Chain and Bracket, Surgical Exposure of Impacted Tooth For OrthodonticsAlthough we often think of the third molars, or "wisdom teeth," when we think of impacted teeth, any of the permanent teeth can fail to erupt properly. This lack of normal tooth eruption can be due to a variety of factors such as failure of the developing tooth follicle to have the correct orientation, improper developmental timing of the tooth bud, or ankylosis of the developing adult tooth to the surrounding alveolar bone. The wisdom teeth can just be extracted and removed, but other teeth that are impacted will have a more noticeable effect on the smile's appearance and also on a patient's occlusion and function.This is especially true of the upper canines, which are the last of the front teeth to emerge and sometimes do become impacted. Usually, they are completely obscured by the bone and visible only in x-rays. Patients who are facing this issue can benefit from a collaborative treatment between an oral surgeon and an orthodontist. The oral and maxillofacial surgeon performs a procedure to uncover the impacted tooth, and the orthodontist moves it into place using specific appliances. This treatment is known as a surgical tooth uncovering and chain-and-bracket procedure. The orthodontist begins the course of treatment, attaching the orthodontic appliances to the visible teeth, creating room for the unerupted tooth. Then, the patient is referred to the oral surgeon for surgical exposure of the impacted tooth and placement of an orthodontic appliance to facilitate its eruption. Sometimes the maxillofacial surgeon may need to also luxate or mobilize the tooth as well, which makes the movement required easier for the orthodontics to achieve in a more efficient manner. That surgery involves lifting the gum tissue overlying the unerupted tooth and removing any bone that may obstruct it from being moved into place. A bracket and chain are bonded to the tooth, and the chain is later connected to the rest of the braces. When everything is in place on the tooth, the gum tissue is then repositioned and sutured. This is all performed under the comfort of sedation and typically can be completed within an hour.After taking a few weeks to heal from the procedure, patients return to the orthodontist to get the adjustments that will put tension and rotation on the tooth in order to bring it properly into position. This process may require considerable patience, as it can take up to a year for everything to be complete. If your orthodontist has recommended a chain-and-bracket procedure as part of your treatment plan, schedule a consultation with our downtown Chicago office to learn more about the oral surgery involved in this process and whether your dental insurance plan will cover a surgical tooth uncovering. This video was created and produced by the AAO (American Association of Orthodontists) and the AAOMS (American Association of Oral and Maxillofacial Surgeons) and explains in detail the process involved in a tooth exposure with the attachment of an orthodontic bracket and chain.
Video Transcript auto-generated by YouTube:
you may know that certain Molars or
wisdom teeth can become impacted but
your canine teeth may also become
impacted requiring surgical treatment
this video tells you more about that
treatment canine teeth sometimes
referred to as eye teeth are located
between the incisors and the premolars
when these teeth are in a position that
will not allow them to enter the mouth
they are said to be impacted patients
who have impacted canines are generally
treated by an orthodontist and an oral
and maxillofacial surgeon as a team our
goal is to bring the impacted tooth down
into its proper position so that it is
aligned with the rest of the teeth the
American Association of orthodontists
recommends a first patient examination
no later than the age of seven in part
so that the orthodontist can monitor
teeth coming in including the canines
sometimes the removal of a certain baby
tooth or making space for a canine tooth
avoids the development of an impact and
need for more extensive oral surgery
at times a canine tooth may actually be
uncovered by the oral surgeon prior to
the placement of braces this uncovering
can often allow the tooth to grow into
the mouth where the orthodontist will
then put a brace on it when the rest of
the braces are placed finally there are
times where braces our first place
making space for an impact canine prior
to referral for uncovering by the oral
surgeon remember though that these are
large teeth often with the longest roots
in the mouth so to bring a canine into
the mouth can literally take months
treatment of impacted canines is usually
a team effort involving both your
orthodontist and an oral and
maxillofacial surgeon your orthodontist
will refer you to a surgeon who will
meet with you to evaluate your
individual situation discuss the
procedure perform certain diagnostic
tests and schedule the surgery for
surgery it's very important that the
mouth be clean we ask patients to brush
and floss their teeth as usual ask your
surgeon about restrict
Shinzon eating and drinking before
surgery finally it's best to go to
surgery wearing loose and comfortable
clothing surgery to expose and impact
the canine is performed in the oral and
maxillofacial surgery office using a
local anesthetic or an IV sedation the
procedure generally takes about 45
minutes during the surgery the surgeon
uncovers the crown of the tooth by
removing some of the gum tissue and bone
that surrounds it depending on the
individual case the oral surgeon may
place a dressing over the tooth that
will be removed after 10 to 14 days in
other instances the oral surgeon will
bond an orthodontic bracket and gold
chain onto the exposed tooth in both of
these situations the patient will return
to the orthodontist to have the tooth
reposition into its proper place in the
dental arch recovery was very fast
it was probably over the weekend and I
know even the swelling of course was
there for a couple days but overall I
felt great it wasn't as bad as I thought
so that was exciting we ask patients to
return to the Oral & Maxillofacial
Surgery office within seven to ten days
after surgery to evaluate the healing
process and make sure they are
maintaining good oral hygiene the
cosmetic benefit of having a canine in
the mouth is that it truly is the
cornerstone of the smile we've all seen
people who've lost their upper eye teeth
and as a result the lips appear sunken
in and thinned this prematurely ages the
smile in the face the roots the canines
provide the support for the corner of
the mouth and your smile of course I'm
not done with my treatment yet but I
know the tooth is moving it is coming
down and so
we're going to all have the excitement
that tooth is going to be out and
they're going to be able to align it
into place and I'm going to have a
beautiful smile at the end the
functional benefit of having the canine
come in is that it allows the
orthodontist to develop normal tooth to
tooth relationships these long rooted
canine teeth take a lot of the chewing
pressure and without them other teeth in
the mouth can become overloaded and
damaged to find out more about the
surgical treatment for impacted canine
teeth consult your orthodontist or your
oral and maxillofacial surgeon
you
