Canine teeth can become impacted and fail to erupt, particularly upper canines. They are usually the last front tooth to erupt and are a critical part of our appearance and the function of the bite. They usually erupt about the age of 13 but may fail to do so if there is not enough room for them. If a canine tooth is impacted orthodontic treatment will be required and techniques used to aid its movement into the proper position in the dental arch. An impacted canine is usually first assessed by the dentist or orthodontist by examination, radiographs and sometimes special scans. Most upper canines are impacted on the roof of the mouth. It is not uncommon for both upper canines to be impacted and occasionally lower canines can also be impacted.
How is an impacted canine managed?
Treatment is a combined effort of the orthodontist and the oral surgeon. The orthodontist will place braces on the teeth to open up a space for the impacted tooth to move into the proper position in the arch. This can be done before or after the impacted canine is exposed. The oral surgeon will perform a surgical procedure to expose the impacted tooth and attach a mesh and small gold chain using a special glue.
How is the surgery done?
This procedure can be done under general anaesthesia in hospital or in our surgical suite at Chatswood under local anaesthetic possibly with use of intravenous sedation. The gum over the impacted tooth is lifted up and the canine is exposed removing any bone blocking its path. If a baby canine tooth is still present it is usually extracted at this time. The mesh and chain are bonded to the tooth and the chain is loosely attached to the orthodontic wire or adjacent teeth or tissues. The gum is mostly returned to the original position and sutured leaving only the chain visible. Sometimes instead of bonding on a chain a hole is cut in the overlying gum and a pack placed. This is left in position for 10-14 days and removed by the surgeon. This will allow the orthodontist to put an orthodontic bracket directly on the tooth.
What is the recovery like?
Following the surgery the area will remain numb for a few hours. After this some pain will be experienced that can usually be managed with mild analgesics and will improve after a few days. The area will be tender for about a week with a soft diet recommended and mouthwashing, avoiding brushing the area. The orthodontic treatment can continue after 1-2 weeks.
What compilations can occur?
Occasionally the glue attaching the chain to the tooth can fail and become detached. If this occurs it can be re-attached in second small procedure under local anaesthetic. In some unusual cases an impacted canine will not be able to be moved into the arch due to its difficult position or being ankylosed (fused to the surrounding bone). If this occurs the tooth may need to be removed to allow the tooth behind to be orthodontically moved into this postion.