Impacted Canines

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. Since there is rarely a functional need for wisdom teeth, they are usually extracted if they develop problems.

The maxillary canine (upper eyetooth) is the second most common tooth to become impacted. The canine tooth is a critical tooth in the dental arch and plays an important role in your “bite”. The canine 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 canine 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 canine 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 canine. Sixty percent of these impacted canine are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted canine 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.

For more information about Impacted Canines or to schedule a consultation with Dr. Hullett or Dr. Hullett, call our office in Houston, TX at Houston Office Phone Number 713-439-7575.

Early Recognition Of Impacted Eyeteeth 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 eyeteeth. 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 40), there is a much higher chance that 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 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 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 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 (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 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 eyeteeth (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 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 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. For most patients, it is performed 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 scheduled for approximately 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. 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 (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 Southwest Oral & Implant Surgery at Houston Office Phone Number 713-439-7575 if you have any questions.

Southwest Oral & Implant Surgery

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I have my wisdom teeth extraction. Dr. Jason Hullett and Dr. Anu Hullett did an outstanding job. The procedure went smoothly. I highly recommend Dr. Hullett.

- Josephine L

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I went to get 2 wisdom teeth extracted, and was so nervous, first time ever. I've heard of so many horror stories of people getting their wisdom teeth pulled. I tell you what, it was total opposite of horror. Both Dr. Anu and Jason Hullett did a tremendous job. They're both very kind, respectful, caring, and excellent at what they do. I had little to no pain after surgery, most definitely no swelling at all! Family and friends were amazed at the recovery time, and zero complications. I highly recommend Dr. Anu and Jason Hullet. Thank you Dr's!

- Ricardo G

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My son needed to have three wisdom teeth removed. The surgery ended up being shorter in duration and less expensive than we had been quoted. No negative side effects, no heavy pain meds needed and he was back to normal within a week. Would highly recommend this team.

- Sally M

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Dr. Jason Hullett and his team did an outstanding job with our son's wisdom teeth extraction. Procedure was pain free and recovery was quick. Thank you Dr. Hullett for this excellent treatment.

- Anonymous

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I came to Dr. Hullett after a tooth extraction by regular dentist could not be completed due to a stubborn root piece. It was important to get the last part out soon, and the office promptly accommodated, finding room on the same day for a visit and the needed surgery. The first thing I want in a dental office is that they get it right, and I was impressed from the front desk, to the aide who took me through all preparation, and finally Dr. Jason who completed the job. I also want compassion, and to feel secure while I'm getting the needed anesthesia, which I was. After 6 decades and more than a few dental mis-adventures, I feel this office was one of the best I've ever visited.

- David K

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This was my first oral surgery to remove 7 teeth. Everyone made me feel at ease and next thing I knew, I was finished and sitting up in the chair. The doctors and staff are just wonderful, really caring and friendly and will take excellent take care of you.

- Natasha L

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Everyone was so great when I came in to get my wisdom teeth taken out. I scheduled my appointment very late about a week before I left for school, but they were so great and were able to squeeze me in and find a time that worked for me early in the morning. I definitely would recommend them!!

- Maggie B

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My 11 year old son had to have a tooth extraction which required general anesthesia. He was anxious and worried and is very inquisitive. Dr's Hullet were beyond compassionate, warm and open to answer all his questions from the initial consultation to the procedure day. The staff is so polite and friendly as well. The key differencing factor that really sets these two Dr's apart is their dedication to their patients. Dr. Anu Hullett asked me to come by since they were still in the same office the day of his procedure so she can check him out, both Dr's checked him out and again answered all this 11 years old question with patience and reassured him and I that everything is fine. They go above and beyond and are truly available to you. I am beyond pleased with the service received and the Dr's attentive and passion beyond what they do. I highly recommend Dr's Hullet due to these qualities which are hard to come by these days. Thank you Dr's Hullet and staff!

- Sejal U

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I was very nervous about getting my wisdom teeth removed, but thanks to Drs. Hullett, it could not have been a more easy and comfortable process. I felt that I was in safe hands on the day of my procedure and was thrilled that my recovery was so quick and seamless. A big thanks to both Dr. Jason Hullett and Dr. Anu Hullett for being very thorough and kind in my interactions with them!

- Lindsey Y

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Dr. Hullett and his entire staff are absolutely wonderful. My daughter had oral surgery today performed by Dr. Hullett and his wife, and they made her feel so at ease. Everyone at his office and the surgical center were very pleasant and went above and beyond the level of customer service that is seldom seen these days. I give this group my highest of recommendations.

- Karen T

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I was so scared of tooth extraction but Dr. Hullett made it simple and painless with, and healing was super fast.

- Dozie N

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Dr Hullett and his staff did everything possible to make me feel comfortable before, during and after my surgery. I had no problems and healed up on schedule. I would highly recommend Dr Hullett for any extraction. CM

- Chuck M

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I would recommend Southwest oral & implant surgery to anyone who needs to get their wisdom teeth taken out. They make their practice feel like a home which is something that stuck out to me. I am glad that I choose Southwest oral and implant surgery and I can't thank the staff enough.

- Jaylon A

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Dr. Hulett did a good job in extracting my wisdom tooth. I didn't feel pain during the procedure. The staff was welcoming and offered good advice for care after surgery. I would definitely recommend this team. They take good care of their patients!

- Ben Y

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Referred to by dentist, felt barely any pain. medication worked well. Hospitality was great. I was comfortable the whole time i was in the office. Thanks to everyone that took care of me!

- Jaden D

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I would definitely recommend this office to any friends looking to have this procedure done, I was very happy with the whole process.

- Andrew M

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I've had several visits to this office for my implants (I had 3 placed) and my dentist just placed the crowns on top--amazing. I can bite my teeth together. The doctor, Dr. Hullett, did a great job with the surgery itself in putting in the implants. This was definitely the easiest of all the dental work I've had done in the past (I had extracted teeth that had root canals, some fillings) but barely had to deal with any after pain. The crowns look like white natural teeth and you can see one when I'm smiling wide and they don't feel like something is stuck in my jaw. They feel pretty good! I'm glad I did it.

- Josh F

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Great service for extracting some of my trouble teeth. The doctor was concerned for my diet and I appreciated the nurse's recommendations, it was real food! Thanks Dr. Hullet you made this visit easy on me.

- L. S

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