Impacted Canines

The maxillary canine (cuspid or upper eyetooth) is the second most common tooth to become impacted. The canine tooth is a critical tooth in the dental arch and plays an important role in your bite. The canine teeth are very strong biting teeth and have the longest roots of any human teeth. They are designed to be the first teeth that touch when your jaws close together so they guide the rest of the teeth into the proper bite.

Normally, the maxillary canine teeth are the last of the front teeth to erupt into place. They usually come into place around age 13 and cause any space left between the upper front teeth to close tighter together. If a canine tooth gets impacted, every effort is made to get it to erupt into its proper position in the dental arch. The techniques involved to aid eruption can be applied to any impacted tooth in the upper or lower jaw, but most commonly they are applied to the maxillary canine (upper eye) teeth. Sixty percent of these impacted canines are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted canines are found in the middle of the supporting bone but stuck in an elevated position above the roots of the adjacent teeth or out to the facial side of the dental arch.

Early Recognition Of Impacted Canines Is The Key To Successful Treatment

The older the patient, the more likely an impacted canine will not erupt by nature’s forces alone even if the space is available for the tooth to fit in the dental arch. The American Association of Orthodontists recommends that a panorex screening x-ray, along with a dental examination, be performed on all dental patients at around the age of seven years to count the teeth and determine if there are problems with eruption of the adult teeth. It is important to determine whether all the adult teeth are present or if there are some adult teeth missing. Are there extra teeth present or unusual growths that are blocking the eruption of the canine? This exam is usually performed by your general dentist or hygienist who will refer you to an orthodontist if a problem is identified. Treating such a problem may involve an orthodontist placing braces to open spaces to allow for proper eruption of the adult teeth. Treatment may also require referral to an oral surgeon for extraction of over-retained baby teeth and/or selected adult teeth that are blocking the eruption of the all-important canines. The oral surgeon will also need to remove any extra teeth (supernumerary teeth) or growths that are blocking eruption of any of the adult teeth. If the eruption path is cleared and the space is opened up by age 11-12, there is a good chance the impacted canine will erupt with nature’s help alone. If the canine is allowed to develop too much (age 13-14), the impacted canine will not erupt by itself even with the space cleared for its eruption.

What Happens If The Canine Will Not Erupt When Proper Space Is Available?

In cases where the canines will not erupt spontaneously, the orthodontist and Dr. Mellin work together to get these unerupted canines to erupt. Each case must be evaluated on an individual basis but treatment will usually involve a combined effort between the orthodontist and Dr. Mellin. The most common scenario will call for the orthodontist to place braces on the teeth. A space will be opened to provide room for the impacted tooth to be moved into its proper position in the dental arch.

In a surgical procedure performed at Dr. Mellin’s office, 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. Once the tooth is exposed, Dr. Mellin will bond an orthodontic bracket to the exposed tooth. The bracket will have a miniature gold chain attached to it. Dr. Mellin will guide the chain back to the orthodontic arch wire where it will be temporarily attached. Sometimes Dr. Mellin will 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. Most of the time, the gum will be returned to its original location and sutured back with only the chain remaining visible as it exits a small hole in the gum.

Dr. Mellin feels this surgical procedure may be one of the best services he provides for his patients.