impacted canines

The problem

The upper canine normally erupts into the mouth between the ages of 11 and 13. Sometimes one or both canines develop in the wrong position. Often they lie across the roof of the mouth behind the front teeth. They are a frequently occurring anomaly, present in 2% to 3% of the population. Management of this problem is both time consuming and expensive and involves surgical exposure (uncovering) followed by fixed braces for 2 to 3 years to bring the canine into alignment within the dental arch.

Why do I need treatment?

The upper canine has a long root making it a strong tooth and it is important tooth for both for biting and smile.

Sometimes they may be left alone and will remain un-erupted for many years, possibly a whole lifetime. They can, however, damage may either damage the roots of the front teeth or push them out of position. They can interfere with the orthodontic movement of other teeth. More rarely cysts can develop around them.

This treatment is provided as a part of orthodontic treatment to help the teeth erupt normally into the mouth.

What does the treatment involve?

Helping the tooth erupt into your mouth involves a relatively minor surgical procedure. This may be carried out under local anaesthetic (injection in the gum) but often takes place under a ‘day case’ general anaesthetic (put to sleep), going home on the same day as surgery.

Depending on the exact position of the un-erupted tooth; one or combination of following procedures will be carried out:

Open Exposure:

If a tooth is in the roof of the mouth a small window will be cut in the gum over the tooth plus some of the bone surrounding the crown of the tooth also needs to be removed

Closed exposure with bracket and chain: if a tooth is very deeply impacted then gum over it will be lifted up, tooth exposed and a gold chain and bracket will be glued on to the tooth. The gum is then put back and the chain is stitched to the outside of the gum usually with a non dissolving stitch, which will be removed prior to placement of braces.

If the canine lies near the outside of the arch, ie near the lip, the gum can be moved up and re positioned, being stitched in new position.

Sometimes it is necessary to hold the gum back in the right position with stitches at the end of the operation. These are usually dissolvable and take about two weeks to disappear.

What happens after the operation?

After the operation your mouth is likely to feel sore and tender for a few days and you will be advised to take painkillers eg. Paracetamol.

It is important to keep cleaning your teeth as usual but obviously take care around the operation site. You will be advised to rinse your mouth with hot saltwater mouthwashes and/or Corsodyl mouthwash.

You should make an appointment to see your Orthodontist 2-3 weeks after the operation.

Could there be any problems after the operation?

As with any type of surgery, certain problems could possibly occur following the operation:

Oozing of blood around the gums- This usually can be stopped by rinsing with cold water and by biting the teeth together so that the tongue presses the roof of the mouth.

Infection – the area around the exposed teeth may become red, swollen and increasingly tender after the operation. This would usually be an indication of infection and you should either contact the Oral & Maxillofacial Department or your Dentist for advice. It may be necessary for you to take a course of antibiotics.

It is possible that the metal bracket may fall off the canine tooth some time after the operation. If this were to happen, it may be necessary to repeat the surgical procedure (only relevant to closed procedure).

The teeth on either side of the canine tooth may be slightly loose following the operation. If this happens, it is important that you do not bite / chew hard foods with these teeth .It may be several weeks before they feel firm again.

Failure to attend orthodontic appointments and failure to brush the exposed tooth may allow gum to grow over the exposed tooth (only relevant to open procedure).