of precisely what was transpiring during the surgery was comforting and helpful.
- Richard C
Patient Review by Mary M
I was terribly nervous about having the implant procedure done and was absolutely astounded at how simple it turned out to be. There was no pain whatsoever during and after the procedure. Dr. Rafetto and his entire staff are excellent, friendly and reassuring. They all made me feel very comfortable and at ease from start to finish. I would very highly recommend this practice!
- Mary M
Patient Review
Laughter is the best medicine for calming nerves...thank you Suzanne and Dr. Rafetto : ) Excellent care by all.
- Anonymous
Patient Review by Amy P
I cannot say enough good things about this experience. My son has a phobia of needles so I made it a point to only schedule a consultation. Dr. Rafetto was so kind and friendly that my son agreed to do the procedure at the initial appointment. My son and I both appreciate the time that Dr. Rafetto took to explain the procedure step-by-step. He was very calm and compassionate. The assistant that helped us during the appointment and throughout the procedure was also incredibly kind and helpful. They both made my son feel at ease which made me feel very comfortable. I highly recommend this practice!
- Amy P
Patient Review by William J
Was reluctant for 2 years to get my cracked nonimpacted wisdom tooth pulled reading and hearing horror stories about wisdom tooth extractions. For tooth extraction of any kind I have had over the years, this was the least painful, and flawless experience I have ever had. I recommend anyone to this practice.
- William J
Patient Review by Brian P
Having had a an awful experience with my last oral surgery, I was very reluctant to have this done. I chose to have my tooth pulled based on the recommendation of my primary dentist and some online reviews of Dr. Raffetto. The entire experience was wonderful. I came in with my nerves completely on edge and docs assistant Susanne was an absolute gem. She calmed me down and got me comfortable. She helped to remind me to breathe during the process which I’m confident took less than 5 minutes. Doctor Raffetto was very cordial and gave me a very comforting vibe. I even joked with Susanne afterwards that I’d do it again (let’s hope not). Left with a packet of goodies for the pain and for the first time all day felt relaxed. Couldn't be happier with the experience. Thank you Dr Raffetto and Susanne for exemplary service.
- Brian P
Patient Review by Michael M
Much better than expected. Not painful and very little swelling.
- Michael M
Patient Review by Kim T
Dr. Rafetto & his staff are just fantastic! Couldn’t have been more comfortable. Very relaxed and enjoyable atmosphere. Not to mention the expertise and professionalism demonstrated by not only Dr. Rafetto, but his staff, as well. Highly recommend.
- Kim T
Patient Review by Brenna H
I cannot recommend Dr. Rafetto enough! Thank you! I used to really dislike going to to dentists or any kind of medical professionals, but Dr. Rafetto and his amazing staff really did change that for me! I would recommend him to anyone who asked! When you get your wisdom teeth out, they will guide you step by step pre and post surgery. My removal was so fast and easy. Danielle and the entire staff are just wonderful. As long as you eat soft foods, use your ice pack, and follow their instructions- you'll be better in no time. Have no fear- Dr. Rafetto is here! Highly recommend if you’re looking for a friendly and professional oral surgery experience. You rock!
- Brenna H
Patient Review by Debbie Q
I went into this procedure terrified. Having teeth removed was my worst nightmare. Danielle and Dr. Rafetto make an excellent team, as everything was explained and their reassurance was very calming. They came highly recommended from my dental team, but I sure never thought getting my teeth removed would be the highlight of 2020! I actually look forward to seeing them again if I need their services!!
- Debbie Q
Patient Review by Beverly C
I was very concerned about the procedure and the Doc. was calming, with lots of assurance and the extraction went perfect.
- Beverly C
Patient Review by Brooke W
I found myself needing an oral surgeon due to an infection caused by an impacted wisdom tooth. I was desperate and searched through google to find an adequate doctor. What I found in Dr. Rafetto's office exceeded my expectations. The staff was efficient in getting me appointments for my consultation and surgery and gave me tips to manage my pain in the meantime. I was given a thorough understanding of the procedure and the aftercare to make my experience as comfortable as possible. I had all 4 impacted wisdom teeth removed and did not need to take a single Percocet. Dr. Rafetto even arranged to see me a week after the surgery to ensure I was healing properly. I am grateful to Dr. Rafetto and all of his staff for being so caring and knowledgeable and would highly recommend his practice to anyone.
- Brooke W
Patient Review by Heather V
I had 4 wisdom teeth extracted with local and nitrous, 2 were impacted. Dr. Rafetto was great! Him and all of the staff made me feel comfortable during every visit, the office and rooms are very clean, neat and organized. I knew exactly what to expect before and after my procedure, I didn’t need the pain meds I only used Tylenol and Motrin after the procedure. A co-worker referred me to Dr. Rafetto and I definitely recommend him to others!!
- Heather V
Patient Review by Fred C
My Dentist Erin Rautio recommended me to Doc Raffeto for an implant procedure, Both of my experiences with my Doctor have been the best in Delaware.
- Fred C
Patient Review by Will S
I was nervous about having my wisdom teeth removed but Dr. Rafetto & his staff did a great job of making sure all my questions were answered & assured me everything was going to be ok. My experience couldn’t have been better. I didn’t have a lot of pain or swelling. I was eating my regular diet by the second day after the procedure. I only had a little swelling for two days & I didn’t need to take any pain medication after the first day.
- Will S
Patient Review by Rebecca L
I came in kinda nervous based on what people say about getting their wisdom teeth out and I was afraid I would be able to feel it, but it was a great experience and I wasn’t able to feel anything and I was calm during the procedure! After my surgery the recovery went really well and I recovered relatively quickly with little discomfort, just make sure to keep it top of medication, the worst part was waiting for the numbness to go away!
- Rebecca L
Patient Review by Katie G
This office was awesome and Dr. Rafetto is wonderful! They met my every need and I had no issues. No swelling or issues post op and the instructions for post op care were very helpful!
- Katie G