What This Guide Covers
This guide explains how orthodontic treatment can bring an impacted tooth into its proper place in your dental arch. It is written for patients, parents, and caregivers who have been told that a tooth is impacted and want to understand what comes next.
A tooth is called "impacted" when it is fully or partially trapped beneath the gum tissue or bone. It cannot break through on its own and needs professional help to reach its correct position. [2] Wisdom teeth are the most well-known example, but they are usually removed rather than saved. Other impacted teeth, especially the upper canines (the pointed teeth near the front of your mouth), are often worth saving because they play a key role in biting, chewing, and arch stability. [1]
The information here covers causes, diagnosis, the step-by-step treatment process, costs, and recovery. If you are looking for general information about braces and tooth alignment, visit the orthodontics page for a broader overview.
Understanding Impacted Teeth
An impacted tooth is one that fails to erupt through the gum into the mouth on its normal schedule. The tooth may be angled sideways, blocked by another tooth, or buried deep in the bone.
Which Teeth Get Impacted
After wisdom teeth, the upper canines are the teeth most likely to become impacted. This happens in roughly 2 percent of the general population. [1] Upper canines are among the last permanent teeth to come in, typically erupting between ages 11 and 13. Because they travel a long path from high in the jawbone down to the gum line, there are many opportunities for the tooth to veer off course.
Other teeth can also become impacted, including lower second premolars and, less commonly, central incisors. However, the treatment principles are similar across tooth types. The goal is always the same: uncover the tooth and guide it into the arch if the tooth is healthy and positioned well enough to be saved.
Why Teeth Become Impacted
Several factors can cause a tooth to become impacted. Crowding is a common reason. When there is not enough space in the jaw, the erupting tooth has nowhere to go. Other causes include extra teeth (called supernumerary teeth) that block the path, early loss of baby teeth that lets neighboring teeth drift into the gap, or unusual growths such as cysts or odontomas (small benign tumors made of tooth-like tissue). [2]
Genetics also play a role. If a parent had an impacted canine, their child is more likely to have one too. In some cases, the tooth simply develops at an abnormal angle with no single identifiable cause.
Risks of Leaving Impacted Teeth Untreated
An impacted tooth that is left in place can cause several problems over time. The trapped tooth may press against the roots of neighboring teeth, causing root resorption (gradual dissolving of the root). This can weaken or even destroy healthy teeth. [2]
Cysts can form around the crown of an impacted tooth. These fluid-filled sacs slowly expand inside the bone and can cause significant bone loss if not addressed. Infection is another risk, especially when the tooth is partially erupted and bacteria can reach the space beneath the gum. For these reasons, most dental professionals recommend treating a known impacted tooth rather than monitoring it indefinitely.
Timing, Detection, and Preparation
Early detection gives your orthodontist more treatment options and often leads to a simpler process overall.
When to Screen for Impacted Teeth
The American Association of Orthodontists recommends that every child have an orthodontic evaluation by age 7. [1] At that age, an orthodontist can look for early signs of crowding, missing teeth, or unusual eruption patterns. A panoramic X-ray (a single image that shows all the teeth and both jaws) is the standard screening tool.
Between ages 7 and 10, there is often a window for interceptive treatment. This may involve removing a stubborn baby tooth to clear the path, using a palatal expander to create space, or placing partial braces to guide the erupting tooth. These steps do not guarantee that impaction will be prevented, but they can reduce the likelihood or simplify later treatment.
Diagnostic Imaging
If an impacted tooth is suspected, your orthodontist will order specific imaging. A panoramic X-ray shows the general position of the tooth. For more detailed planning, a cone-beam computed tomography (CBCT) scan may be used. CBCT is a type of 3D X-ray that shows the exact location of the impacted tooth relative to roots, nerves, and the sinus floor.
This three-dimensional view helps the oral surgeon plan the surgical approach and helps the orthodontist decide the best direction to apply force. The radiation dose from a dental CBCT scan is significantly lower than a medical CT scan, though it is higher than a standard dental X-ray. Your provider will use it only when the added detail is needed for safe treatment planning.
How to Prepare
Before the surgical exposure appointment, your orthodontist will typically place braces on most or all of your teeth. The braces create a stable framework that will later be used to apply traction to the impacted tooth. In some cases, an archwire with a gap or a small hook is placed in advance so the surgeon can immediately bond an attachment during the exposure procedure.
Your oral surgeon's office will give you pre-operative instructions. These usually include guidelines on eating, medications, and arranging transportation if sedation will be used. If you take blood-thinning medications, tell both your orthodontist and your oral surgeon well before the procedure date.
What to Expect During Treatment
Treatment for an impacted tooth typically involves three phases: surgical exposure, orthodontic traction, and final alignment.
Phase 1: Surgical Exposure
An oral surgeon performs the exposure procedure, usually in an outpatient setting. The surgeon lifts the gum tissue to uncover the crown of the impacted tooth. If bone is covering the tooth, a small amount is carefully removed. Once the crown is visible, the surgeon bonds a small bracket or button directly to the tooth surface. A thin gold chain or elastic thread is attached to the bracket.
Two common surgical techniques exist. In an "open" exposure, the surgeon removes the tissue and leaves the tooth visible while it heals. In a "closed" exposure, the surgeon bonds the bracket, feeds the chain through the gum, and then stitches the tissue back over the tooth. The choice depends on the tooth's position, the amount of gum tissue present, and the clinical judgment of the surgeon and orthodontist working together.
The procedure typically takes 30 to 60 minutes. Local anesthesia (numbing shots) is standard. Some patients, especially younger ones, may receive sedation as well. Most people return to normal activities within a few days. Mild swelling and discomfort are common for the first two to three days.
Phase 2: Orthodontic Traction
About one to two weeks after surgery, your orthodontist begins applying gentle force through the chain or elastic. The chain is typically attached to the archwire or to a hook on a neighboring bracket. Light elastic bands or spring-loaded devices provide a slow, steady pull.
The goal is to move the impacted tooth at a controlled rate, typically about one millimeter per month, though the actual speed depends on the tooth's position and the patient's biology. Your orthodontist will adjust the force at regular appointments, usually every four to six weeks. Over time, the tooth gradually erupts through the gum and begins to appear in the arch.
This phase requires patience. Moving an impacted canine into position typically takes 6 to 18 months, depending on how deep the tooth sits and whether it must travel around roots of other teeth. During this time, you will wear braces as usual and follow standard care instructions for brushing and food restrictions.
Phase 3: Final Alignment and Retention
Once the impacted tooth reaches the arch, the orthodontist replaces the bonded button with a standard bracket if needed. Fine adjustments are made to align the tooth with its neighbors, close remaining gaps, and refine the bite. This final detailing phase may take several additional months.
After the braces come off, you will wear a retainer to hold the teeth in their new positions. Retainers are a critical part of any orthodontic treatment. Without them, teeth tend to shift back toward their original positions over time. [1] Your orthodontist will advise you on how long and how often to wear the retainer.
Cost and Insurance Considerations
The total cost depends on the complexity of the case and involves fees from both the orthodontist and the oral surgeon.
Orthodontic treatment that includes management of an impacted tooth typically ranges from $3,000 to $7,000 or more for the orthodontic portion alone. The surgical exposure usually adds $500 to $2,500, depending on the number of teeth being exposed, the type of anesthesia, and geographic location. Costs vary by location, provider, and case complexity, so these figures are general estimates rather than fixed prices.
Many dental insurance plans cover a portion of orthodontic treatment, especially for patients under 18. However, coverage limits, waiting periods, and lifetime maximums vary widely between plans. The surgical exposure is sometimes covered under the medical insurance rather than dental insurance, particularly if the procedure is classified as a surgical service. Ask both your orthodontic office and your surgeon's office to submit pre-authorization to your insurance before treatment begins.
Most orthodontic practices offer payment plans that spread the cost over the length of treatment. Flexible spending accounts (FSAs) and health savings accounts (HSAs) can also be used for both the orthodontic and surgical fees. Discuss all financial options during your initial consultation so there are no surprises.
When to See a Specialist
A specialist evaluation is recommended whenever a dentist notices that a permanent tooth has not appeared on schedule.
Your general dentist may be the first to spot an impacted tooth on a routine X-ray. If a permanent tooth is more than six months behind its expected eruption time, or if the opposite tooth erupted normally but the other side has not, a referral to an orthodontist is appropriate. [1] The orthodontist will assess the position of the tooth and coordinate with an oral surgeon if surgical exposure is needed.
You should also see an orthodontist if you notice a baby canine that is still in place past age 13, a visible bump high on the gum above the front teeth, or unexplained shifting of front teeth. These can all be signs of an underlying impacted canine pushing on neighboring roots.
In some cases, the impacted tooth is in a position that makes orthodontic eruption impractical. For example, a tooth that is fused to the bone (called ankylosis) or one that is severely angled toward the midline may need to be extracted instead. An oral surgeon and orthodontist working together can evaluate whether the tooth can realistically be saved. If extraction is the better option, the orthodontist can close the space with braces or plan for a future replacement such as a dental implant.
If your child has not yet had an orthodontic evaluation, the orthodontics page can help you learn what to expect at a first visit and how to find a qualified orthodontist near you.
Find an Orthodontist or Oral Surgeon
If you or your child has been told about an impacted tooth, the next step is a consultation with an orthodontist who has experience managing these cases. Use the My Specialty Dentist directory to search for orthodontists and oral surgeons in your area, read about their training, and request an appointment directly through the site.
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