Normally all permanent teeth have erupted by the early teenage years. Occasionally, some teeth do not make it all the way into the mouth and become impacted, or stuck in the jaw. When this occurs, it is important to guide these teeth into the mouth or they will be permanently impacted. This condition occurs most frequently in the upper cupids but could occur in any location. In addition to wanting all teeth in the mouth for function and aesthetics, leaving a tooth impacted can lead to resorption of adjacent teeth and the development of cysts and tumors. Bringing the tooth into the mouth is extremely important.
An impacted tooth can have a bracket bonded attachment applied, enabling the orthodontist to guide the tooth safely into the mouth. The patient can be either awake or asleep depending upon the desires of the patient and complexity of the procedure. The tooth is exposed and the bracket is bonded just as normal orthodontic brackets are bonded to the front surface of the tooth. The bracket typically has a gold chain attached to it, which will be brought out of the gum tissue and tied to the adjacent orthodontic appliances. After healing, the patient returns to the orthodontist for traction on the gold chain to guide the tooth into the mouth. Depending on the depth of impaction, the tooth is often erupting in just a few months. On rare occasions, the impacted tooth will be “ankylosed” (fused with the bone and rendering it totally immobile) but the tooth is brought into the mouth successfully in over 97% of the cases.