Impacted 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 Janet M
I haven't been seen in several years, when I called requiring an appointment, it was like they just saw me yesterday, felt great when needing a doctors visit.
- Janet M
Patient Review by Angela S
I have already recommended 2 people I know who need their wisdom teeth removed! Best experience I've ever had going to a doctor. Love the staff!
- Angela S
Patient Review by Christine G
Both of my experiences with Dr. Rafetto and his staff were great. When I make an appointment with them, I know I'm in good hands!
- Christine G
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Staff is amazing and very courtious, professional and top notch for a dental service!
- Carole Z