174 F. D. Fragiskos

Fig. 7.164 a, b. Surgical field after suturing. a Diagrammatic illustration. b Clinical photograph

7.9

Exposure of Impacted Teeth for Orthodontic Treatment

Often, certain permanent teeth remain impacted inside the bone, resulting in a delay of their eruption, causing orthodontic problems. This delay may be the result of endocrine problems (hypothyroidism), supernumerary teeth, odontomas, crowding of teeth, sclerosis of soft tissues covering tooth, etc. In these cases, to facilitate eruption, a combination of surgical and orthodontic techniques is considered necessary.

The procedure usually involves exposing the tooth, which is achieved by creating a flap and removing the bone over the tooth. If there are still deciduous teeth, supernumerary teeth, or odontomas, these are removed, and, after exposing a large part of the crown, orthodontic brackets are bonded to the crown, and the tooth is gradually aligned in its correct position. Sometimes the crowns of impacted teeth are covered only by soft tissue. In cases such as these, the soft tissue is removed using a scalpel or electrosurgical blade, thus creating a “window” at the crown of the tooth, which will help it to erupt, either on its own or with orthodontic treatment.

7.9.1

Impacted Canine with Palatal Position

After removal of the deciduous teeth, a palatal flap is created, underneath which part of the bone covering the teeth is exposed. A round bur is then used to remove the bone covering the crowns and orthodontic brackets are placed for traction of the teeth into their normal position in the dental arch. The area is then irrigated with saline solution and the flap is closed with interrupted sutures (Figs. 7.165–7.171).

Fig. 7.165. Radiograph showing impacted maxillary canines with a palatal localization

Chapter 7 Surgical Extraction of Impacted Teeth

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Fig. 7.166. Clinical photograph of the area of impaction

Fig. 7.168. Reflection of the mucoperiosteal flap. Arrow points to the nasopalatine nerve

Fig. 7.167. Palatal incision along the cervical lines of teeth using a scalpel with a no. 15 blade

Fig. 7.169. Removal of the bone covering the crowns of impacted teeth

Fig. 7.170. Surgical field immediately after exposure of Fig. 7.171. Surgical field after suturing impacted teeth. Orthodontic brackets have been placed on

exposed parts of the crowns of the teeth

176 F. D. Fragiskos

Fig. 7.172. Radiograph showing the impacted mandibular canine, which gives the impression of complete bone impaction

Fig. 7.173. Clinical photograph of the area of impaction of the case shown in Fig. 7.172

7.9.2

Impacted Mandibular Canine with Labial Position

Exposure of the tooth may be achieved in two ways. The first technique, which has already been mentioned, is used if the area locating the impacted canine presents a slight protuberance and the crown of the tooth is covered by soft tissue only. To expose the tooth, first an incision using an electrosurgical blade is made over the crown, and then the soft tissue is excised using scissors and a periosteal elevator, so that exposure is adequate. Afterwards, a surgical dressing is applied to the wound until the day the orthodontist bonds the bracket for traction of the tooth to its normal position in the dental arch (Figs. 7.172–7.177).

The second technique involves exposure of the crown by creating a flap. More specifically, after creating an L-shaped incision, a small flap is reflected and the crown of the impacted tooth is exposed. The tooth is then dried and after the orthodontist has placed the bracket on the crown of the tooth, the flap is repositioned and the wound is sutured.

Fig. 7.174. Incision created using an electrosurgical blade to expose the crown of the impacted tooth

Fig. 7.175. Removal of soft tissues covering the crown of Fig. 7.176. Surgical field after exposure of the crown the tooth

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Fig. 7.177. Operation site covered with surgical dressing

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