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 the space, some teeth, particularly the canines or eyeteeth, may be impacted and not have had 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 the orthodontist 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 these unerupted eyeteeth to erupt. Each case must be evaluated on an individual basis and 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.

Common Treatment Scenario

Many times, the orthodontist will place braces on the teeth of at least the upper arch. They will open a space to provide room for the impacted tooth to moved 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. As 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 orthodontic brackets have been placed or not, the orthodontist may request Dr. Noraian to perform a simple surgical procedure where the gum on top of the impacted tooth will be lifted up to expose the hidden tooth underneath. If there is a baby tooth present, it will be removed 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 there made be a need for a soft tissue graft which is another procedure covered on this site.

Once the tooth is exposed, Dr. Noraian will bond an orthodontic bracket to the exposed tooth and depending on the method requested by the orthodontist, the bracket may or may not have a miniature gold chain attached to it. If used, Dr. Noraian will guide the chain back to the orthodontic arch wire where it will be temporarily attached. The best way to get a picture of this procedure is to think of Dr. Noraian as 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 the gum may be returned to its original location and sutured back with only the chain remaining visible as it exits a small hole in the gum.

We encourage you to see the orthodontist within days to weeks after the uncovering as your orthodontist refers. 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 archwire 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

These basic principles may be adapted for use around any impacted tooth in the mouth. Though less common, both of your eyeteeth may be impacted and two procedures may be required, one or each tooth. Because the front teeth are single-rooted they are easier to rupt 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 dentification of impacted teeth is important and treatment should be initiated 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 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 still be stubborn to erupt or develop a condition called ankylosis, which is when the tooth fuses to the jawbone and permanently impedes your tooth’s movement. With a hole in your smile, treatment considerations include leaving the tooth and having a bridge placed, or surgically removing the tooth and considering 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.