Impacted Teeth in Orthodontics

Situations where permanent teeth remain embedded in the jaw for many reasons and cannot be inserted in the mouth where they should come out are frequently encountered since childhood. The first teeth, the milk teeth, and the permanent teeth that start to appear in the mouth in the later period, are a process that progresses with very delicate balances.

Decay or premature loss of milk teeth for any reason prevents the permanent tooth that will come after it from settling properly. In these cases, the teeth adjacent to the lost tooth are tipped towards the existing space, closing the place of the tooth that should come from below. Or, in people with genetically large tooth form and small jaw structure, permanent teeth may not find a place in the mouth when it is time to erupt.

In cases such as skeletal jaw stenosis, or in cases where there are cysts or tooth fragments that have not completed their formation, or excess teeth (supernumerary teeth) in the area where the teeth will erupt for any reason, the case of impacted teeth may occur. Even in cases with a very thick bone structure or soft tissue structure, the teeth may not be able to come into the mouth.

Well, what should be the treatment approach to these teeth that can remain in the mouth for many reasons like this?

In these cases, only intraoral examination is not sufficient, it is absolutely necessary to make a comprehensive evaluation by obtaining x-ray examination and even tomographic images. The orthodontist, surgeon and radiologist evaluate these data and decide whether the tooth can be placed properly where it should be.

In some rare cases, the roots of the tooth remaining in the bone are attached to the bone (ankylosis) or the root structure of the tooth may not be suitable for maintenance because the root structure is excessively curved.

The most important is the angle between the space where the tooth should come out and the normal eruption position. In other words, if the tooth is in its natural position, with a very horizontal angle compared to the direction it should travel, it will be very difficult to maintain and sometimes it may be decided to be removed.

In cases where the position of the tooth is suitable for maintenance and the root structure is healthy, the normal orthodontic treatment process is initiated. After the space in which the tooth will be maintained is prepared, the top of the tooth is opened with a surgical operation and a wire is attached to the tooth that remains in the bone. Thanks to the apparatus or wires extending outward from this tooth, ideal forces are applied by taking support from other teeth or mini-screws applied in the mouth and the tooth inside is slowly moved to its own place.

This process will be different in each individual depending on the position of the tooth and the structure of the bone. But the patient’s own tooth is so valuable that it is worth going through this whole process. After the tooth is in its original place, orthodontic treatment is terminated with normal protocols by ensuring full compatibility with the teeth in the adjacent and opposite jaw.

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