Orthodontic Treatment for Impacted Teeth: What You Need to Know

Types of Tooth Impaction

The position of the impacted tooth determines the treatment approach. A palatally impacted canine is displaced toward the roof of the mouth. This is the most common type and generally has a good prognosis for orthodontic treatment. A buccally impacted canine is displaced toward the cheek side. A transversely impacted tooth lies horizontally in the bone.

Your orthodontist will use a panoramic X-ray and often a cone-beam CT scan (CBCT) to determine the exact position, angulation, and proximity to neighboring tooth roots. This information is critical for planning the surgical approach and the direction of orthodontic traction.

Which Teeth Can Become Impacted

While upper canines are the most commonly treated, other teeth can also become impacted. Lower canines, premolars, and central incisors are less common but do occur. In rare cases, multiple teeth are impacted, which may indicate a systemic condition such as cleidocranial dysplasia or other developmental disorders.

Crowding and Arch Length Deficiency

When there is not enough room in the dental arch, teeth may not have a clear eruption path. Crowding is the most common reason for canine impaction. The canines are among the last permanent teeth to erupt (around age 11 to 13), so they are the most likely to run out of space.

Abnormal Tooth Position

Sometimes the tooth germ (developing tooth) is positioned at an abnormal angle from the start. The canine may be aimed toward the midline, toward the roof of the mouth, or horizontally. Genetics plays a role, as canine impaction often runs in families.

Other Contributing Factors

Additional factors include early loss of baby teeth (which removes the eruption guide for the permanent tooth), extra teeth (supernumerary teeth) that block the path, cysts or tumors in the jaw, and ankylosis (fusion of the tooth to the surrounding bone). Missing or peg-shaped lateral incisors are associated with a higher rate of canine impaction because the lateral incisor root normally helps guide the canine into position.

Step 1: Creating Space with Braces

Before the impacted tooth can be moved, there must be room for it in the arch. Your orthodontist will place braces on the other teeth first and use them to open a space where the impacted tooth belongs. This phase typically takes 4 to 8 months.

Step 2: Surgical Exposure and Bonding

Once enough space is available, your oral surgeon performs a minor surgical procedure to uncover the impacted tooth. The surgeon lifts the gum tissue, removes any bone covering the tooth's crown, and bonds a small orthodontic bracket with a gold chain or elastic thread to the exposed tooth surface.

The procedure is typically performed under local anesthesia with or without sedation and takes 30 to 60 minutes. There are two main surgical techniques: the open eruption technique (the tissue is removed and the tooth is left exposed to erupt on its own) and the closed eruption technique (the tissue is repositioned over the tooth and the chain extends through the gum to the orthodontic wire).

Step 3: Orthodontic Traction

After surgery, your orthodontist attaches the chain or elastic thread from the impacted tooth to the braces archwire. A gentle pulling force is applied to slowly guide the tooth through the bone and gum tissue into its correct position. This is called orthodontic traction.

The force is kept light, typically activated every 4 to 6 weeks. Moving the tooth too quickly can damage the root or the bone. The traction phase usually takes 6 to 12 months, depending on how far the tooth needs to travel.

Step 4: Finishing and Detailing

Once the impacted tooth reaches the arch, the orthodontist bonds a regular bracket to it and completes the alignment and bite correction. The finishing phase takes an additional 6 to 12 months. Total treatment time from start to finish is typically 18 to 30 months.

After the Surgical Exposure

Swelling and discomfort are normal for 3 to 5 days after the exposure surgery. Over-the-counter pain medication and ice packs usually provide adequate relief. Eat soft foods for the first few days. Avoid chewing near the surgical site. Your surgeon will provide specific post-operative instructions.

The surgical site heals over 1 to 2 weeks. Stitches (if used) may dissolve on their own or be removed at a follow-up appointment. Most patients return to normal activities within 2 to 3 days.

During the Traction Phase

As the impacted tooth moves through bone, you may feel mild pressure or aching after each adjustment. This is similar to the soreness felt when regular braces are tightened. The discomfort typically lasts 2 to 3 days after each activation.

Maintain excellent oral hygiene throughout treatment. The surgical site and the chain or elastic thread require careful brushing. Your orthodontist and surgeon will monitor the tooth's progress with periodic X-rays.

Retention After Treatment

After braces are removed, a retainer is essential to maintain the position of all teeth, including the formerly impacted tooth. Your orthodontist may recommend a fixed retainer bonded behind the front teeth, a removable retainer, or both. Lifelong retainer wear is recommended.

When Extraction Is Recommended Instead

Not all impacted teeth can be successfully moved into position. If the tooth is severely angled, fused to the bone (ankylosed), or positioned where movement would damage neighboring roots, extraction may be the better option. If an impacted canine is extracted, the orthodontist can close the space by moving adjacent teeth together or plan for a future dental implant to replace it.

The Value of Early Screening

A panoramic X-ray taken at age 7 to 10 can reveal whether the canines are developing in a normal position. If a canine is heading off-course, your orthodontist may recommend removing the baby canine early (which can redirect the permanent canine's eruption path in about 60 to 80 percent of cases) or starting an expander to create more room. These interceptive steps are simpler and less expensive than treating a fully impacted tooth later.