What is surgical exposure of impacted teeth?

Surgical exposure of impacted teeth is performed as part of orthodontic therapy when it is necessary to bring out an unerupted tooth. And, place it in the position that naturally belongs to it in the occlusal plane.

In the blog ahead of you, you will learn about all the stages of the complex, long-term therapy of extracting multiple impacted teeth from our adolescent patient.

Definition of impacted teeth

Impacted teeth are those that fail to erupt, i.e., those that have not emerged at the right time for various reasons.

These teeth remain trapped in the upper and/or lower jaw (to a greater or lesser extent) and disrupt the position of adjacent teeth. They can also cause inflammatory processes (infections) and other complications.

Therefore, they must either be extracted or surgically released. Depending on the space they occupy, the size of the jaw, and the interdental (between-teeth) relationships. In other words, the type of therapy and the goals to be achieved.

In most patients, the impacted teeth are usually wisdom teeth and canines. But they can also be other teeth.

Surgical exposure of impacted teeth and orthodontics

Combined oral surgical and orthodontic therapy, carried out at the Dr. Veselinović dental clinic, began when the patient was 11 years old. In this case, three teeth were impacted (the upper left canine and the lower two premolars).

The individualized orthodontic therapy plan initially aimed to surgically release the second left premolar (the fifth tooth). Since there was space for its growth at that position.

Intervention on the right side had to be delayed because space for the tooth still needed to be created.

Regarding the upper canine, a special 3D scan was taken to assess the exact condition.

The analysis showed that the tooth was positioned palatinally. It means that the crown of this canine was resting on the root of the adjacent incisor (see X-ray images below).

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How were the oral surgical and orthodontic therapies carried out?

This interdisciplinary therapy involved several stages:

• surgical opening (exposure) of the canine;
• bringing the tooth to the surface of the jaw;
• repositioning the tooth.

X-ray images show the condition before and after placing the orthodontic appliance. Which followed the surgical exposure of the tooth – creating space through surgery.

The surgical intervention to expose the canine was performed under local anesthesia and proceeded smoothly.

Then, an orthodontic bracket was attached to the tooth, and the process of pulling it began using a force of 30 grams/cm³.

A ligature wire (chain) was placed distally towards the fourth tooth. It was fixed with liquid material to the wire arc of the fixed appliance to encourage the pulling.

This procedure was carried out to prevent the sliding of the wire. The second reason is tooth repositioning, i.e., to redirect the canine and maintain the desired alignment of its axis.

Since special rules were followed and the pulling forces were carefully measured, the plan proved highly successful.

The result was the alignment of the canine’s axis, allowing it to erupt in the correct position.

The moment the impacted tooth began to emerge is visible in the attached X-ray and photograph below.

The most recent photos (2 and 3) show that the previously impacted canine is now in the correct position in the occlusal plane. The tooth is fully in the jaw ridge and has been pulled enough to be in line with the other teeth.

The therapy will continue for a few more months until the space on the left side is fully closed.

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Surgical exposure of impacted teeth and extraction of the second left premolar

As mentioned earlier, the first part of the therapy involved extracting the impacted second left premolar (fifth tooth) in the mandible (lower jaw).

There was enough space for this tooth, so everything proceeded smoothly.

The blue fillings on the teeth (noticed in the top image) were used for therapeutic purposes.

These fillings were only temporary – once this part of the therapy was completed, they were removed.

Oral hygiene in orthodontic therapy

The process of correcting tooth positions is typically long and requires a great deal of patience. To prevent the development of cavities and other oral diseases, it is particularly important to maintain proper oral hygiene during orthodontic therapy.

Our orthodontists continuously remind patients about this and provide practical and helpful tips at every check-up.

Unfortunately, our patient, now 14 years old (therapy started at 11), still neglects the importance of oral hygiene. Despite the helpful guidance provided at our clinic.

Nevertheless, we strive to persevere through her rebellious teenage years. We do everything to keep her teeth healthy and achieve a successful outcome.

Because Dr. Veselinović dental clinic truly is a friend to your smile – a healthy, bright, and happy one!

If your child or you have any issues with tooth arrangement and positioning, you can schedule a specialist consultation. And, get expert advice from one of the most experienced orthodontists in Montenegro, Dr. Jasna Veselinović.

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