Operative exposure of a retained tooth

The treatment mostly concerns canines. Abnormalities of eruption caused by an incorrect position of the tooth bud, too small width of the jaw or trauma in childhood, necessitate the orthodontic insertion of the tooth into the arch. The procedure is performed under anaesthesia and involves determining the position of the tooth based on radiographic diagnosis, followed by surgical exposure ('finding it') and bonding of the orthodontic bracket. Thanks to orthodontic forces, such a tooth has a chance to be in the correct position of the dental arch after about 15-24 months. 

However, it is not always possible to bring an impacted tooth into the dental arch. Anatomical conditions, an unfavourable position of the stopped tooth in relation to the neighbouring teeth may lead to resorption (atrophy) of the roots of these teeth when an attempt is made to set it in its proper position. This rules out the advisability of an orthodontic treatment procedure to bring the retained tooth into the dental arch. In limited cases, retained teeth do not yield to orthodontic forces, remaining in retention. In such cases, it is necessary to use a technique piezosurgery, which involves incising the bone plate adjacent to the retained tooth, thus weakening the bone block and speeding up the orthodontic procedure. 

If bringing an impacted tooth into the dental arch is too risky for the neighbouring teeth, or if surgical/orthodontic measures do not have the desired effect, it is advisable to extract the impacted tooth, together with the necessary bone regeneration, e.g. with Bio-Oss bone substitute, and then dental implant placement.