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Impacted tooth surgery

An impacted tooth is one that cannot come through, usually because there is no room or it is growing at an angle. Surgery either removes it or uncovers it so an orthodontist can guide it into place. It is done under local anaesthetic, and which option is right depends on which tooth it is and your age.

What impaction means

A tooth is impacted when it is formed but cannot come through into the mouth, either because there is no space for it or because it is pointing the wrong way. Wisdom teeth are the most common. Upper canines are the ones that matter most, because they are hard to replace and important to the bite.

The two options

Removal, where the tooth has no useful future: a wisdom tooth, a tooth that is badly positioned, or one that is damaging its neighbours and cannot be saved. This is covered on wisdom tooth removal when it is a wisdom tooth.

Exposure and bonding, where the tooth is worth keeping. The gum over the tooth is opened, a small bracket with a fine gold chain is bonded to it, and the gum is closed with the chain left accessible. An orthodontist then uses that chain to draw the tooth into position over the following months.

Which of the two is right depends on the tooth, its position, its condition, and your age. Younger patients respond better to being guided into place.

How the surgery runs

  1. A 3D scan, which is the only reliable way to see exactly where the tooth sits and which way it is facing.
  2. Planning with the orthodontist, where the plan is to keep the tooth, so that the bracket is placed where the traction needs to pull from.
  3. The surgery, under local anaesthetic, usually thirty to forty five minutes.
  4. Healing, about a week for the gum, before orthodontic traction begins.

Afterwards

Soreness and some swelling for two to four days, which painkillers handle. Soft food for a few days. Keep the area clean gently, including around the chain if one has been placed.

The long part is the orthodontics that follows, and that is measured in months.

Questions people ask

Because some teeth are worth keeping. An upper canine is a cornerstone of the bite and the smile, and replacing one is difficult. If it is impacted but healthy and in a reachable position, uncovering it and letting an orthodontist bring it down is a far better outcome than removing it.

Months, sometimes more than a year, and that part is orthodontics rather than surgery. The surgical appointment uncovers the tooth and attaches a small bracket with a chain. The orthodontist then applies gentle traction over time. Patience is the main requirement.

Usually less uncomfortable. Exposing a tooth involves a smaller opening than removing a buried one, and there is no socket left behind. Expect soreness and some swelling for a few days rather than the stiff jaw that follows a lower wisdom tooth.

A 3D scan. A flat X-ray cannot tell you whether an impacted canine is sitting towards the lip or towards the palate, and that changes the whole surgical approach. It also shows whether the impacted tooth is damaging the roots of its neighbours, which sometimes decides the plan.

Appointments

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