About Bonding and Brackets After Exposure

An impacted tooth is a common problem encountered during orthodontic treatment. Exposure of an impacted tooth is a surgical procedure needed to prepare the tooth for bonding and bracketing when the tooth is partially or entirely hidden below the surface of the gum tissue. 

An extraction may also be necessary to remove extra teeth blocking the eruption of any adult teeth or if adult teeth do not have the proper space to erupt. If there is a baby tooth present, it will also be removed simultaneously. The process is a combined effort between the orthodontist and oral surgeon, and each case is evaluated individually. It’s critical to address impacted teeth as soon as possible.

Exposing a Tooth for Bonding/Bracketing

One of the main reasons an impacted tooth needs to be exposed is because it cannot be bonded or bracketed in its usual location. This may be due to several factors, including

  • Poor positioning
  • Lack of space in the mouth
  • Abnormal growth patterns

The most common teeth that need to be exposed are the upper canine teeth or cuspids, also known as “eye teeth.” The cuspid is a critical tooth in the dental arch, and these teeth need to erupt into their proper position in the dental arch as they play a very important role in your bite. 

While bonding/bracketing an impacted tooth requires a specialized procedure and careful coordination between an oral surgeon and an orthodontist, it is essential to ensure that proper ongoing orthodontic treatment is possible. For some patients, this may be the only way to achieve their desired results.

The procedure involves two steps: surgical exposure and bonding/bracketing.

  • Surgical exposure is carried out by an oral surgeon who uses specialized tools to remove any soft tissue that may be blocking access to the impacted tooth.
  • Bonding/bracketing is a process that involves attaching a bonding material or bracket to the exposed tooth. This will allow the tooth to be moved into its correct position over time.

What Are Brackets?

An orthodontic bracket is a small metal or ceramic piece attached to the teeth using bonding materials. They serve as a foundation for bonding wires, which are used to guide teeth into their correct position during orthodontic treatment. An orthodontic bracket can be placed on any tooth experiencing abnormal growth patterns or misalignment, and they may be used in combination with other orthodontic devices, such as expanders or headgear.

Activating the Tooth

Once the surgical site has healed, and the bonding/bracketing material has been placed on the exposed tooth, you will need to see your orthodontist to activate the tooth for the eruption process. The orthodontist may attach a rubber band to the miniature gold chain attached to the bracket to allow for proper eruption of the tooth. This is typically done 1-14 days after the initial procedure, depending on your consultation with the orthodontist. This is a controlled, slow process that will take several months.

Your orthodontist will later attach a wire to the bonding/bracketing material, which will be gradually tightened to adjust the position of the tooth over time into its ideal position. This process will continue until your orthodontist is satisfied with the alignment of your teeth.

What is Ankylosis?

Ankylosis is a condition that occurs when the growth of some teeth is restricted due to abnormal bonding between the teeth and surrounding bone tissue. This can result in misalignment or improper positioning of the teeth, which may require surgical exposure to be corrected.

Sedation Methods

To ensure that the patient experiences minimal discomfort during the surgical exposure, IV sedation or general anesthesia will be used.

  • IV sedation: This type of sedation is administered through an IV, and it helps to relax the patient and make them drowsy during the procedure. You may not be completely asleep during the procedure but will likely not remember much of it afterward.

General anesthesia: This type of sedation will put the patient also through an IV to sleep for the duration of the procedure.

Bleeding

In some cases, surgical exposure may result in some bleeding, but this is typically minor and will resolve on its own within a few days. In rare cases, more significant bleeding may occur and may require treatment with stitches or pressure dressings.

Swelling

Some facial swelling is normal after the surgical exposure of an impacted tooth. This can be managed with ice packs and over-the-counter pain medication. The degree of swelling will be different for each individual. In most cases, the swelling will resolve in a few days.

  • Ice packs should be applied for 20 minutes and then removed for 20 min. While the patient is awake.
  • Never apply ice packs directly to the skin unless it is a modified ice pack that has a proactive barrier made for direct contact to the skin. Otherwise, wrap the ice pack with a thin towel.

Diet

After oral surgery for an impacted tooth, it is important to stick to a soft diet for at least 24 hours and may require even several days. This will help to minimize any discomfort and allow the area to heal properly. Avoid hot foods, things like hard candy and chewing gum, and sharp food items like chips or seeds, as these may increase the risk of bleeding or swelling after surgery.

Get That Perfect Smile

If you require bonding/bracketing of a tooth for orthodontic purposes, consult with your orthodontist and oral/maxillofacial surgeon to discuss the best course of treatment. At AZ Max, we make sure the surgical exposure of an impacted tooth is a quick and relatively painless procedure under sedation that can be done in one visit. 

To book an appointment with a surgeon at any of our 5 locations,
call (480) 830-5866