Oral & Maxillofacial Surgical Arts – Los Angeles CA
An impacted tooth simply means that it is “stuck” and cannot erupt into function. Patients frequently develop problems with impacted third molar (wisdom) teeth. These teeth get “stuck” in the back of the jaw and can develop painful infections among a host of other problems (see Impacted Wisdom Teeth under Procedures). Since there is rarely a functional need for wisdom teeth, they are usually extracted if they develop problems. The maxillary cuspid (upper eyetooth) is the second most common tooth to become impacted. The cuspid tooth is a critical tooth in the dental arch and plays an important role in your “bite”. The cuspid teeth are very strong biting teeth and have the longest roots of any human teeth. They are designed to be the first teeth that touch when your jaws close together so they guide the rest of the teeth into the proper bite.
Normally, the maxillary cuspid teeth are the last of the “front” teeth to erupt into place. They usually come into place around age 13 and cause any space left between the upper front teeth to close tighter together. If a cuspid tooth gets impacted, every effort is made to get it to erupt into its proper position in the dental arch. The techniques involved to aid eruption can be applied to any impacted tooth in the upper or lower jaw, but most commonly they are applied to the maxillary cuspid (upper eye) teeth. Sixty percent of these impacted eyeteeth are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted eye teeth are found in the middle of the supporting bone but stuck in an elevated position above the roots of the adjacent teeth or out to the facial side of the dental arch.
Early Recognition Of Impacted Eyeteeth Is The Key To Successful Treatment
The older the patient, the more likely an impacted eyetooth will not erupt by nature’s forces alone even if the space is available for the tooth to fit in the dental arch. The American Association of Orthodontists recommends that a panorex screening x-ray, along with a dental examination, be performed on all dental patients at around the age of seven years to count the teeth and determine if there are problems with eruption of the adult teeth. It is important to determine whether all the adult teeth are present or are some adult teeth missing. Are there extra teeth present or unusual growths that are blocking the eruption of the eyetooth? Is there extreme crowding or too little space available causing an eruption problem with the eyetooth? This exam is usually performed by your general dentist or hygienist who will refer you to an orthodontist if a problem is identified. Treating such a problem may involve an orthodontist placing braces to open spaces to allow for proper eruption of the adult teeth. Treatment may also require referral to an oral surgeon for extraction of over-retained baby teeth and/or selected adult teeth that are blocking the eruption of the all-important eyeteeth. The oral surgeon will also need to remove any extra teeth (supernumerary teeth) or growths that are blocking eruption of any of the adult teeth. If the eruption path is cleared and the space is opened up by age 11-12, there is a good chance the impacted eyetooth will erupt with nature’s help alone. If the eyetooth is allowed to develop too much (age 13-14), the impacted eyetooth will not erupt by itself even with the space cleared for its eruption. If the patient is too old (over 40), there is a much higher chance the tooth will be fused in position. In these cases the tooth will not budge despite all the efforts of the orthodontist and oral surgeon to erupt it into place. Sadly, the only option at this point is to extract the impacted tooth and consider an alternate treatment to replace it in the dental arch (crown on a dental implant or a fixed bridge).
What Happens If The Eyetooth Will Not Erupt When Proper Space Is Available?
In cases where the eyeteeth will not erupt spontaneously, the orthodontist and oral surgeon work together to get these unerupted eyeteeth to erupt. Each case must be evaluated on an individual basis but treatment will usually involve a combined effort between the orthodontist and the oral 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 eyetooth has not fallen out already, it is usually left in place until the space for the adult eyetooth is ready. Once the space is ready, the orthodontist will refer the patient to the oral surgeon to have the impacted eyetooth 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 oral surgeon will bond an orthodontic bracket to the exposed tooth. The bracket will have a miniature gold chain attached to it. The oral 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 surgery (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 to erupt the impacted tooth and not to extract it! 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 surgery” required to add bulk to the gum tissue over the relocated tooth so it remains healthy during normal function. Your dentist or orthodontist will explain this situation to you if it applies to your specific situation.
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Exposure and Bracketing of an Impacted Cuspid
These basic principals 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 surgery 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 than the posterior molar teeth. The molar teeth are much bigger 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 eyeteeth (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 oral surgeon before braces are even applied to the teeth. As mentioned earlier, the surgeon will be asked to remove over-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 eyetooth 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 eyetooth will have erupted enough that the orthodontist can 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!).
What To Expect From Surgery To Expose & Bracket An Impacted Tooth?
The surgery to expose and bracket an impacted tooth is a very straightforward surgical procedure that is performed in the oral surgeon’s office. For most patients, it is performed with using laughing gas and local anesthesia. In selected cases it will be performed under IV sedation if the patient desires to be asleep, but this is generally not necessary for this procedure. The procedure is generally scheduled for 75 minutes if one tooth is being exposed and bracketed and 105 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 preoperative consultation with your doctor. You can also refer to Preoperative Instructions under Surgical Instructions on this website for a review of any details.
You can expect a limited amount of bleeding from the surgical sites after surgery. Although there will be some discomfort after surgery at the surgical sites, most patients find Tylenol or Advil to be more than adequate to manage any pain they may have. Within two to three days after surgery 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; it can be minimized by applying ice packs to the lip for the afternoon after surgery. Bruising is not a common finding at all 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. Your doctor will see you seven to ten days after surgery to evaluate the healing process and make sure you are maintaining good oral hygiene. You should plan to see your orthodontist within 1-14 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 surgery. Simply call Oral & Maxillofacial Surgical Arts at Los Angeles Phone Number 310-670-0220 if you have any questions.
Read Our Patient Reviews
Oral & Maxillofacial Surgical Arts
Patient Review By Jerry S
Dr. Cheung was outstanding. Very friendly and makes you feel comfortable. Painless extraction!!!
- Jerry S
Patient Review By John L
The entire office was friendly, responsive, accommodating--especially to one in several days of pain and several disappointing experiences with other dentists. I would recommend this office enthusiastically to anyone and definitely will return again.
- John L
Patient Review By frank r
Dr. Ho was marvelous and the staff (Esther, Mari, Linda, Ale & Val) were so pleasant to work with. Everything went well and they the whole staff seemed to really care about the treatment they gave me and my well-being. I would recommend this group to anyone that needs specialized dental care.
- frank r
Patient Review By Rene B
Dr. Cheung and his staff are the best professionals you can ask for in oral surgery. The staff is amazing to work with. They are always genuinely happy to see you and are always happy to answer your questions. They will always ensure you're comfortable during the procedure and will check up on you afterwards. If you need oral surgery, I recommend you call their office. You will not be disappointed in their expertise and will be taken care of like a real person.
- Rene B
Patient Review By Christina V
Dr. Ho clearly explained the procedure and minimized the pain. Post-op has also been easy as well. The staff, particularly Ale, Val and Mari, were very welcoming, friendly and helpful. They were also very responsible about keeping the space sanitized. After the procedure, they followed up via phone or text, just to make sure I was OK. Very easy to schedule an appointment - they answered my call quickly, and then sent me a reminder notification just before the appointment. I didn't have to spend a lot of time in the waiting room because they allowed me to fill out my health forms (as a first time patient) online before my appointment. Overall, it has been a good experience, considering I had to have an impacted molar removed.
- Christina V
Patient Review By Mart A
Staff members are great. Good customer service very friendly.
- Mart A
Patient Review By Audrey D
I was so pleased with the service provided by Dr. Cheung and his staff. He is such an awesome, professional Doctor of Dentistry. I can't thank you enough!!!!!
- Audrey D
Patient Review By Elizabeth F
Everything ran smooth for me, I was very happy with over all experience! :0)
- Elizabeth F
Patient Review By Emily S
wish Dr. Cheung was a regular dentist - I'd be a patient for life. If I ever need any future oral surgery I will absolutely go back to him. He and his team made the experience very positive, for surgery, that is. Leslie and Zoraida were my patient card coordinators and they were really great - made me feel informed and at ease.
- Emily S
Patient Review By Ruth G
I really liked the follow up of the Dr when he text me the same day to check up on my daughters surgery. He was very professional and all my questions were answered.
- Ruth G
Patient Review By Eric B
Dr. Cheung and his staff were very patient with my many questions and concerns. The staff explained the procedure fully and I even told Dr. Cheung to tell me the "play-by-play" during the extraction. I think he enjoyed narrating the surgery. So far, 3 days later, everything is good.
- Eric B
Patient Review By John O
Everything was "perfect".
- John O
Patient Review By Timothy W
Friendly and professional. I healed quickly with minimal pain. Thank you!
- Timothy W
Patient Review By Barry F
Dr Cheung made me feel very comfortable and eased my fears of being at the dentist. The entire team made me feel at ease. The procedure was absolutely painless.
- Barry F
Patient Review By Paul M
I am very pleased with Dr. Rennie Cheung and his entire staff in the Woodland Hills office. They help to make the oral surgery experience much more pleasant.
- Paul M
Patient Review By Maxine S
Dr. Sagong was exceptional. He was clear about the procedure and kept me fully appraised as the procedure went forward. He was calm and professional, and at the same time calming. His assistant, Zoraida, helped me immensely through a difficult procedure. I thank them both for helping me through in such a warm and professional manner.
- Maxine S
Patient Review By Erick M
Zoraida was a really friendly help for my daughter's extraction surgery. Dr Rennie Cheung was funny, gentle and professional surgeon. He's the best!
- Erick M
Patient Review By Albert J
I am very happy with the doctor and staff
- Albert J
Patient Review By Robin A
I was very nervous going in but the staff made me feel very comfortable and at ease. The doctor also made be feel at ease with his reassurance he would would take good care of me and with his humor.. Overall having 2 extractions was quite a pleasant experience.
- Robin A
Patient Review By Susan W
They took wonderful care of me. They made a less than pleasant experience (tooth extraction) as easy and painless as possible. The office called me just before they closed and the surgeon called me that evening, to check on how I was doing. Excellent care!
- Susan W
Patient Review By NEIL K
I had SUPERB dental work, an extraction, at Southern California Oral & Max, the Manchester Ave. office. Both Dr. Benjamin Yagoubian, D.D.S. and his Dental Asst. Hasmick are superb! FIVE STARS! AAAAA+ Highly recommended.
- NEIL K
Patient Review By Ilan B
I have been coming to Dr. Ho for many years & he has always taken my issues in consideration. He has been great to me & my wife.
- Ilan B
Patient Review By Laura M
The staff is super nice, helpful, & understanding. Best dentist experience I have ever had. They pulled my tooth & I didn't feel a thing.
- Laura M
Patient Review By Karen S
I really feel comfortable with Dr. Victor Ho's office, his staff are incredibly nice & accommodating. Dr. Ho is truly the best oral surgeon I know. I have refereed people to him!
- Karen S