Impacted Canines

Next to wisdom teeth, the maxillary canine (upper eyetooth) is the second most common tooth to become impacted. The canine tooth plays an important role in your bite. The canine teeth are very strong biting teeth and have the longest roots. 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. The upper canine teeth are the last of the front teeth to grow into place. They usually come into place around age 12 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 bite. Sixty percent of impacted canines are located on the roof of the mouth side of the bite. 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 lip side of the bite.

Early Recognition

Early recognition of the impacted canine tooth is critical to being able to move it into the bite.  The older the patient, the more likely an impacted canine will not erupt by natural forces alone even if the space is available for the tooth to fit into the bite.

The American Association of Orthodontists recommends that a panoramic screening x-ray, along with a dental examination, be performed on all dental patients 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 are some adult teeth missing, if there are extra teeth present or unusual growths that are blocking the eruption of the permanent teeth, if there is extreme crowding or too little space available causing an eruption problem with the permanent teeth, especially the canine tooth. This exam is usually performed by your general dentist or hygienist who will refer you to an orthodontist if a problem is identified. Treating an impacted canine may involve an orthodontist placing braces to open spaces to allow for proper eruption of the canine.

Treatment may also require referral to an oral surgeon for extraction of baby teeth and/or selected adult teeth that are blocking the eruption of the important canine teeth. The oral surgeon is also involved in removing any extra teeth (supernumerary teeth) or growths that are blocking eruption of the canine. 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 naturally. If the canine is allowed to develop too much (age 13-14), the canine will not erupt by itself even with the space cleared for its eruption. The older a patient is after the canine tooth is fully grown, the higher the chance the tooth will be fused to the bone. In these cases the tooth will not budge despite all the efforts of the orthodontist and oral surgeon to erupt it into place. Sadly, the only option at this point is to extract the impacted tooth and consider an alternate treatment to replace it such as a crown on a dental implant or a fixed bridge.

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

In cases where the canine will not erupt spontaneously, the orthodontist and oral surgeon need to work together.  Each case must be evaluated on an individual basis but the most common scenario will call for the orthodontist to place braces on the teeth, and the space opened to provide room for the impacted tooth to be moved into its proper position in the dental arch. Once the space is ready, the orthodontist will refer the patient to the oral surgeon to have the impacted canine exposed and a bracket and chain bonded to the canine to give the orthodontist a way to “tug” the canine into position with elastic traction.

In a simple procedure performed in the office, the gum on top of the impacted canine 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, the oral surgeon will bond an orthodontic bracket to the exposed tooth. The bracket will have a miniature gold chain attached to it. The oral surgeon will guide the chain back to the orthodontic arch wire where it will be temporarily attached. Sometimes the surgeon will leave the exposed impacted tooth completely uncovered by leaving the gum high up 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 stitched back with only the chain remaining visible as it exits a small hole in the gum.

Shortly after surgery the patient will return to the orthodontist. A rubber band will be attached to the chain to put a light pulling force on the impacted tooth. This will begin the process of moving the tooth into its proper place in the dental arch. This is a carefully controlled, slow process that may take several months to complete.