Impacted canine exposure and bonding

Upper canines are the teeth this visit is usually about. They can stay in the palate or sit high in the gum, in the way of other teeth or simply missing from the smile. Exposure and bonding is the surgical step that lets orthodontic treatment continue. It is not a substitute for braces, and it is not the same as taking the tooth out.

Sometimes the impacted tooth cannot be brought in, and an extraction is the honest plan. Sometimes a baby tooth is still holding the space and also needs to come out. Dr. Curtis or Dr. Samimi makes that call with the orthodontist’s films, not from a photo.

Most patients are teenagers or young adults already in orthodontic treatment, or about to start, whose canine has not erupted.

• Your orthodontist asked for the tooth to be uncovered and a bracket placed
• A baby canine is still present and blocking the adult tooth
• The adult canine is visible on a film but not in the mouth
• You were given a plan to extract the canine and want that recommendation checked before the tooth is lost

Referring offices can start from the for doctors page. Patients can request a consult themselves and bring the orthodontic records.

The consultation reviews the orthodontist’s images and the position of the tooth — palate side or cheek side changes the incision. The surgeon and the orthodontist should agree on the direction of traction before surgery day.

On the day of surgery the area is numbed. IV sedation is available, and many younger patients use it. The gum is opened, the tooth is uncovered, and a bracket with a fine chain or wire is bonded to the enamel. The chain is left where the orthodontist can reach it. You go back to the orthodontist for the movement. This office does not put the braces on.

The day of surgery

Expect numbness for much of the day, gauze if there is oozing, and a soft diet. Ice on the day of surgery, 15 minutes at a time, if the cheek was involved. Do not pull on the chain. If you were sedated, an escort takes you home and you do not drive.

The first week

The site feels like a small gum procedure: sore for several days, then quieter. Stitches, if they were used, are often dissolving over the first week. Brush gently and leave the chain alone. The orthodontist usually starts light traction after the site has calmed, on a schedule the two offices agree to. There is no single week when every canine begins to move.

After the tooth starts to move

Follow-up for the movement is with the orthodontist. Call this office if the chain comes loose or the gum looks worse, not better. How long the tooth takes to arrive in the arch is an orthodontic question. This page does not put a number on it.

Call us if…

• Bleeding does not slow with pressure
• The bonded chain or bracket comes off
• Swelling is worse after the first few days
• You are still numb the morning after surgery
• You cannot keep fluids down after sedation

What impacted canine exposure and bonding costs depends on the plan written at your visit. Dr. Chad M. Curtis or Dr. Soroush Samimi will tell you the surgical fee after they have examined you and looked at current imaging.

The things that usually change that fee:

• Whether grafting or a membrane is part of the same surgery
• The anesthesia plan — local anesthesia, IV sedation, or general anesthesia
• The restoration your dentist builds afterward, such as a crown, a bridge, or a full arch
• Whether new imaging is needed before a plan can be written

This office takes most PPO dental plans. Call (561) 278-0004 after the consultation for an estimate of your portion. The tooth or teeth your dentist makes on top of the surgery are usually billed by that dental office.