Other Therapies FAQs

1. WHAT ARE THE BENEFITS OF ESTHETIC CROWN LENGTHENING?
2. WHAT CAN BE DONE WHEN THE EYE TOOTH WILL NOT ERUPT EVEN THOUGH PROPER SPACE IS SURGICALLY MADE AVAILABLE?
3. WHAT CAN I EXPECT FROM THERAPY TO EXPOSE AND BRACKET AN IMPACTED TOOTH?

1. WHAT ARE THE BENEFITS OF ESTHETIC CROWN LENGTHENING?

Functional crown lengthening is an important part of an integrated effort to optimize your health, appearance, comfort, and function. A beautiful new smile and improved periodontal health are your keys to smiling, eating and speaking with comfort and confidence.

2. WHAT CAN BE DONE WHEN THE EYE TOOTH WILL NOT ERUPT EVEN THOUGH PROPER SPACE IS SURGICALLY MADE AVAILABLE?

In cases where the eye teeth will not erupt spontaneously, the orthodontist and Dr. Caldwell and Dr. Dimmitt will work together to get these un-erupted eye teeth to erupt into the proper positions. Each case must be evaluated on an individual basis, but treatment will usually involve a combined effort between the orthodontist and the surgeon. The most common scenario will call for the orthodontist to place braces on the teeth (at least the upper arch). A space will be opened to provide room for the impacted tooth to be moved into its proper position in the dental arch. If the baby eye tooth has not fallen out already, it is usually left in place until the space for the adult eye tooth is ready. Once the space is ready, the orthodontist will refer the patient to the surgeon to have the impacted eye tooth exposed and bracketed.

In a simple surgical procedure performed in the surgeon’s office, the gum on top of the impacted tooth will be lifted up to expose the hidden tooth underneath. If there is a baby tooth present, it will be removed at the same time. Once the tooth is exposed, the surgeon will bond an orthodontic bracket to the exposed tooth. The bracket will have a miniature gold chain attached to it. The surgeon will guide the chain back to the orthodontic arch wire where it will be temporarily attached. Sometimes the surgeon will leave the exposed impacted tooth completely uncovered by suturing the gum up high above the tooth or making a window in the gum covering the tooth (on selected cases located on the roof of the mouth). Most of the time, the gum will be returned to its original location and sutured back with only the chain remaining visible as it exits a small hole in the gum.

Shortly after therapy (1-14 days) the patient will return to the orthodontist. A rubber band will be attached to the chain to put a light eruptive pulling force on the impacted tooth. This will begin the process of moving the tooth into its proper place in the dental arch. This is a carefully controlled, slow process that may take up to a full year to complete. Remember: the goal is eruption of the impacted tooth; not extraction! Once the tooth is moved into the arch in its final position, the gum around it will be evaluated to make sure it is sufficiently strong and healthy to last for a lifetime of chewing and tooth brushing. In some circumstances, especially those where the tooth had to be moved a long distance, there may be some minor “gum therapy” required to add bulk to the gum tissue over the relocated tooth so it remains health during normal function. Dr. Caldwell, Dr. Dimmitt, or your orthodontist will explain this situation to you if it applies to your specific situation.

These basic principles can be adapted to apply to any impacted tooth in the mouth. It is not that uncommon for both of the maxillary cuspids to be impacted. In these cases the space in the dental arch form will be prepared on both sides at once. When the orthodontist is ready, the surgeon will expose and bracket both teeth in the same visit so the patient only has to heal from therapy once. Because the anterior teeth (incisors and cuspids) and the bicuspid teeth are small and have single roots, they are easier to erupt if they get impacted in comparison to the posterior molar teeth. The molar teeth are much larger teeth and have multiple roots, making them more difficult to move. The orthodontic maneuvers needed to manipulate an impacted molar tooth can be more complicated because of their location in the back of the dental arch.

Recent studies have revealed that with early identification of impacted eye-teeth (or any other impacted tooth other than wisdom teeth), treatment should be initiated at a younger age. Once the general dentist or hygienist identifies a potential eruption problem, the patient should be referred to the orthodontist for early evaluation. In some cases the patient will be sent to the surgeon before braces are even applied to the teeth. As mentioned earlier, the surgeon will be asked to remove any retained baby teeth and/or selected adult teeth. He will also remove any extra teeth or growths that are blocking eruption of the developing adult teeth. Finally, he may be asked to simply expose an impacted eye tooth without attaching a bracket and chain to it. In reality, this is an easier surgical procedure to perform than having to expose and bracket the impacted tooth. This will encourage some eruption to occur before the tooth becomes totally impacted (stuck). By the time the patient is at the proper age for the orthodontist to apply braces to the dental arch, the eye-tooth will have erupted enough for the orthodontist to bond a bracket to it and move it into place without needing to force its eruption. In the long run, this saves time for the patient and means less time in braces (always a plus for any patient!).

3. WHAT CAN I EXPECT FROM THERAPY TO EXPOSE AND BRACKET AN IMPACTED TOOTH?

The therapy to expose and bracket an impacted tooth is a very straightforward surgical procedure that is performed in the surgeon’s office. For most patients, it is performed with using oral sedatives and local anesthesia. In selected cases, it will be performed under I.V. sedation if the patient desires to be asleep, but this is generally not necessary for this procedure. The procedure is generally scheduled for 60 minutes if one tooth is being exposed and bracketed and 90 minutes if both sides require treatment. If the procedure only requires exposing the tooth with no bracketing, the time required will be shortened by about one half. These issues will be discussed in detail at your pre-therapy consultation with Dr. Caldwell or Dimmitt.

You can expect a limited amount of bleeding from the surgical sites after therapy. Although there will be some discomfort after therapy at the surgical sites, most patients find Tylenol or Advil to be more than adequate to manage any pain they may have. Within 2-3days after therapy, there is usually little need for any medication at all. There may be some swelling from holding the lip up to visualize the surgical site that can be minimized by applying ice packs to the lip for the afternoon after therapy. Bruising is not a common finding after these cases. A soft, bland diet is recommended at first, but you may resume your normal diet as soon as you feel comfortable chewing. It is advised that you avoid sharp food items like crackers and chips, as they will irritate the surgical site if they jab the wound during initial healing. Our staff will see you 7-10 days after therapy to evaluate the healing process and make sure you are maintaining good oral hygiene. You should plan to see your orthodontist within 14 to 21 days to activate the eruption process by applying the proper rubber band to the chain on your tooth. As always your doctor is available at the office or can be beeped after hours if any problems should arise after therapy.