Surgical Exposure of Unerupted Teeth

If you are undergoing orthodontic treatment, many times the orthodontist needs to make space for teeth that have not yet erupted. With or without space, some teeth, particularly the canines or eyeteeth, may be impacted and not have enough room to erupt into the mouth without assistance. For over 20 years, Dr. Noraian has been helping with orthodontic treatment as far back as his days at the University of Chicago where he assisted orthodontists to restore healthy smiles.

Assistance to Aid with Tooth Eruption

When the eyeteeth are not able to erupt spontaneously, Dr. Noraian will work with your orthodontist to help get the eyeteeth to erupt. He must evaluate each case on an individual basis. Taking a low dose cone beam CT may help with the evaluation process. With a combined effort, Dr. Noraian and the orthodontist will help make recommendations that are appropriate for you.

Common Treatment Scenario

Many times, the orthodontist will place braces on the teeth of at least the upper arch. Braces open a space to provide room for the impacted tooth to move into its proper position in the dental arch, and sometimes this movement may be all you need for the eyetooth to erupt into position. If your baby eyetooth has not fallen out already, it may be left in place until the space for the adult eyetooth is ready. If the tooth just fails to move into place on its own with an appropriate amount of waiting time, the orthodontist will recommend exposure of the tooth with Dr. Noraian’s help once the space is ready.

Surgical Uncovering

Whether your othodontists placed orthodontic brackets or not, your orthodontist may request Dr. Noraian to perform a simple surgical procedure where he lifts up the gum on top of the impacted tooth to expose the hidden tooth underneath. If there is a baby tooth present, Dr. Noraian will remove it at the same time. As a periodontist, Dr. Noraian works to save the preferred attached gum tissue around the tooth to eliminate the risk of requiring a soft tissue graft later. Even under the best circumstances, the eruption trajectory is not always predictable and you may need a soft tissue graft which is another procedure covered on this site.

Once he exposes the tooth, Dr. Noraian will bond an orthodontic bracket to the exposed tooth and depending on the method requested by the orthodontist, the bracket may have a miniature gold chain attached to it. If used, Dr. Noraian will guide the chain back to the orthodontic arch wire where he will temporarily attach it. Essentially, Dr. Noraian is making an alleyway which will allow the tooth to erupt into the mouth with less resistance. This alleyway may leave the exposed impacted tooth completely uncovered by suturing the gum up high above the tooth or making a window in the gum covering the tooth. Sometimes this window may end up on the palate or roof of the mouth, and sometimes Dr. Noraian can return the gum to its original location and suture it back with only the chain remaining visible as it exits a small hole in the gum.

Dr. Noraian encourages you to see your orthodontist within days to weeks after the uncovering as your orthodontist prefers. Once the orthodontist observes your progress, the tooth may still erupt on its own or the orthodontist may need to engage the bracket with the old chain or an arch-wire to help guide the tooth into place. Movement of the tooth into position may be rather quick or may take even a year. The objective is to try to save the tooth and not extract it.

Single Versus Multi-Rooted Teeth

Periodontists may adapt these basic principles for use around any impacted tooth in the mouth. Though less common, both of your eyeteeth may be impacted and you may require two procedures, one or each tooth. Because the front teeth are single-rooted they are easier to erupt compared to molar teeth, which are bigger and have larger roots.

What If Your Tooth Does Not Come In?

Recent studies have shown that early identification of impacted teeth is important, and dental professionals should initiate treatment at a younger age. Early detection of teeth that are not coming in is very important, even by your general dentist, and referral to an orthodontist or periodontist is important. Some people are born with extra unneeded, or supernumerary, teeth which also block the eruption of other teeth. The periodontist may assist by removing such a tooth if it is in the way.

Even with the best of intentions and effort, impacted teeth can still be stubborn to erupt or develop a condition called ankylosis, which is when the tooth fuses to the jawbone and permanently stops the tooth’s movement. With a hole in your smile, treatment considerations include leaving the tooth and placing a bridge, or surgically removing the tooth and placing a dental implant. In either case, Dr. Noraian, your orthodontist, and your restorative dentist, will help you a develop a plan that works best for you if your tooth does not come in.