What is tooth exposure and why is it suggested?
When a tooth fails to erupt through the gum, this is known as an ectopic or impacted tooth. In addition to the numerous problems ectopic/impacted teeth can cause, they prevent tooth movement during orthodontic treatment, making it difficult to straighten the teeth and correct the bite. Tooth exposure refers to a minor surgical procedure that encourages the ectopic/impacted tooth to erupt.
Additionally, an unerupted tooth must not be left under the gum, otherwise, it can form an eruption cyst around it. This can potentially become infected or may even start to erode other teeth in the area, leading to their compromise or loss.
A tooth exposure procedure is suggested during orthodontic treatment so the ectopic/impacted tooth can be extruded (pushed out through the gum) and eventually aligned with the other teeth. Having this procedure after orthodontic treatment has been completed can lead to further issues, such as the tooth fusing to the bone or further braces being required to assist its eruption.
What are the reasons for an ectopic/impacted tooth?
Teeth fail to erupt for a variety of reasons. They become ectopic/impacted because something interferes with their normal eruption through the gum.
The most common reason is that the eruption path is blocked by another tooth due to dental crowding. Alternatively, baby teeth (whose roots would normally dissolve allowing them to drop out) have not yet been lost and prevent the adult teeth from coming through. If this is prevented for long enough, root growth on the adult tooth finishes, and there is nothing left to “push” it through the gum.
Other possible causes of ectopic/impacted teeth are soft tissues that are abnormally dense, blockage by another misaligned tooth, or eruption cysts around the area of the unerupted/ectopic tooth. Impacted teeth are sometimes obvious to the naked eye, but in most instances, an X-ray is necessary to identify the extent of the impaction. The technology in our clinic allows us to obtain a focused X-ray of the area.
Tooth exposure procedure
The exposure procedure involves making a small incision in the gum adjacent to the impacted/unerupted tooth. A bracket is then bonded onto the tooth with a chain attached to the bracket. This chain can then be tied to your regular orthodontic wires.
An oral surgeon undertakes your exposure procedure – please note that we do not complete this within our practice. After this procedure, you will then return to our clinic to have the chain connected to your orthodontic wire. Then through a series of appointments, the tension of the chain will continuously be increased, which will eventually encourage the ectopic/impacted tooth to erupt.
Any retained baby teeth within the same area may have to be removed at this time as well. This will leave a gap in the smile until the adult tooth erupts.
Are there risks of tooth exposure?
Like all invasive procedures, exposure surgery carries some risks. Your oral surgeon will assess your circumstances and will explain the associated risks so that you can make an informed decision regarding whether or not the procedure may be right for you.
On the rare occasion that the exposed tooth will not respond to treatment, Dr De Angelis and his team will devise an alternative plan.
What can I expect?
Patients can generally expect some localized discomfort. Your oral surgeon or periodontist will provide more information and guidance at your consultation appointment.
There are always side effects that accompany every procedure, and these include some swelling, soreness and slight bleeding.
The decision to undergo the exposure procedure is a decision that can only be made by you. Please ensure that you understand the procedure and have asked any questions that you require before agreeing to undergo any procedure.