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Orthodontic Exposure Explained

Posted in Oral Surgery

Impacted teeth are teeth which for one reason or the other fail to emerge from below the gum line, or only emerge partially. While not all impacted teeth require treatment, certain teeth, such as the upper canine teeth, are crucial for functional occlusion and for their aesthetic value. Orthodontic exposure is the dental procedure used to treat unerupted teeth that are too valuable to extract or leave alone. The procedure involves using orthodontic appliances attached to the teeth to pull impacted teeth up from below the gum line.

Orthodontic exposure is done after braces have been put on the teeth. It is also called ‘surgical exposure’ because it requires that the gums be surgically cut to expose the impacted tooth. This simple surgery is typically done using only local anesthesia. An incision is made in the gums and a section of the gum tissue and bone is removed to expose the tooth.  The incision may be sutured afterward to help the gum tissue heal and a surgical dressing called periodontal packing may be placed to protect the area. Once the impacted tooth is exposed, a metal bracket is bonded to it and a small, taut chain is used to attach the bracket to the arch wire of the braces.  Over time, the traction of the chain and bracket pulls the impacted tooth up into its correct position in the dental arch.

Post-operative care is necessary with orthodontic exposures, initially to remove any surgical dressings and sutures and thereafter, to periodically tighten the chain which gradually loses traction. During follow-up visits, the orthodontist may make other adjustments to the bracket and chain to carefully guide the positioning of the gradually emerging tooth. Some tightness will be felt, but the process by which the tooth slowly moves is painless. After about a year, the end result will be a fully erupted tooth that is properly positioned and aligned with the rest of the teeth.

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