Surgical Orthodontics

What happens when one gets left behind?
When your child reaches about 6 years of age he/she will lose their first primary teeth to make way for the permanent teeth to erupt. This will continue until all of the primary teeth have been lost and the permanent teeth have erupted.

Impacted Cuspid

Eruption of Impacted Maxillary Cuspid

Occasionally a permanent tooth may not erupt at the proper time and may become trapped under the gums and bone. When this happens your child’s dentist or orthodontist may say that the tooth is impacted.

Regular dental visits help your dentist and orthodontist keep track of your child’s developing dentition. An impacted tooth can often be detected at an early age on dental x-rays. Any tooth may be affected; however, the most common tooth affected is the upper cuspid or “eye tooth.” Many factors can lead to impacted teeth. Commonly, lack of space or prolonged retention of primary teeth can cause a tooth to become delayed in its eruption and ultimately impacted. Teeth that remain impacted can damage the roots of other teeth and are also at risk for developing tooth related cysts and other pathologic conditions.

Impacted cuspids must be brought into their proper position through careful planning and treatment. They are best treated through a team approach. Your dentist, orthodontist, and oral surgeon each add special skills and expertise necessary to appropriately diagnose and treat impacted teeth.

Your dental team will thoroughly examine your child to determine his/her individual needs. Often a three-dimensional x-ray is needed to assess the exact position of the impacted tooth. Your child may only need timely extraction of primary teeth and orthodontic treatment to provide space for the permanent tooth; however, a surgical procedure together with orthodontic treatment is usually required to expose the impacted permanent tooth and to help bring it into position.

In Traction

Your orthodontist will place orthodontic brackets (braces) on the other teeth to act as anchors, to provide a unified force to bring the tooth into position and minimize the unwanted movement of the other erupted teeth.

Our surgical team will expose the tooth and bond an orthodontic bracket to the enamel portion of the tooth. A small gold chain is connected to the bracket and emerges through the gums to allow your orthodontist to gently guide the tooth into place in the arch. The tooth may remain exposed or the gums may be closed over the tooth leaving only a small portion of the gold chain visible. We take special care to ensure that there is adequate gum tissue to surround the tooth once it erupts. Healing is usually rapid with return to normal activities in 1-2 days.

In Final Position

During the next orthodontic the orthodontist will begin to guide the tooth into place. The time required for the impacted tooth to move into its proper place varies with the amount of space available, and the severity of the impaction.

Temporary Anchorage Devices

In recent years small Titanium screws referred to as “temporary anchorage devices” (TADs) have been used as an adjunct in orthodontic treatment.  They can be placed in numerous locations around your teeth.  They provide a stable anchorage point(as opposed to using teeth as anchorage) which can be used to place traction on teeth that need to be moved without risking the unwanted movement of other teeth that are already in good position.  If your dentist or orthodontist feels that you may benefit from TADs he/she will refer you to us for a consultation so we can discuss the surgical placement of TADs in detail.  Once your orthodontic treatment is completed we will then remove the TADs.

TAD Canine Retraction Screw

TAD Molar Protraction Chain

TAD Molar Instrusion Chain

As an adjunct to your orthodontic treatment, your orthodontist may recommend various surgical solutions

Extraction of All Four 1st Bicuspids

Extraction of All Four 2nd Bicuspids

Extraction of A Retained Deciduous Second Molar (Ankylosed)

Labial Frenectomy