Skip to main content

Impacted Canines

An impacted tooth simply means that it cannot erupt into function. Patients frequently develop problems with impacted third molar (wisdom) teeth. These teeth can develop painful infections, among a host of other problems (see Wisdom Teeth under Procedures). Since there is rarely a functional need for wisdom teeth, they are usually extracted before they develop problems. The maxillary canine is the second most common tooth to become impacted. Thecanine tooth is a critical tooth in the dental arch and plays an important role in your “bite”. Thecanine teeth are very strong biting teeth and have the longest roots of any human tooth. 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 maxillarycanine 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 together. If acanine 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 maxillarycanine teeth. Sixty percent of these impacted canines are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted teeth are found in the middle of the supporting bone, but are stuck in an elevated position above the roots of the adjacent teeth, or are out to the facial side of the dental arch.

Early Recognition Of Impacted Canines Is The Key To Successful Treatment

The older the patient the more likely an impacted canine will not erupt by natural 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 panoramic x-ray, along with a dental examination, be performed on all dental patients at the age of seven 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 if some adult teeth missing.

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 allowing 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 canines. The oral surgeon will also need to remove any extra teeth (supernumerary teeth) or growths that are blocking the eruption of any adult teeth.

If the eruption path is cleared and the space is opened up by age 11-12, there is a good chance that the impacted canine will erupt with nature’s help. If the canine is allowed to develop too much under the surface (by age 13-14), the impacted canine will not erupt by itself, even with the space cleared for its eruption. If the patient is older (over 20), there is a much higher chance that the tooth will be fused in position. In these cases, the tooth will not move despite all the efforts of the orthodontist and oral surgeon to erupt it into place. 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 Canine Will Not Erupt When Proper Space Is Available?

In cases where the canine will not erupt spontaneously, the orthodontist and oral surgeon will work together to get these teeth 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 canine has not fallen out already, it is usually left in place until the space for the adult canine is ready. Once the space is ready, the orthodontist will refer the patient to the oral surgeon to have the impacted canine exposed and bracketed.

In a surgical procedure performed in the surgeon’s office, the tissue on top of the impacted tooth will be lifted up to expose the overlying bone. The bone is removed 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 and impacted tooth completely uncovered by suturing the gum up high above the tooth, or making a window in the gum covering the tooth. 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 the patient will return to the orthodontist. The orthodontist 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 has 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 that it remains healthy during normal function. Your dentist or orthodontist will explain this procedure to you if it applies to your specific situation.


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 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 that the patient only has to heal from one surgery. 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 canines (or any other impacted tooth other than the 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 the eruption of the developing adult teeth. Finally, he may be asked to simply expose an impacted canine 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 canine will have erupted enough so that the orthodontist can bond a bracket to it and move it into place without needing to force its eruption. 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.  The surgery 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. 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 after surgery. 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 when clearance is given to activate the eruption process (applying the proper rubber band to the chain on your tooth). As always, your doctor is available at the office and can be contacted after hours if any problems should arise after surgery. Simply call Central Virginia Oral and Facial Surgeons, PLC. at Charlottesville Office Phone Number 434-973-3348 if you have any questions.

Central Virginia Oral and Facial Surgeons, PLC.

5 out of 5 stars based on 97 Canine Exposure reviews

Our Latest Patient Testimonials

I just wanted to thank Dr. Gemmill and his staff for the great job in removing a wisdom tooth. They were kind, professional and painless. From the consultation thru the surgery they were all first class. Thank you!

- Barry M

5 out of 5 stars on

Our Latest Patient Testimonials

I got Dr. Jackson and he was absolutely wonderful. Him and his team did so well on my wisdom teeth that they didn't even hurt the next day. I recommend Dr. Jackson if you are ever looking for someone.

- Amillia B

5 out of 5 stars on

Our Latest Patient Testimonials

By far the best experience I’ve had, They worked with me professionally on my anxiety issues. Dr Jackson and his associates are outstanding in their work. Would highly recommend to anyone. Thanks to all the staff

- David H

5 out of 5 stars on

Our Latest Patient Testimonials

Everyone from Dr. Solomon to every staff member was Outstanding. They all were considerate, friendly, compassion to my feelings, I was a little uneasy about where the tooth had to be pulled, I had a broken root, and it was close to my sinus. Dr. Solomon answered all my questions and put me at ease. Thanks to All and God Bless.

- JoAnn T

5 out of 5 stars on

Our Latest Patient Testimonials

First, I want to explain that I have a tremendous fear of dentists. Not just anxiety, but the type of fear that leaves you ignoring your dental health for years and only when I have no other choice do I give in and seek treatment. However, after meeting with and being treated by Dr. Summers, I can honestly say that she and her team are the absolute best! They didn't mind my tears and helped me by being both compassionate and understanding of what I was experiencing. It was a blessing to meet the wonderful people at CVOFS, from the front staff to the surgical team, I could not have asked for a more kind and supportive group of professionals. I would highly recommend Dr. Summers and her team to anyone seeking the best in oral surgery care!

- Elizabeth W

5 out of 5 stars on

Our Latest Patient Testimonials

Everyone was helpful friendly and knowledgeable! I felt very comfortable!

- Susan D

5 out of 5 stars on

Our Latest Patient Testimonials

Great service and wonderful staff all around.

- LYNN S

5 out of 5 stars on

Our Latest Patient Testimonials

I have significant anxiety, and the days leading up to my procedure (tooth + wisdom tooth extraction) saw a definite increase in instances. I say this so you will understand how incredibly good Dr. Summers and the entire staff at CVOFS are. They were so caring! All of my questions were answered and concerns met with kindness and understanding. The day of the procedure came and it went so quickly and smoothly! Do I ever want to have to have teeth extracted again? No. If the day ever comes when it is necessary though, I can only hope that Dr. Summers is available.

- Carrie R

5 out of 5 stars on

Our Latest Patient Testimonials

I very much appreciated the individual care I was given and the nice conversation with the surgery technicians prior to starting the procedure. I also appreciated your team submitting a pre-approval to Delta Dental. it was helpful to know prior to the procedure that dental insurance approved most of the costs.

- Lynda S

5 out of 5 stars on

Our Latest Patient Testimonials

The doctor was excellent however we were told that we would owe $863.20 for our daughter’s wisdom teeth extraction and then afterwards we were sent a bill of $439.80. Wow. My husband called billing and they told us we could break the payment down to pay half on December 1st and half on Jan 1st since we were not expecting this huge fee after the procedure. Today I received a bill saying it had to be paid in full within 3 days since it was sent out in November 21st and we just received it today. Happy holidays to you as well. Thank you so much.

- Traci P

2 out of 5 stars on

Our Latest Patient Testimonials

Excellent experience.

- Richard R

5 out of 5 stars on

Our Latest Patient Testimonials

I had Dr.Solomon for my dentist, when i walked into the office is because i have neglect my teeth for many many years, and it showed, Dr.Solomon did not make me feel bad at all for the neglect.. I explained to him that i was terrified of the dentist. This man is so compassionate in the way that he takes care of his patients, Dr. Solomon and his staff is one in a million.

- linda h

5 out of 5 stars on

Our Latest Patient Testimonials

The entire process went smoother than I expected. Dr. Summers and her entire staff have been great during our adventure together.

- James M

5 out of 5 stars on

Our Latest Patient Testimonials

Outstanding service from welcoming staff, technicians and physicians!

- Carmon H

5 out of 5 stars on

Our Latest Patient Testimonials

Very satisfied with all aspects of visit, office staff, dentist, tooth extraction

- James W

5 out of 5 stars on

Our Latest Patient Testimonials

Everyone was very helpful and answered all my questions. Dr. Conner did a great job extracting my tooth. No pain or bleeding after. Only took Ibuprofen and Acetaminophen the fist day.

- Sue H

5 out of 5 stars on

Our Latest Patient Testimonials

Everyone was very professional and thorough.

- Crystal N

5 out of 5 stars on

Our Latest Patient Testimonials

Very professional, great work, and pain free procedure.

- Frank L

5 out of 5 stars on

Our Latest Patient Testimonials

We could not be more grateful for all of the team at cvofs. Dr. Tricker and his team have now taken care of both of our children and wisdom teeth removal and he and his team are amazing, professional, extremely kind and caring. I would give them 10 stars out of 5 if I could. Simply exceptional care. Cannot recommend them highly enough. So grateful.

- Gina D

5 out of 5 stars on

Our Latest Patient Testimonials

Dr. Connor and his staff in the Culpeper office was very prompt to my needs and I am truly grateful they were able to help me in my situation. Would recommend others to consider Dr. Connor and his staff for oral surgery needs.

- Brent L

5 out of 5 stars on
Click to open and close visual accessibility options. The options include increasing font-size and color contrast.