What is an Impacted Tooth/Teeth?

An impacted tooth/teeth refers to permanent tooth/teeth that have failed to come through at the right age. The teeth usually affected are the permanent canine teeth, and the permanent premolar teeth. The permanent canine and premolar teeth are usually fully present inside the mouth by 10 to 13 years of age.

An unerupted tooth can cause aesthetic, function issues and many times can cause damage to the surrounding teeth if left untreated. Due to its complexity, the impacted teeth are best to be managed by specialist orthodontist.

If found early, there is preventative treatment that sometimes can help to allow the impacted tooth to erupt on its own, by opening sufficient space for its path with simple orthodontics, however, if the angulation is severe, or the teeth development is no longer favourable, minor surgery maybe indicated.

Why do impacted teeth need to be corrected?

If left by itself, it can cause permanent damage to the roots of the adjacent adult teeth. Often, you would be unaware of this,  as there is no pain, and may only be noticed when an x-ray is taken.

When an adult tooth is impacted, it means the baby tooth may remain; this is often much smaller than the adult tooth, and typically results in reduced aesthetics. Eventually, the baby tooth can loosen and fall out spontaneously, leaving an unfilled large gap.

Impacted teeth that are left untreated are much harder to treat at a later age, often requiring a minor surgery and there is an increased risk of complications, including the risk of non movement (ankylosis) of the impacted tooth due to its prolonged impaction.

If the impacted tooth does erupt by itself, it can erupt high against the gum, leaving an inflamed gum that can be hard to correct, even through successful orthodontic treatment with braces.

What are the treatment options?

Depending on the complexity, severity, and age of diagnosis of the impacted tooth there are many different treatment options.

  • In children, if detected and managed early, often a space maintainer may be sufficient for the impacted tooth to erupt by itself. Occasionally if there is marked crowding and a narrow upper jaw, a custom made expander may be required to regain space.
  • In teenagers, if the impacted permanent tooth is moderate to severe, surgical exposure of the impacted tooth is often required. This is where a chain is attached to the impacted tooth by an oral surgeon. The chain is attached to the braces by the orthodontist, who uses it to guide the impacted tooth into the correct position. Upper and lower braces are often required to straighten the impacted tooth.
  • In adults, orthodontic positioning of the impacted tooth is advised. This is usually done with upper and lower braces.

If the impaction position is very severe, often an elective decision will be made to keep either keep the impacted tooth and straighten the teeth around it OR remove the impacted tooth and straighten the overlying teeth with braces.

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