impacted tooth

impacted tooth

An impacted tooth is a tooth that has failed to erupt and "sleeps" in the gum or even in the jaw bone. There are cases when only a part of the dental crown is erupted outward and is visible, and the rest of the tooth is covered by the gum - such teeth are called partial impacted teeth.

Most often, teeth which got impacted are canines and wisdom teeth - the notorious eights, but there are cases of impaction of the central and lateral incisors, and the former are a little more common.

The growing up and development of a child should be accompanied by monitoring of his health. This is especially true of the teeth, when there is a change of milk for permanent ones. It is at this moment that the child may face such a problem as impacted teeth.

What it is?

A formed tooth is considered impacted, but for some reason it has not erupted. It remains entirely in the jaw, or is partially hidden by the gum. In cases where a tooth begins to erupt, it collides with others located nearby. As a result, the growth of the tooth stops and it remains in the jaw.

There are two types of impaction:
Partial impaction. The tooth is not completely erupted. A separate part of it is visible from under the gum.
Complete impaction. The tooth has not erupted. It is completely hidden in the jaw under the gum. It is impossible to feel or see such a tooth.

Such teeth can also be located in different ways, both being in "their" place in the dentition, and occupying an incorrect position outside the dentition.

Vertically impacted
Horizontally impacted
Angled to the jaw
If a tooth has erupted in the wrong place beyond the border of the dentition, they speak of a dystopia of the tooth.
There is even a reverse retention, when the tooth lies "upside down", that is, upside down.

The impacted tooth can be one in the dentition, or two impacted teeth can be arranged symmetrically. This problem concerns both milk and permanent teeth.

Reasons for the appearance of impacted teeth:
Weakened immunity;
Improper artificial feeding of the child;
Thick walls of the dental sac that surround the cutting tooth;
Influence of general diseases of the body;
Delay in the replacement of milk teeth with permanent ones;
Incorrect positioning of the primordia of the molars in the jaw bone, due to which the impacted tooth in the child is directed to the root of the neighboring one. This not only interferes with teething, but also harms others.

Retention symptoms and diagnosis of impacted teeth

It is extremely difficult to independently detect such a defect in a child at the initial stage. This is due to the fact that the impacted tooth may not declare itself in any way. The child simply will not feel discomfort. The deviation is detected only at the dentist's appointment.

But partial retention can be found at home. It is enough to feel the excessively protruding gums. An x-ray will also help to identify deviations, which will be prescribed by the attending dentist.

The main symptoms are:
Increased pain in the area of ​​the impacted tooth when pressed;
Pain in the gum area;
General weakness, malaise, fever;
Redness of the gums, swelling is possible;
When pressing on the impacted tooth, an unpleasant taste is felt in the mouth.

If, when symptoms are detected, you do not consult a specialist in time and take no action, then complications are likely to occur. They can cause damage to the mouth, malocclusion, and pronunciation problems.

How are impacted teeth diagnosed?

Often, impacted teeth are "found" by chance, during X-ray diagnostics for another dental reason. If a patient asks about orthodontic treatment and some teeth are missing, or with symptoms that may be caused precisely by the presence of hidden impacted teeth, then a special diagnosis is performed.

The problem of impacted teeth is solved by two specialized dentists - an orthodontist and a surgeon, so the patient will have to undergo diagnostics by an orthodontist and diagnostics by a surgeon . Most of the diagnostic procedures in this case will be general, and the key is X-ray diagnostics, moreover, it is preferable to do CT - computed tomography (3D diagnostics). Unlike an orthopantomogram (OPTG), it shows the spatial location of an impacted tooth in the jaw and relative to other teeth, which is very important for the surgical stage of traction - exposing its crown, because enables the surgeon to choose the optimal "approach".

Treatment of impacted teeth in children

This process is quite complex. Treatment is selected strictly individually for each child. First, the dentist decides on the basis of the X-ray whether to retain or remove the impacted tooth. If it is located correctly, then under local anesthesia, the tooth is released by cutting off the mucous membrane that interfered with the eruption. If the impacted tooth is located incorrectly and there is no room for it in the alveolus, then it is removed.

What to do if an impacted tooth is found?
There are 3 solutions to the problem of an impacted tooth: Orthodontic traction and placement in the dentition. This is more often done with impacted teeth that are in the smile zone - canines and incisors, provided that there is a place for them in the dentition, and the tooth itself is healthy.

Removal is a common fate for impacted eights, especially if the patient is undergoing orthodontic treatment. Very often, it is the wisdom teeth that partially erupt - this provokes inflammation and complications. Even a completely impacted ("hidden") tooth is a potential source of caries, tooth displacement, instability of orthodontic treatment. There are many reasons - there is only one verdict: it is better to delete. Other indications for the removal of different types of impacted teeth are - cyst, signs of inflammation, lack of space in the dentition, destruction of the tooth neck, caries.

Conservation and observation. It is justified when the patient has no problems with the place in the dentition, bite, orthodontic treatment is not required, the tooth does not provoke complications and its absence does not spoil the aesthetics of the smile. Such teeth are observed, in case of the slightest trouble, they are shown to be removed.

How to pull out and place an impacted tooth in the dentition?

In some cases, if the root of the impacted tooth has not yet been formed, and there is an obstacle to its eruption, then removing such an obstacle is enough for the tooth to come out of the gum and take its place in the dentition. If the tooth root is already formed, this method will not help.

To "reach" and move a fully formed impacted tooth into the dentition, treatment is carried out in 3 stages. Here we present a "classic" scheme, because in individual cases there may be deviations from this scheme.

Preparatory orthodontic stage - you need to prepare a place in the dentition to which the orthodontist will move the extracted tooth. For this, a bracket system is installed, which aligns the teeth in the dentition and frees up the necessary space. The surgical stage is the formation of the crown of the impacted tooth, on which a bracket or a button is installed, to transmit the force from the arch or elastic element.

Orthodontic main stage, during which the impacted tooth is stretched and placed in its "rightful" place in the dentition.

How is the operation to expose the crown of an impacted tooth performed?

As a preliminary stage, preparation for the operation is carried out. The patient is given occupational hygiene and sanitation to reduce the amount of infection in the oral cavity and speed up postoperative healing.

The operation to expose the impacted tooth is performed under local infiltration anesthesia and is considered a rather serious surgical intervention.

The operation to expose the crown of the impacted tooth and the installation of an orthodontic element on it can be carried out according to 2 schemes:

I Delayed bracket placement.
The mucous membrane in the projection of the crown of the impacted tooth is excised, the crown of the tooth is exposed entirely, and a special tampon is inserted into the wound.
After 2-3 days, a button or bracket is installed on the crown of the exposed tooth, which is tied to the orthodontic arch and traction begins.

II Installation of a bracket during surgery
The dentist surgeon peels off a small muco-periosteal flap and exposes a part of the crown of the impacted tooth, on which the locking element is immediately fixed.

The bracket is tied to an orthodontic arch or additional devices.
After installing the orthodontic element, the tissue flap is placed in place and the wound is sutured.
The disadvantage of this method is that in this case, repeated surgical intervention is possible if the bracket on the tooth comes off.

After the operation, the patient, if necessary, is prescribed antibiotics and antiseptic rinses for early healing. Light, non-traumatic food is recommended. How is orthodontic traction of an impacted tooth performed? Since the resistance of the impacted tooth located in the bone is quite high, orthodontic treatment during this period is most often carried out on a rigid steel rectangular arch of 18 mm. Traction should be started as soon as possible after the crown is exposed. If this is not possible, then no later than 2-3 weeks after the operation.

What difficulties can there be in traction of impacted teeth?

One of the difficulties in the orthodontic pulling of an impacted tooth can be its ankylosis - this means that the entire tooth or only some part of it has fused with the jaw bone. Such a tooth will not give in to the movement of the bracket-system - the abutment teeth may even shift. To solve the problem surgically, by separating the tooth from the bone, it is possible only with partial fusion. In order not to face such a problem, it is important to conduct a full preliminary diagnosis.

How to prevent the formation of an impacted tooth?

The expectant mother needs to take care of the full development of the fetus in the embryonic period. Pay attention to prevention, careful hygiene and timely treatment of milk teeth in order to prevent their early loss and damage to the rudiments of permanent teeth.
Monitor the development of the dentition in adolescence and, if necessary, begin timely orthodontic treatment for adolescents.

In the event that, due to retention, the soft tissues of the gums surrounding the tooth become inflamed, it is also removed. When the crown of the impacted tooth is clearly visible, the dentist will remove it using forceps or a bayonet elevator. In cases where such a tooth is completely hidden, an operation is performed - the tooth is cut out with the help of a drill.

But not always an impacted tooth is its inevitable extraction. In some cases, these teeth are pulled out. This primarily applies to canines. Due to the fact that they are a strategically important part of the entire dentition, their removal is almost impossible. Then the dentists apply traction of the impacted tooth. But it should be borne in mind that this is a rather lengthy procedure. On average, it takes 1.5 or 2 years to put a tooth in place.