Impacted canine tooth exposure for orthodontics
Impacted canine tooth exposure is a common issue, occurring in up to 2.8% of canines, that we need to address during orthodontic treatment.
What are the different severities in canine impaction?
There are a few major types of situations that we see when a canine is not erupting. The surgical steps for correction depend on the severity of bone and tissue coverage and the location of the canine.
- The canine is almost in and only has soft tissue covering it. As long as these cases have plenty of keratinized tissue, a simple laser uncovering is all we need to do.
- Eruption is too high and there is little to no keratinized tissue around the canine. In this case we use a tissue flap design to ensure the patient has a nice long term final result.
- The tooth is under bone and/or tissue and is near the facial aspect of the jaw. In this situation we use a careful flap design and then remove bone.
- A canine is under bone and/or tissue and is on the roof of the mouth. In this situation a laser exposure is ideal, removing both bone and tissue. Flap design, if we use at all, is not as critical.
Video of impacted canine tooth and orthodontic treatment
Canine tooth exposure – example #1
Canine tooth exposure – example of #2
Impacted canine tooth surgery – example of #3
Palatal canine impaction surgery – example of #4
Impacted canine tooth surgery on a live patient – example of #4
What is the cost of canine exposure? Dental codes used?
The cost will vary significantly based on the severity of the case and who is doing the procedure. Dental codes and normal costs for your zip code can be found on the fair health consumer website. Some of the more common codes that may be used are D4245 for moving gum tissue, D7280 for removal of both bone and tissue, and D7283 for the placement of a bracket.
How much pain does an impacted canine tooth surgery cause?
This depends entirely on how buried we are talking and what method was used to access the tooth. Bone does not have a lot of pain nerve fibers so cutting bone may seem more severe, it doesn’t increase the pain levels that much. Cutting tissue is what causes the most pain after the numbness wears off. Cutting done with a laser with be less painful than that done with a scalpel. The wider of area that has to be cut, the more pain you will feel after the numbness wears off. Prescription pain medication is usually not necessary. Alternating Tylenol and Advil will allow the patient to manage most of the pain.
Open vs closed surgical exposure for impacted canines
Open exposure is when we simply remove bone and tissue covering the canine and allow the tooth to erupt naturally or bracekt without a flap. A closed surgery is when we place a flap and expose the canine, add a bracket to it, and then cover and suture the tooth. This is only a debate on the palate. Meta-analyses by Cassina Eur J Ortho 2018 show the open method is faster and has lower rates of ankylosis. However, the open technique may risk more complications and is more painful. Bjorksved Eur J Ortho 2018
What are the alternative treatment choices?
There are of course several options but none as good. Options include the following:
- Leave the canine tooth in place
- Extract the impacted canine
- Surgical exposure and orthodontic treatment
Patients can have our Wheaton dental and orthodontic office handle nearly all of these situations at the same location. Patients looking for a Wheaton orthodontist or Wheaton dentist to handle an impacted canine, give us a call!