Impacted teeth, like canines, need treatment to move them into proper placement. The expose and bond procedure involves a small incision through the gums and the placement of a bracket on the impacted tooth. Next a small wire or chain (called an archwire) is connected from the bracket to a nearby tooth. Then the incision is usually closed, only leaving the archwire exposed. Over time, your orthodontist will use the anchor tooth, archwire and tension between the two to gradually move the impacted tooth into position.
This procedure generally requires the coordination of treatment from both an oral surgeon and an orthodontist – and we have both of those right here at Blue Ridge Orthodontics.
When a tooth is buried or stuck (impacted) beneath the gums, it may need assistance moving into the correct position. An impacted tooth may be caused by lack of space, the tooth’s position, if baby teeth are obstructing the path, or additional factors like cysts or tumors.
When the impacted tooth is a wisdom tooth, the common course of treatment is to remove the tooth. Other teeth, like canines, can also become impacted. Since canine teeth are very important to the bite, alignment, and function of the mouth, extra measures are taken. Expose and bond is a common treatment to bring impacted teeth into their proper positions.
The actual procedure to make the incision and place the bracket usually takes fewer than 60 minutes and, in most cases, you’ll go home the same day. The remainder of the work – moving the tooth gradually into position using the placed bracket – varies based upon the size of the tooth, degree of impaction, amount of surrounding bone and the maturity of the tooth. Our orthodontic and oral surgery team will be able to give you a timeline based upon your or your child’s specific needs.
The ideal time for moving an impacted tooth is when the majority of the tooth is formed but is not fully mature. An immature tooth will move much easier through the surrounding soft bone than a mature tooth with fully formed roots through a mature, harder jawbone. Because every child is different, the time for maturation may vary but can be easily evaluated through routine dental x-rays and orthodontic assessments.
After the surgery a gold chain will be attached to the orthodontic wire (if braces treated began prior to the expose and bond procedure) or attached to the adjacent tooth. This chain will be used to maneuver the affected tooth into its correct position.
Oral Hygiene
Mouth cleanliness is essential to the healing process. After each meal teeth and mouth should be brushed and cleaned as best as possible.
Bleeding
The best way to stop bleeding from the expose and bond procedure is to place a piece of damp gauze in the mouth and gently bite for 30 to 60 minutes. Rest quietly with the head elevated. If bleeding continues, use gauze for an additional 30 minutes. Pink or blood-tinged saliva may be seen for 2-3 days following the surgery and does not indicate a problem.
Swelling
Swelling is the body’s normal reaction to surgery and healing. The swelling will not become apparent until 24 hours after surgery and will not reach its peak for 2-3 days. Swelling may be minimized by the immediate use of ice packs. Apply the ice packs to the face on the outside of the affected area for 20 minutes then remove for 20 minutes, continuing while awake for the first 24 hours.
Pain & Medications
We send prescriptions to the patient’s chosen pharmacy. Unfortunately, most oral surgery is accompanies by some degree of discomfort. We recommend that patients who are not allergic to non-steroidal anti-inflammatory medication, take over-the-counter medication (like ibuprofen, Motrin and Advil) prior to the local anesthetic wearing off.
More in-depth and personalized instructions for pain management and medication is provided to patients at their appointments.
Diet
Drinking lots of fluids post-surgery is important for recovery. Immediately after the procedure while still numb, patients should avoid hot beverage and food. The day of the procedure only soft foods should be consumed. After the first day patients can progress to solid foods, with chewing localized away from the surgical site.
You can request an appointment for oral surgery here. If you or your child is currently an orthodontic patient in our office, one of our orthodontists will be able to advise you on the needed oral surgery. You may also be referred to our oral surgery department by a dentist or other orthodontist.
