Helping Impacted Canine Teeth Move Into Place
Sometimes an adult canine tooth does not come into the mouth the way it should. Instead, it may remain trapped under the gum tissue or bone. This is called an impacted canine.
Canine teeth are very important teeth. They help guide the bite, support the lips, and play a major role in the appearance of the smile. When a canine tooth is impacted, orthodontic treatment is often needed to help guide it into the correct position.
At Schiffman Oral Surgery, we work closely with orthodontists to treat impacted canine teeth using a procedure commonly called canine exposure, expose and bond, or exposure and bonding.
The goal is to uncover the impacted tooth and attach a small orthodontic bracket and/or chain so your orthodontist can gradually move the tooth into place.
What is an Impacted Canine?
An impacted canine is a canine tooth that has not erupted normally into the mouth.
Most people have four canine teeth: two upper canines and two lower canines. The upper canine teeth are the most commonly impacted canines. They may be positioned toward the roof of the mouth, toward the cheek side, or high up in the jaw.
In many cases, the baby canine tooth is still present, and the adult canine is stuck underneath. Other times, the baby tooth may have already fallen out, but the adult canine still has not come in.
An impacted canine does not always cause pain, so it is often discovered by a dentist or orthodontist on an x-ray.
Why is the Canine Tooth so Important?
The canine teeth are some of the most important teeth in the mouth.
They help:
- Shape the smile
- Support the upper lip
- Guide the bite during chewing
- Protect the back teeth from excessive side-to-side forces
- Maintain proper spacing and alignment
Because canine teeth are so important, orthodontists often try to bring an impacted canine into the correct position rather than simply removing it.
What is an Expose and Bond Procedure?
An expose and bond is a minor oral surgery procedure used to help an impacted tooth erupt during orthodontic treatment.
During the procedure, the oral surgeon exposes the impacted canine by gently moving gum tissue, removing a small amount of bone if needed, and uncovering the tooth. A small orthodontic bracket with a tiny gold chain is then bonded to the tooth.
The chain is left accessible so your orthodontist can use it to slowly guide the tooth into the correct position over time.
The oral surgery procedure does not move the tooth by itself. Instead, it gives the orthodontist access to the tooth so they can gradually bring it into place with braces or other orthodontic appliances.
Why would someone need Canine Exposure?
Canine exposure may be recommended when an adult canine tooth is impacted and unlikely to come in properly on its own.
This may happen if:
- The canine tooth is stuck under the gum or bone
- The adult canine is angled in the wrong direction
- There is not enough space for the tooth to erupt
- The baby canine tooth has not fallen out
- The canine is positioned near the roots of nearby teeth
- Orthodontic treatment is needed to guide the tooth into place
Your orthodontist will usually identify the impacted tooth and refer you to an oral surgeon for the exposure and bonding procedure.
How is the procedure planned?
Planning is very important because impacted canines can be positioned in different locations.
Some are closer to the roof of the mouth. Others are closer to the cheek side. Some are high in the jaw or close to the roots of nearby teeth.
Before the procedure, we review your x-rays and orthodontic plan. Most of the time, a 3D CBCT (Cone Beam CT) scan may be recommended to better understand the exact position of the tooth and its relationship to the surrounding teeth.
We coordinate with your orthodontist so that the procedure is performed in the way that best supports your orthodontic treatment.
What Happens During the Procedure?
Canine exposure is performed in our comfortable oral surgery office in Woodmere, NY.
First, we make sure you are completely comfortable. The procedure is most commonly performed under IV sedation to provide the safest, most well controlled surgical environment. However, depending on the patient’s age, medical history, and the position of the tooth, the procedure may be done with local anesthesia, laughing gas, IV sedation, or a combination of these options.
Once the area is numb, the gum tissue is gently opened to locate the impacted canine. If necessary, a small amount of bone is removed to uncover the tooth. A small orthodontic bracket and chain are then attached to the tooth.
The gum tissue is repositioned, and the chain is left visible or accessible so the orthodontist can activate it later.
In some cases, a baby canine tooth may also be removed at the same appointment if recommended by the orthodontist.
What happens after the procedure?
After the expose and bond procedure, your orthodontist will typically continue treatment about 1 week later.
Usually, the orthodontist will wait for initial healing and then begin applying gentle force to the chain. This slowly guides the impacted canine into the correct position.
This process takes time. The tooth usually moves gradually over months, not days or weeks. The exact timeline depends on the position of the tooth, the patient’s age, the amount of movement needed, and the orthodontic plan.
The oral surgery portion is just one step in a larger orthodontic process.
What is recovery like?
Recovery from canine exposure is usually very manageable.
For the first few days, patients should expect some soreness and mild swelling. A soft diet is usually recommended at first. It is important to avoid pulling on the chain, playing with it, or eating foods that could dislodge the bracket.
We may recommend:
- Soft foods for the first few days
- Avoid brushing around the surgical area
- Warm salt water rinses when instructed
- Avoiding hard, sticky, crunchy, or sharp foods
- Taking medications as directed
- Following up with your orthodontist as scheduled
If the bracket or chain becomes loose, or if there is increasing pain, swelling, drainage, fever, or a bad taste, you should contact our office.
Will the tooth definitely come into place?
In most properly selected cases, the impacted canine can be guided into position with orthodontic treatment. However, no procedure can guarantee that a tooth will move exactly as planned.
Sometimes an impacted canine is fused to the bone, positioned unfavorably, or unable to move despite appropriate treatment. This is uncommon, but it can happen. If the tooth does not move as expected, your orthodontist and oral surgeon will discuss the next best option.
The success of treatment depends on several factors, including the position of the tooth, the patient’s age, available space, root development, and orthodontic mechanics.
Why choose Schiffman Oral Surgery?
Canine exposure requires careful coordination between the oral surgeon and orthodontist. The procedure must be planned and performed in a way that gives the orthodontist the best opportunity to move the tooth successfully.
At Schiffman Oral Surgery, we frequently work with orthodontists throughout the Five Towns, Nassau County, Queens, and surrounding Long Island communities. We understand how important communication, timing, and surgical technique are for a successful orthodontic result.
Our goal is to make the surgical portion of treatment as smooth, comfortable, and predictable as possible.
Frequently Asked Questions About Canine Exposure / Expose and Bond
Is canine exposure the same as removing the tooth?
No. In most cases, the goal is not to remove the canine. The goal is to uncover the impacted tooth and attach a bracket and chain so the orthodontist can guide it into the mouth.
Who does the procedure, the orthodontist or the oral surgeon?
The oral surgeon performs the exposure and bonding procedure. The orthodontist then uses the attached chain to slowly move the tooth into position with braces or other orthodontic appliances.
Why does the canine tooth need a chain?
The chain gives the orthodontist a way to gently pull the impacted tooth in the correct direction over time. The movement is gradual and controlled.
Will my child be asleep for the procedure?
The procedure is most often performed under IV sedation, especially in younger patients or patients who are nervous. To optimize the chances of success, it is critical that the patient remain absolutely still during this very delicate procedure. We will discuss the best option based on the patient’s age, comfort level, medical history, and the position of the tooth.
How long does it take for the canine to come in?
The surgical procedure is only the first step. The tooth usually moves gradually over several months during orthodontic treatment. The exact timing depends on how deeply impacted the tooth is and how far it needs to move.
What if the bracket or chain falls off?
If the bracket or chain becomes loose or comes off, contact our office and your orthodontist. In some cases, it may need to be reattached.
Can both canine teeth be exposed at the same time?
Yes, if both canines are impacted and your orthodontist recommends it, both can often be exposed during the same procedure.
Is a baby tooth removed during the procedure?
Sometimes. If the baby canine is still present, the orthodontist may request that it be removed at the same time as the exposure. We will confirm the plan before surgery.
What foods should be avoided after canine exposure?
Avoid hard, sticky, crunchy, sharp, or chewy foods that could irritate the area or pull on the chain. Soft foods are usually best for the first few days.
What should I do if my orthodontist referred me for expose and bond?
Call Schiffman Oral Surgery to schedule a consultation. We will review the x-rays, coordinate with your orthodontist, and explain what to expect before, during, and after the procedure.
Schedule a Consultation
If you or your child has been referred for canine exposure, expose and bond, or treatment of an impacted canine, call 516-569-1111 to schedule a consultation. You will be examined in our state of the art private office in Woodmere, NY and a custom, personalized treatment plan will be tailored to suit your specific desires and needs.
Dr. Leonard Schiffman and Dr. Michael Schiffman offer oral surgery services to the Five Towns in Long Island, New York and surrounding towns on the South Shore of Nassau County including Woodmere NY • Hewlett NY • Cedarhurst NY • Valley Stream NY • Woodsburgh NY • Lawrence NY • Inwood NY • Far Rockaway NY • Lynbrook NY • Oceanside NY • Rockville Centre NY