Exposure and bonding of impacted teeth

Exposure and bonding of an impacted tooth is a procedure to treat teeth that have not come through the gum normally. This most often concerns the canines, but can also affect other teeth.

Why expose and bond an impacted tooth?

Exposure and bonding of an impacted tooth are carried out as part of orthodontic treatment, to guide the blocked tooth to its correct position on the dental arch and thus ensure an optimal function and smile.

The upper canine is the tooth most often concerned: it is impacted in about 2% of the population, most often on the palate side. Screening is done around the age of 10–12, when the canine cannot be felt in the gum. The earlier the exposure is done, the faster the traction.

Imaging and planning

Three-dimensional imaging is frequently required for precise planning of the procedure. It gives a detailed view of the position of the impacted tooth and of its relationship with the adjacent structures, which makes it possible to determine the most suitable approach for exposing it while keeping potential risks to a minimum.

Types of anaesthesia

Depending on the position of the tooth and how difficult it is to reach, several anaesthesia options are available:

Local anaesthesia — numbing of the area around the tooth; there is no pain, but pressure and noises are still perceived. You go home immediately.

Sedation — a light sedative given intravenously, combined with local anaesthesia: deeply relaxed, drowsy, unaware of noises or pressure, while breathing on your own. Performed as day surgery at Molière, with far fewer risks than general anaesthesia; discharge in the late afternoon, accompanied.

General anaesthesia — total absence of sensation and consciousness during the procedure; reserved for deeply impacted teeth or particular situations, as day surgery at Molière.

The exposure procedure

1. Local anaesthesia

2. Incision of the gum so that it can be folded back to expose the tooth and the bone

3. Removal of the bone blocking access to the impacted tooth

4. Exposure of the impacted tooth

5. Bonding of an orthodontic traction chain

6. Suturing with resorbable stitches, the chain emerging through the gum to be connected to the orthodontic appliance

Duration: 30 to 45 minutes. Orthodontic follow-up is needed to start pulling the tooth, guiding it progressively to its correct position, generally within the following 2 to 3 weeks. Traction lasts 6 to 18 months depending on the initial position.

Risks and complications

Although exposure and bonding are generally safe, some very rare complications can occur:

• Damage to neighbouring teeth (resorption of the root of an incisor already weakened by the canine).

• Post-operative infection.

• Detachment of the chain: the bonding then has to be redone during a short procedure.

• Ankylosis: the tooth is fused to the bone and does not move despite traction. Rare, more frequent in adults; an alternative (extraction and replacement) is then discussed with the orthodontist.

Recovery day by day

Day 0

• Bruising of the gum appears a few hours after the procedure and resolves within a few days.

• Cold on the cheek (cold pack or ice pack wrapped in a cloth), most effective during the first 48 hours.

• Take painkillers before the anaesthesia wears off. The prescription is registered on your identity card and usually includes an antibiotic, an anti-inflammatory, a painkiller and a mouthwash, generally three times a day after meals; complete the course of antibiotics.

• Do not pull on the chain, do not touch the area with your tongue.

• Do not smoke.

• Sleep on your back, head raised on two pillows.

• Gentle brushing from this evening taking care with the stitches, prescribed mouthwash from the first evening, without force.

• Diet: soft and cold or lukewarm. Yoghurt, fruit compote, smoothies, lukewarm blended soup, purée.

Days 1–3

• Swelling peaks on days 1 and 2, then decreases. For a palatal canine, the discomfort is mainly on the palate.

• Diet: soft and lukewarm. Purée, scrambled eggs, flaked fish, well-cooked pasta, omelette, custard.

Days 4–14

• Pain clearly decreasing. The stitches dissolve within two weeks.

• Avoid intense physical activity for two weeks.

• Appointment with the orthodontist to activate the traction.

• Diet: normal but tender, avoiding sticky foods that could catch on the chain.

When to ask for a check-up

A quick check-up is possible without an appointment in case of: significant pain that increases after day 3; swelling that increases after day 3, fever above 38.5 °C; a chain that comes loose; heavy bleeding that does not stop after 30 minutes of pressure.

FAQ — Impacted teeth

At what age should the exposure be done?

As soon as the orthodontist has created the space on the arch, generally between 11 and 14. In adults, the procedure remains possible but traction takes longer and the risk of ankylosis is higher.

Is it painful?

Not during the procedure. Recovery is comparable to that of a wisdom tooth, often easier.

How long does it take for the tooth to come down?

6 to 18 months of orthodontic traction depending on the depth and orientation of the tooth.

What happens if the chain comes loose?

It is bonded again during a short procedure under local anaesthesia. This happens in fewer than 10% of cases.

Can the tooth fail to move?

Rarely, in case of ankylosis. The orthodontist and the surgeon then discuss an alternative: extraction and closure of the space, or replacement by an implant at the end of growth.

Is the exposure reimbursed?

Yes, surgical exposure of an impacted tooth is reimbursed by the INAMI/RIZIV (national health insurance).