Under normal circumstances, when a child loses his or her baby teeth, the permanent tooth erupts from the gum as part of the growth process. However, sometimes a tooth cannot erupt normally and becomes impacted. This is particularly common with the third molars (wisdom teeth) and may also occur with the cuspids or upper eyeteeth.

An impacted tooth can cause problems because the remaining teeth may shift or get out of position. In some cases, impacted teeth will never fully erupt, which can be particularly true as the patient ages. The solution to an impacted tooth depends on its location and on other factors, including the size of the patient’s jaw and on their overall oral health. In some cases, braces may be necessary to give impacted teeth adequate room to erupt. In other cases, retained baby teeth that are blocking the permanent tooth must be removed by a periodontist.

Occasionally, a patient’s teeth will be so tightly crowded in the jaw that the periodontist will need to remove adjacent teeth in order to allow room for the impacted tooth to be removed or to erupt. If an impacted tooth remains in place until the patient reaches middle age, it will typically become fused into position and will then need to be removed under general anesthesia.

Ideally, the periodontist will try to save the impacted tooth by removing the gum on top of it, thereby exposing the tooth. An orthodontic bracket will then be bonded to the exposed tooth’s surface, and a tiny chain with a rubber band will be attached to the bracket and to an orthodontic arch wire. The tension on the chain will very gradually move the tooth into position, just as if it had normally erupted.

The procedure will be performed in the periodontist’s office using nitrous oxide (laughing gas) or IV sedation and a local anesthetic and will take about 90 minutes to two hours to complete. The recovery period is typically a week, and you will need to avoid certain foods containing sharp edges, like crackers. Although it may take up to a year to correct the problem, this procedure is the best solution for saving the tooth.

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A dental implant is placed into the bone to simulate a root. Once the implant has healed your dentist will place the crown.


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Periodontal surgery is performed on patients who have periodontal disease in order to reduce pockets.