What Impacted Teeth Are, Why They Matter & How We Treat Them

A Complete Guide to Impacted Tooth Treatment

A tooth is considered impacted when it's prevented from erupting, or coming in, the way it should. Impacted teeth can be positioned in several different ways. Some grow sideways toward a neighboring tooth. Some partially poke through the gum but stop there. Others remain completely hidden beneath the bone. The upper eye teeth follow this pattern about 60% of the time on the palate side of the arch (the roof of the mouth), with the remaining cases found in a high position above neighboring roots or along the outer side of the dental arch.

When a critical tooth like an eye tooth fails to come in, it leaves a gap in the dental arch, puts pressure on surrounding teeth, and can lead to bite problems that become harder and more expensive to fix the longer they're left unaddressed.

Why Early Identification Is So Important

The American Association of Orthodontists recommends that all dental patients have a panoramic x-ray and dental exam around the age of seven. This early screening allows dentists and orthodontists to count the developing teeth, spot any that are missing or extra, and identify potential eruption problems well before they become serious.

The younger the patient when an impacted tooth is identified, the better the chance that creating the right amount of space in the arch will allow the tooth to move on its own. If the issue is caught and addressed by around ages 11 to 12, nature sometimes handles the rest. By the ages of 13 to 14, the tooth is less likely to erupt without surgical help. And in patients over 40, there's a much higher chance the tooth has fused to the surrounding bone and won't move at all, in which case extraction and replacement with a dental implant or bridge may be the only option. Early action makes a real difference.

The Expose, Bond, and Bracket Procedure

When an impacted eye tooth won't erupt on its own, even after space has been created for it orthodontically, the oral surgeon and orthodontist work together to bring it in. The process typically goes like this:

First, the orthodontist places braces and opens up the space in the arch where the tooth needs to go. Once that space is ready, the patient is referred to our surgeons for the exposure and bracketing procedure.

In a straightforward in-office procedure performed under appropriate anesthesia, the surgeon lifts the gum tissue over the impacted tooth to uncover it. If a baby tooth is still in place, it's removed at the same time. Once the tooth is exposed, a small orthodontic bracket is bonded directly to it, with a miniature chain attached. That chain is then connected to the orthodontic arch wire.

In some cases, the tooth is left fully uncovered by repositioning the gum tissue above it or creating a small opening over it. In most cases, the gum is sutured back into place with only the chain visible as it exits through a small opening.

Within one to fourteen days after surgery, the patient returns to the orthodontist, where a small rubber band is attached to the chain to apply a gentle, steady pulling force on the tooth. This slowly guides it into position over the course of several months, and sometimes up to a full year. The goal throughout is to erupt and preserve the tooth, not to extract it

When Both Eye Teeth Are Impacted

It's not uncommon for both upper eye teeth to be impacted at the same time. When that's the case, the orthodontist prepares space on both sides of the arch simultaneously, and the surgeon exposes and brackets both teeth in the same visit so the patient only has to go through surgery and recovery once.

Recovery After Impacted Tooth Removal

Recovery from the expose and bracket procedure is generally quite manageable. Some bleeding from the surgical site is normal, but it's limited. Most patients find that over-the-counter pain relievers like Tylenol or Advil are more than enough to manage any discomfort, and within a couple of days, there's usually little need for any medication at all. Some swelling around the lip is possible, but it can be minimized by applying ice for the first afternoon after surgery. A soft diet is recommended at first, with a gradual return to normal eating as comfort allows. Sharp or crunchy foods like chips or crackers should be avoided early on to protect the healing surgical site.

A follow-up visit with our surgeons is scheduled for 7 to 10 days after surgery to check healing. Patients should plan to return to their orthodontist within two weeks to activate the eruption process.