What is a surgical exposure?
Many times, a permanent tooth will not come through the gum normally and will be “trapped” or “stuck” completely or partially under the gum. This is very common for wisdom teeth, and they are usually surgically removed to avoid complications such as pain or infection. The upper canine, or “eye tooth”, is the second most common tooth to become impacted. It is almost never recommended that canine teeth be removed, as they are very important in maintenance of a proper bite, and to maintain proper function with chewing.
Usually, an Orthodontist will evaluate the canine teeth if there are any problems noticed by your Dentist as your teeth are erupting. If the canine teeth are not coming in properly by the ages of 12 or 13, then evaluation for surgical exposure of the teeth may be necessary to allow the Orthodontist to help in erupting the tooth or teeth into a normal position. Other teeth (such as the incisors or premolars) in the mouth can also be impacted (“stuck”), and may require evaluation and surgical exposure during orthodontic treatment.
Prior to performing a surgical exposure, a consultation appointment is necessary to perform a dental exam and to evaluate any available xrays. If the impacted/unerupted tooth is in an abnormal position which may complicate the surgery, or could involve any increased risk of damage to the adjacent teeth, then a Cone Beam CT Scan will be performed in our office to evaluate the position of the tooth 3-dimensionally, and evaluate adjacent structures such as tooth roots, nerves, or the sinuses.
After the evaluation, the surgery can be planned. The surgery is performed in the office and is usually performed with General Anesthesia (patient is asleep). The surgery can take between 45 and 90 minutes, depending on the difficulty. At the time of surgery, the tooth is completely surgically exposed, and an orthodontic bracket with an attached chain is bonded to the tooth with a special cement. The chain is then attached to the orthodontic wires, and stitches are placed in the gums, if needed.
How will my tooth come in after the surgery?
Your orthodontist will use the attached chain to gently “pull” the tooth into position. This can take several months, depending on the tooth’s original position. There is a very small risk that the tooth could be ankylosed (fused to the bone) and may not come through the gum as planned, but this only happens rarely.
What sort of risks are involved in a surgical exposure?
Surgical exposure of teeth is a very safe procedure when performed by a properly trained Oral Surgeon, who has planned the procedure properly.
Some complications may include:
• Swelling or bruising at the surgical site
• Damage to the tooth being exposed
• Damage to the adjacent teeth or tooth roots
• Damage to bone
• Soft tissue or gum damage, that may require additional surgery
• Failure of the tooth to erupt as planned, possibly resulting in the need for extraction of the tooth
Early recognition of abnormally impacted or unerupted teeth is important and is the key to successful treatment!
The American Association of Orthodontics recommends a full evaluation of all of the teeth, including a Panorex xray to evaluate the developing adult teeth, around age 7. If there are problems with the proper development or eruption of permanent teeth, early orthodontic intervention is important. If baby teeth are in the way of the permanent teeth, they can be removed. If there is not adequate spacing for permanent teeth, then sometimes space can be created by moving other teeth with braces or other orthodontic appliances, or by extracting other permanent teeth to avoid problems with eruption of the canine teeth.
If, in spite of previous treatment, the canine teeth, or other permanent teeth, still do not erupt naturally into normal positions, then early surgical intervention to expose the tooth for orthodontic eruption is very important to assure success. The longer a tooth remains impacted or unerupted, the more difficult it will be to orthodontically reposition, and the risk of failure will be increased.