Canine exposure surgery

The canines, or cuspids, are a very commonly impacted tooth in the mouth. This is the third tooth from the front, and is the one that has the pointy tip, like a canine. 

Why are canines so often impacted? There are several reasons for this. First, they have a long eruption path compared to most of the other teeth in the mouth. They start out as developing tooth buds high up in the upper jaw, near the eye sockets (this is why they are also referred to colloquially as “eye teeth”). Second, they generally erupt between age 11 and 13, and are one of the last teeth to erupt. Second, if you imagine the upper teeth form a U shape in the mouth, their position is at the corners of the U. They are not quite in the front, and not quite in the back; they are right in the middle. So they have a long path to travel and a long time to develop, and they have to land in between other teeth that have already been developing are erupting. On top of this, there may not be enough space in the mouth for them.

The canines happen to be a very important tooth in the mouth. Functionally, they are sharp and strong, which make them very important for for incising food. They are actually much stronger than the other front teeth. They are also very implant in guiding our teeth and jaws in the range of functional motion. They are also very importantly cosmetically- their roots in the upper jaw bone help to provide the projection and support to our mid face, lending to a youthful face. And of course, they are the cornerstones of the smile. These are very important teeth and we need them to erupt!

Now, before we had X-rays and means to remove the teeth, they remained impacted, and caused infections and cysts. Nowadays, when they are impacted, there are several treatments that may be implemented. Of course, the first step is to make sure your child is under the case of both a pediatric dentist and an orthodontist. 

The various tools we have in our toolbox to help remedy impacted canines are the following:

1- We may extract the baby canines, to “invite” the permanent canines into the spot. But, for this to work, the spot has to be big enough and the canine needs to be in a position that makes it easy to drop into the correct spot in the proper orientation.

2- We may recommend palate expansion, to create more space in the jaw (If we think of a parking lot that is full, but we have to get more cars into it, this is analogous to increasing the size of the parking lot)

3- We may decide to extract one set of premolar teeth (Moving some cars out of the lot to make room for new cars). This option is not for everyone, and multiple other factors are considered in making this decision. 

If the canine remains impacted (remember, buried and not in the correct position), then the orthodontist may recommend an exposure and bracketing, or “expose and bond” of the impacted canine. This is a surgical procedure in which an oral surgeon makes an incision in the gums, surgically removes tissue to expose the buried canine, and attaches a special bracket to the canine. This bracket has a gold chain attached to it. The chain is secured to your braces, and the surgeon either closes up the gums with sutures or sometimes may leave it open. 

Then, when the gum tissue heals, you go back to your orthodontist, and he or she will now be able to use the chain to put gentle orthodontic traction on the tooth to help it erupt into place in your mouth. It’s kind of like a tow truck pulling your car out of a ditch so it can drive on the road again (cars are a helpful analogy here!). 

The most common question I get is how long it will take for the orthodontist to pull the tooth into the mouth. The answer is extremely variable, depending on your age, density of your bone, position of the tooth, and many more factors. It also depends on how often you see your orthodontist- Getting the canine to erupt will take multiple visits, as at each visit, the orthodontist will tighten the chain, just like they tighten the rest of the braces. 

If you or your child has been referred for a canine exposure, we recommend scheduling a consultation. It is best not to delay too long, because the best chance for success is when we intervene early. We will do an exam, take a CBCT (3D x-ray) to see the exact location of the impacted canine and it’s orientation to the nearby teeth, and discuss anesthesia options and how the procedure will go. Many children and tweens can have the procedure done with local anesthesia and laughing gas, but a small percentage of patients will need IV sedation. We believe that a visit to our office should be smooth and stress-free, and the best way to avoid anxiety is to be prepared. We’d love to tell you about your options.