Impacted Tooth! What to do?

Impaction of the teeth is a common event that most often affect the last tooth in the lower jaw (Wisdom Tooth) and upper jaw canine, although it can happen on any tooth (Figure 1 & 2).

Figure 1
Figure 1: Examples of Wisdom Teeth Impaction.

 

Figure 2: Example of Impacted Upper Canine.
Figure 2: Example of Impacted Upper Canine & its radiograph.
  • Causes:

Impaction occurs because of obstruction from crowding of from some other physical barrier. Occasionally, it may be due to an abnormal eruption path, presumably caused by unusual orientation of the tooth germ.

Ankylosis, the fusion of a tooth to surrounding bone (Figure 3), is another cause of impaction. This usually occurs in association with erupted primary teeth molars. Depending on the case, most common scenario clinically is that the tooth is in low level when compared with the adjacent teeth (Figure 4).

Figure 3
Figure 3
Figure 4
Figure 4

It may result in impaction of a subjacent permanent tooth. The reason for ankylosis is unknown, but its believed to be related to periapical inflammation (inflammation around the root of a tooth) and subsequent bone repair. With focal loss of periodontal ligament, bone and cementum, inextricably mixed, causing fusion of the tooth to alveolar bone.

  • Treatment:

Impaction is treated according to the cause by eliminating it & it also depends on the case. It may involve extractions to provide space for permanent tooth to erupt or surgical extraction of an impacted tooth.

As in case of ankylosis, it requires a surgical extraction of ankylosed tooth and a space maintainer may be applied to preserve the space generated after the extraction for the permanent teeth to erupt as space closure will be done by teeth merging to close the gap, resulting in a necessity for an orthodontic treatment.

After removal of the cause, the teeth may or may not require orthodontic treatment.

Reference: Edited with respect to Oral Pathology: Clinical Pathologic Correlations, sixth edition. By Regezi, Sciubba, & Jordan.


Now i want to hear from you!

Have you ever experienced an impacted tooth? & what did you do to treat it?

I read each & every comment.

Haider Maitham, DDS

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