An impacted tooth is an unerupted tooth that is "stuck" either because there is not enough room in the dental arch, or because the tooth is unfavorably positioned and cannot erupt normally. While any permanent tooth can become impacted and require assistance to move into a functional position, this most commonly occurs with the maxillary (upper) cuspid, canine, or "eye" tooth. An impacted cuspid tooth, if left untreated, will usually not erupt on its own. The "expose and bracket " procedure is most commonly performed to help erupt an abnormally positioned cuspid tooth, but can be used to treat any impacted permanent tooth.
The "expose and bracket" procedure entails uncovering the impacted tooth by making an incision in the gum tissue, and then removing a limited amount of bone, if necessary, to expose the crown of the impacted tooth. Once the crown of the impacted tooth is exposed, the tooth surface is etched and a orthodontic bracket with a small length of gold chain is bonded to the tooth in the same way conventional orthodontic brackets are applied. The wound is closed and the chain on the bracket is exited through the gum tissue and attached to the orthondontic appliances already in place. After a short healing period, the orthodontist will place gentle traction on the chain attached to the impacted tooth and gradually move the tooth into its proper position. This phase of the treatment usually requires weeks to months to complete. In most individuals, erupting an impacted tooth in this fashion is highly predictable.
Depending on the difficulty in exposing the impacted tooth, the "expose and bracket" procedure can be carried out under local anesthesia, local anesthesia with nitrous oxide, or under light general anesthesia.