Impacted canine tooth surgery is a dental procedure in which a canine tooth that is unable to properly erupt through the gum tissue and jawbone is surgically maneuvered into its functional position. The four canine teeth (also called eye teeth or cuspids) are the more pointed single-rooted teeth located on either side of the front four incisors on both the bottom (mandibular) and top (maxillary) jaw.
Canine Tooth Purpose
Canine teeth are strong biting teeth that serve several critical purposes in dental function, including:
- Chewing and tearing food
- Guiding teeth into proper bite alignment
- Preventing other teeth from coming into unhealthy contact with each other
- Aesthetically shaping the smile
Because the maxillary (top) canine teeth are typically the last anterior teeth to erupt (usually between the ages of 11 and 13), sometimes the space available in the dental arch is insufficient to accommodate the larger incoming permanent canines, which are much wider than the primary teeth.
When a canine tooth becomes stuck and cannot erupt into position, it is considered to be impacted. The maxillary canine teeth are the second most commonly impacted teeth, with wisdom teeth being the most common. However, while wisdom teeth can often be extracted without functional repercussions, the canine teeth are much more crucial to oral health, so dental professionals will go to great lengths to aid in their proper eruption.
Cause of an Impacted Canine Tooth
Common reasons for canine teeth impaction include:
- Insufficient space
- Inability to follow proper track along the adjacent teeth
- Alignment problems with other teeth
- Early loss or removal of primary teeth
Canine teeth typically have a narrow pathway in which to erupt due to:
- Sequence of eruption: All other front teeth are fully established
- Size: Permanent canine teeth are much larger than the temporary teeth they are replacing
- Slow development: Canines have longer roots than most other teeth, therefore a longer eruption path
Diagnosing Impacted Canine Teeth
Diagnosing impacted canine teeth early is key to their successful treatment. According to the American Association of Orthodontics (AAO), children should have a dental examination which includes a panorex screening x-ray by age 7, in order to determine the presence and location of all the teeth and to identify any problems with tooth eruption. Keeping close watch on areas of concern will assist with early recognition of impacted canine teeth.
If a canine tooth has not erupted at the proper time, your dentist will do a thorough examination including:
- Observing the position and angulation of adjacent teeth
- Feeling the gum line for evidence of the missing tooth
- X-rays (possibly several types)
X-rays for impacted canines are used to:
- Determine if the tooth is actually impacted
- Clarify tooth position relative to adjacent teeth and jaw
- Identify problems the impaction may be causing to other teeth and structures
- Create the best treatment plan for the patient’s unique circumstances
Occasionally, a CT scan may be recommended to acquire 3-dimensional information regarding the impacted tooth. Pacific Oral Surgery uses our on-site Cone Beam Computerized Tomography (CBCT) scanner for convienence to the patient.
Types of Canine Tooth Impaction
The maxillary canine teeth are the most common to become impacted, and most affected patients (90%) only experience impaction on one side. When existing, well-established teeth block the incoming canine teeth, the result can be ectopic eruption (the tooth does not follow its proper path).
Approximately 60-85% of canine ectopic eruptions are palatal impactions (the tooth heads inward toward the roof of the mouth, or palate), while the remaining head outward toward the cheek or are stuck above the roots of adjacent teeth in an elevated position within the jaw.
Impacted canine teeth affect women twice as often as men with approximately 2% of the population experiencing the condition.
Problems With Impacted Canine Teeth
Some impacted canine teeth can remain untreated with little effect to the patient, however, the condition should be carefully and frequently monitored, as there is the potential for serious problems to arise. Aesthetically, the area where the canine tooth should erupt will either be vacant or the smaller baby tooth will remain.
Other possible consequences of untreated impacted canine teeth include:
- Resorption: Damage to adjacent healthy teeth which can result in tooth loss
- Misalignment of teeth: The impacted canine tooth can push adjacent teeth out of position
- Abnormal tissue growth: Cysts or tumors which require removal can form around the impacted tooth
- Premature wear on other teeth: Without the canines absorbing much of the bite impact, the other teeth can become damaged
- Lessened tooth function: Due to lack of a critical canine tooth or tooth damage
- Bone loss
Treatment for Impacted Canine Teeth
The goal of treatment for an impacted canine tooth is to bring the tooth into proper alignment with the other teeth. Typically, the first course of treatment is to create a sufficient space for the canine tooth to erupt. If impaction is detected early, removal of the primary canine tooth or other teeth blocking the way can clear the pathway, allowing the canine to come in.
Another technique, a gingivectomy or open exposure procedure, involves removing the overlying gums to promote the natural eruption of the impacted canine.
If creating sufficient space and clearing the pathway for the canine tooth does not facilitate eruption, your dentist, orthodontist, and oral surgeon will often work as a team to create and carry out a treatment plan to move the tooth into place.
The type of procedure performed will depend on:
- Which tooth is impacted
- Position of impacted tooth in the jawbone
- Degree of impaction
Exposure and Bracketing for Impacted Canine Teeth (Braces)
The most common treatment for impacted canine teeth is called exposure and bracketing, which involves the use of orthodontics and a simple surgical procedure.
Once a space is opened up for the impacted canine tooth to be moved into position, the exposure and bracketing procedure will be performed by your oral surgeon. Exposure and bracketing for one tooth is typically performed using local anesthesia and nitrous oxide (laughing gas) and is an in-office, short (usually just over an hour) surgery. In some cases, IV sedation may be utilized for more complex procedures.
During the exposure and bracketing surgery, the gum over the impacted canine tooth is lifted and the tooth is exposed. The surgeon then bonds an orthodontic bracket equipped with a small gold chain to the exposed impacted tooth. The chain is attached to an orthodontic arch wire and, in most cases, the gum is then sutured closed leaving only the chain visible. If the impacted tooth is located in the roof of the mouth, it may be left uncovered.
Several days later, the orthodontist places rubber bands on the chain to create a slight pulling force to gradually move the impacted tooth into its correct position. The exposure and bracketing process can take up to a year to achieve the optimal results and should be closely evaluated along the way.
When the impacted canine requires moving a longer distance than normal, minor gum surgery may be necessary to give the gum tissue over the tooth more bulk. Success rate for exposure and bracketing decreases as the patient ages and if the tooth is too horizontally positioned.
After Exposure and Bracketing Surgery for Impacted Canine Teeth
After your exposure and bracketing surgery, you will have some slight bleeding from the surgical site. Over-the-counter pain medications should alleviate any discomfort you experience for a few days.
Other tips for after your impacted canine tooth surgery include:
- Apply ice packs if you experience any swelling
- Eat a soft, bland diet until you are comfortable with chewing
- Avoid crunchy or sharp foods (chips, crackers) that can irritate surgery site
- Maintain good oral hygiene
- Visit your orthodontist within 2 weeks of surgery
An impacted canine tooth may need to be extracted on rare occasions, such as:
- Ankylosis (tooth will not move due to fusion with bone)
- Resorption compromising the tooth
- Extremely severe impaction
- Adjacent teeth are seriously jeopardized
- Pathological changes (cysts and tumors)
If you are concerned about an impacted canine tooth or think that you or your child may have one, contact our office for an evaluation.
If you would like to arrange a consultation with a doctor at Pacific Oral Surgery, please submit an online appointment request or call one of our Pacific Oral Surgery offices located in Ventura, Thousand Oaks and Simi Valley.
Our team of oral, maxillofacial and dental implant surgeons, Dr. James Jacobs, Dr. John Webb, and Dr. Sebastian Carlson, welcomes you to our Pacific Oral Surgery practice.