The concept of an impacted tooth
A tooth is impacted when it has become stuck in the bone, and therefore the gum, meaning that it is still there 2 years after the normal age when it usually grows in.
Although any tooth can become impacted, the problem is most frequently found in the canines and the third molars or wisdom teeth, and particularly in the bottom teeth. If the wisdom teeth are impacted, we wait to see how they evolve. In the event of an infection, they are extracted. The canines and other teeth such as the incisors or premolars, if not too many years have passed since the usual age for them to grow in, can be moved into the correct position with orthodontics.
If all of the teeth have grown in except for one or two and a year has gone by since the others grew in, we must consider the possibility that the tooth or teeth are impacted.
Given that a tooth grows in when it has two-thirds of its root, if we can only see half of the root on studying an X-ray, we will know that it is still too early for it to grow in.
When orthodontic treatment is necessary
Un diente puede no estar impactado sino solo bloqueado en su camino de salida. Esto se da cuando no hay espacio para todos los dientes y tienden amontonarse. Así, el canino o a veces algún otro diente, si ya han salido los de al lado, se encuentra que no tiene espacio suficiente para salir y colocarse en su sitio, entonces se queda atascado en el hueso sin erupcionar.
Si el diente no sale por estar bloqueado o impactado, queda un hueco estrecho sin rellenar en la boca, aunque a veces, está el diente de leche o temporal que no se ha caído porque el definitivo no lo ha empujado. Si el diente está sólo bloqueado, se abre el espacio con ortodoncia y entonces, sale. Esto ocurre si el canino está vertical y saliendo por la parte externa. Se ve o se palpa por la parte de fuera. Si el canino está horizontal, es decir que en la radiografía panorámica se ve tumbado dentro del hueso, además de hacerle sitio con ortodoncia, hay que ir a por él.
También si el canino está vertical, pero saliendo por el paladar. En estos casos hay que acceder a la corona del canino con una pequeña cirugía, pegarle un bracket con forma de botón y con un alambre tirar lentamente de él hasta el lugar que le corresponde.
The situation may arise where a tooth is not impacted, but is simply suffering some kind of blockage as it grows in. This happens when there is not enough space to accommodate all of the teeth, so that they start growing over one another. Thus, the canine or perhaps another tooth may find, when those around it have grown in, that it doesn’t have enough space to move into its allotted space, leaving it trapped in the bone.
If a tooth doesn’t grow in due to being blocked or impacted, a narrow unfilled gap will appear in the mouth, although sometimes we may find that the milk or temporary tooth hasn’t fallen out because the permanent tooth hasn’t grown in to push it out. If the tooth is simply blocked, we can make space for it with orthodontics and it will grow in. This is the case if the canine is found to be growing in vertically and externally, in which case it can be seen or felt from the outside. If the canine is lying horizontally, i.e. if in the X-ray we can see it lying down inside the bone, in addition to making a space for it with orthodontics, we will have to draw the tooth out from the bone.
The same applies if the canine is vertical, but growing in through the palate. In cases such as these a small surgical operation is required to reach the crown of the canine, fix a button bracket to it and gently pull it into the corresponding place.
This emigration usually takes a year, although in the case of adults or horizontal teeth, it can take as long as 2 years.
Added to this, we must consider the time it takes to prepare a space for the tooth, and the time needed to align and coordinate the teeth. The combined treatment will last for a little more than 2 years.
Age for recovering impacted teeth
Para recuperar un diente impactado tirando de él, necesitamos tener todos o casi todos los dientes restantes erupcionados, ya que con ortodoncia debemos hacerle sitio. Además a esos dientes les pondremos un arco flexible al que uniremos el alambre que tira del canino. Por tanto tienen que tener buen anclaje. Debido a eso, el paciente tiene que ser adolescente o adulto. No puede tener dientes de leche en los que apoyarse para tirar.
Por otro lado, con respecto al canino impactado, tiene que tener ligamento periodontal, es decir, no estar soldado al hueso, anquilosado.
To recover an impacted tooth by pulling it into place, all of the other teeth must have grown in to allow us to apply orthodontics in order to make space for it. We will also attach a flexible arch to these teeth, which we will join to the wire used to draw out the canine. The teeth used for this purpose must therefore be very well anchored. This means that the patient must either be of adolescent or adult age, since themilk teeth cannot be used as support to pull the other teeth.
On the other hand, with respect to the impacted canine, it must have a periodontal ligament, i.e. it must not be welded to the tooth or ankylosed.
After 25 years of age, we may have problems in moving the impacted teeth, although it is possible to move them even in people aged 50.
If the canine fails to move in a year, it has become what is known as ankylosed, meaning that an alternative treatment will be required, consisting of extracting one or more teeth. However, if we extract a canine, we must also extract the canine on the other side to make the mouth symmetrical, using orthodontics to close the gaps left by the missing teeth.
On rare occasions, the canine or other impacted tooth can damage the roots of the adjacent teeth and, in the worst cases, cause the loss of one or more teeth. This is rather improbable; we use a very flexible arc on the adjacent teeth in order that they will move if the emigrating tooth touches the surrounding roots. The other risk is that the ankylosed tooth doesn’t move and must be extracted.
The technique to recover impacted teeth has been highly studied and is regularly carried out, meaning that in fact the procedure involves very few risks, similar to a normal orthodontic treatment for crowding.
We must remember that an impacted tooth will always leave a gap, usually smaller than normal than that of an extracted tooth, but which requires filling, either with a bridge or implant. In both cases orthodontics are required to fit a false tooth of normal size.
This is why orthodontics must be applied in any case, meaning that it is worthwhile trying to coax the tooth into its place. At the end of the day, the patient will be satisfied with the aesthetic and functional results of the work done.