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How Does Orthodontics Work for Ectopic or Impacted Canines?

Impacted Canines

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Impacted Canines

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The upper canine teeth, technically called cuspids and also referred to as eye teeth, are the third teeth from the center on either side of your smile. They’re known as canines because they look fang-like and resemble actual canine, or dog, teeth. These strong, sharp powerhouses are used to tear and rip food. 

Aside from their fun nicknames, upper canines also have the distinction of being the second most common teeth to be impacted (the wisdom teeth are the first). When a tooth is impacted, it means it’s stuck under bone or tissue and unable to erupt. Sometimes, ectopic eruption can occur too, which is when a canine tooth erupts in the wrong spot in the mouth. 

Unlike an impacted wisdom tooth, an impacted canine isn’t just the domain of an oral and maxillofacial surgeon. In fact, getting these teeth to erupt is usually a dual effort between your orthodontist and oral surgeon. As for ectopic canine teeth, depending on the situation, orthodontic treatment alone might be enough to get them back on track. 

As a Papillion, NE orthodontist, Dr. Nathan Hawley is experienced in complex cases and multidisciplinary treatment, including orthodontics for impacted canines and ectopic teeth. In this post, we’ll be covering everything you need to know about the process. 

The Basics of Your Canine Teeth

The upper cuspids, or canines, erupt when a toddler is between 16 and 22 months of age. The lower canines generally come in between 17 and 23 months of age. 

These teeth stay in place for quite a while and are often the last baby teeth to fall out, with most kids losing their lower canines between ages 9 and 12 and their upper ones between 10 and 12. By age 13, the permanent canines should be in place. 

The canines have some of the longest roots of any teeth, which gives them the strength and stability to effectively bite and tear into food. They also help with speech, protect your other teeth from coming into contact with one another, support the structure of your mouth and add to your smile aesthetics. 

What is an Impacted Tooth?

When permanent teeth erupt normally, they break through the gums and make their way down until they fill their rightful home in the dental arch. Unfortunately, sometimes the path can be blocked, causing a permanent tooth to get partially or fully trapped underneath the jawbone or soft tissues. When this happens, we say the tooth is impacted. 

Because we can function just fine without our wisdom teeth, when they become impacted, usually an oral surgeon will extract them. The canine teeth, on the other hand, play crucial roles. This is why we do our best to save your natural permanent canine teeth by guiding their eruption. 

Why does a tooth get impacted? The most common reasons include:

  • Not enough room in the jaw
  • Lack of space from excessive crowding or misaligned teeth
  • Improper timing of primary tooth loss (i.e., losing baby teeth too early or too late)
  • Extra teeth, also called supernumerary teeth
  • An abnormal growth

Most commonly, an upper canine on one side of the mouth becomes impacted and the other erupts normally. Less commonly, you can have impacted canines on both sides or experience an impacted lower canine .

Is an Ectopic Canine Tooth the Same Thing as an Impacted Canine Tooth?

They are similar! But the difference is that an ectopic canine tooth takes an abnormal eruption path and makes its debut in the wrong place. While an ectopic canine can become impacted, an impacted tooth isn’t always ectopic, because it can be on the correct eruption path but something prevents it from breaking through.

The ectopic eruption of canines happens for the same reasons teeth become impacted. Because the canine doesn’t have room to come in where it’s supposed to, it tries to squeeze in wherever it can, which could be:

  • Higher in your gums if it’s an upper canine
  • Lower in your gums if it’s a lower canine
  • Behind the top teeth on the palate (roof of the mouth)
  • Behind the bottom teeth 

Why Do Impacted Canine Teeth Need to be Treated?

Having a missing tooth in the front of your mouth will affect the appearance of your smile and can make you feel self-conscious. Aside from cosmetic concerns, impacted canines may also cause:

  • Damage to the jawbone
  • Damage to the roots of the adjacent teeth, leading to root resorption
  • Crowding or shifting of teeth
  • Infection
  • A misaligned bite
  • Difficulty chewing
  • Tooth loss
  • Abnormal wear of existing teeth
  • Cysts 

Why Do Ectopic Canines Need Treatment?

What about ectopic canines that fully erupt? Do they really need to be fixed? Yes. Just like impacted teeth, ectopic teeth can make you feel self-conscious about how your smile looks and cause similar problems if not treated, such as root resorption, jaw and TMJ pain, bite issues and more. 

How are Ectopic and Impacted Canines Diagnosed?

The ectopic eruption of canines is easy to see, as long as impaction doesn’t occur, because teeth show up where you’re not supposed to have teeth. Identifying an impacted canine can be a bit tougher. Since the tooth is stuck underneath bone or tissue, there might not be any visible signs at first. 

One of the reasons the American Association of Orthodontists recommends kids have their first orthodontic evaluation by age 7 is so an orthodontist like Dr. Hawley can identify missing, extra or impacted teeth. X-rays and an exam can reveal what’s going on below the surface of your child’s gums and allow Dr. Hawley to identify a canine that will likely become impacted. 

If the problem isn’t diagnosed early, it will be very evident when a teen is 13 or 14 and hasn’t gotten their permanent canine and the baby tooth is still in place. At this point, canine impaction treatment will likely be necessary. 

What Does Treatment for Impacted or Ectopic Canines Involve?

With early diagnosis, interceptive treatment may be possible for ectopic or impacted canines. In these cases, a child’s dentist or oral surgeon might extract the primary canine tooth. Sometimes, this is enough and it will clear the way for the permanent canine to erupt on its own in the right direction with no further treatment. 

If there still isn’t sufficient space to accommodate the canine after extraction, Dr. Hawley can coordinate with your child’s dentist and use braces or another orthodontic appliance to make enough room to encourage healthy eruption. 

Once the canine becomes impacted, other options will need to be considered. While there are several different treatments, including extracting the permanent canine and replacing it with a dental implant or dental bridge, Dr. Hawley prefers non-extraction orthodontics when possible. Therefore, he may recommend a technique called assisted eruption. 

The first step in this canine impaction treatment is getting braces. Dr. Hawley will create a personalized treatment plan and ensure the braces will make enough space in the dental arch for the canine. 

Then, if needed, an oral and maxillofacial surgeon will perform impacted canine surgery. Don’t worry. It’s quick and usually only requires a local anesthetic. During the procedure, the surgeon carefully moves the gum and/or bone to expose the impacted canine. 

A bracket with a tiny chain attached to it is bonded to the tooth. Dr. Hawley will apply light force to the chain to help the tooth erupt and gradually guide it into place. He’ll then wrap up your treatment by ensuring all of your teeth are aligned and your bite is healthy and stable. 

When an ectopic canine fully erupts, you don’t need oral surgery to expose the tooth. However, the treatment plan will still involve making room for the tooth and then using a bracket and auxiliaries to move it into position. 

How Long are Braces Worn for Impacted Canines?

Every case is unique and depends on several factors, including the location of the impacted canine and the alignment of your other teeth and jaw. In general, for a multi-step treatment involving exposing and bracketing the impacted tooth, most patients will have braces for about two to two-and-a-half years from start to finish.

Treatment of ectopic canines that have erupted is usually shorter because the tooth has less distance to travel. 

Do I Need Orthodontics for Impacted Canines?

The only way to know for certain whether you could benefit from orthodontics for impacted or ectopic canines is to visit an orthodontist. 

At Hawley Orthodontics, we use cutting-edge technology and advanced treatments to give our patients healthy smiles more comfortably and efficiently. If your canines are causing orthodontic concerns, Dr. Hawley will develop an accurate diagnosis and personalized treatment plan to give you properly positioned, straight teeth and a strong bite. Schedule a complimentary consultation with our Omaha orthodontist today!