An impacted tooth is one that is stuck and cannot erupt into function. After wisdom teeth, the maxillary cuspid (upper eyetooth) is the second most common tooth to become impacted. The cuspid is a critical tooth in the dental arch: it has the longest roots of any tooth, is among the strongest biting teeth, and is designed to be the first teeth to touch when the jaws close, guiding the rest of the teeth into proper position.
Cuspids are normally the last front teeth to erupt, usually around age 13. If a cuspid becomes impacted, every effort is made to guide it into its proper position rather than remove it.
Early recognition is the key to successful treatment
The older the patient, the less likely an impacted eyetooth will erupt on its own. The American Association of Orthodontists recommends a panoramic screening x-ray and dental examination around age seven to count the teeth and identify eruption problems early. Treatment may involve an orthodontist placing braces to open space, and referral to an oral surgeon to remove over-retained baby teeth, selected adult teeth, or extra (supernumerary) teeth blocking eruption.
If the eruption path is cleared and space is opened by age 11 to 12, there is a good chance the impacted tooth will erupt with nature's help. If allowed to develop too long (age 13 to 14), it will likely not erupt on its own even with space available. In patients over 25, there is a much higher chance the tooth is fused in position and cannot be moved, in which case the only option is extraction and replacement with a dental implant or fixed bridge.
What if the eyetooth will not erupt on its own?
When an eyetooth will not erupt spontaneously, the orthodontist and oral surgeon work together. Typically the orthodontist places braces and opens space for the impacted tooth. Once the space is ready, the patient is referred to the oral surgeon, who lifts the gum to expose the hidden tooth, removes any baby tooth present, and bonds an orthodontic bracket with a small gold chain to the tooth. The chain is guided to the orthodontic arch wire. Shortly after surgery (1 to 14 days), the orthodontist attaches a light elastic to the chain to gently guide the tooth into place, a carefully controlled process that can take up to a year.
What to expect from surgery
Surgery to expose and bracket an impacted tooth is performed in the oral surgeon's office, generally under general anesthetic, and is scheduled for about 30 minutes for one tooth. Expect a limited amount of bleeding afterward. Most patients find Tylenol or Advil more than adequate for discomfort, with little need for medication within two to three days. Mild swelling can be minimized with ice packs to the lip, and bruising is uncommon. Start with a soft, bland diet and avoid sharp foods like crackers and chips during initial healing. Plan to see your orthodontist within 1 to 14 days to begin the eruption process. For questions, call us at 403-286-2551.