What makes an attractive smile? Of course, shiny, straight and defect-free teeth are a big factor. But there’s another equally important element: all your teeth have come in.
Sometimes, though, they don’t: one or more teeth may remain up in the gums, a condition known as impaction. And if they’re in the front like the upper canines (the pointed teeth on either side of the front four incisors) your smile’s natural balance and symmetry can suffer.
Impaction usually happens due to lack of space on a small jaw. Previously erupted teeth crowd into the space of teeth yet to come in, preventing them from doing so. As a result the latter remain hidden within the gums.
While impaction can interfere with the smile appearance, it can cause health problems too. Impacted teeth are at higher risk for abscesses (localized areas of infection) and can damage the roots of other teeth they may be pressing against. That’s why it’s desirable for both form and function to treat them.
We begin first with an orthodontic examination to fully assess the situation. At some point we’ll want to pinpoint the impacted teeth’s precise location and position. While x-rays are useful for locating impacted teeth, many specialists use cone beam CT (CBCT) technology that produces highly detailed three-dimensional images viewable from different vantage points.
If the tooth is in too extreme a position, it might be best to remove it and later replace it with a dental impact or similar restoration once we’ve completed other necessary orthodontic treatment. But if the tooth is in a reasonable position, we might be able to “move” the tooth into its proper place in the jaw in coordination with these other tooth-movement efforts to make room for it.
To begin this process, an oral surgeon or periodontist surgically exposes the tooth crown (the normally visible portion) through the gums. They then bond a small bracket to the crown and attach a small gold chain. An orthodontist will attach the other end to orthodontic hardware that will exert downward pressure on the tooth to gradually bring it into normal position.
Dealing with impacted teeth of this nature is often part of a comprehensive effort to correct the bite. If we’re successful, it could permanently transform both the smile and overall dental health.
If you would like more information on treating impacted teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Exposing Impacted Canines.”
It’s a big moment after months of wearing braces to finally get a glimpse of your new smile. The crooked teeth and poor bite are gone — and in their place are beautiful, straight teeth!
If you’re not careful, though, your new look might not last. That’s because the natural mechanism we used to straighten your teeth may try to return them to their previous poor positions.
Contrary to what many people think, teeth aren’t rigidly set within the jaw bone. Instead, an elastic, fibrous tissue known as the periodontal ligament lies between the teeth and the bone and attaches to both with tiny fibers. Though quite secure, the attachment allows the teeth to move in very minute increments in response to growth or other changes in the mouth.
Orthodontic appliances like braces or clear aligners put pressure on the teeth in the direction we wish them to move. The bone dissolves on the side of the teeth where pressure is being applied or facing the direction of movement and then builds up on the other side where tension is occurring.
The ligament, though, has a kind of “muscle memory” for the teeth’s original position. Unless it’s prevented, this “memory” will pull the teeth back to where they used to be. All the time and effort involved with wearing braces will be lost.
That’s why it’s important for you to wear an appliance called a retainer after your braces have been removed. As the name implies, the appliance “retains” the teeth in their new position until it’s more permanently set. For most people, this means wearing it for twenty-four hours in the beginning, then later only a few hours a day or while you sleep.
The majority of younger patients eventually won’t need to wear a retainer once bone and facial growth has solidified their teeth’s new position. Older adults, though, may need to wear one from now on. Even so, it’s a relatively slight inconvenience to protect that beautiful, hard-won smile.
If you would like more information on retainers, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “The Importance of Orthodontic Retainers.”