The surgical uncovering of impacted teeth for bracket placement is one of the many procedures that we are happy to perform for orthodontic patients with braces or in preparation for braces. An important part of properly positioned teeth is the way that teeth grow in through the process of “erupting” through the gums. A common problem in the positioning of teeth is impacted teeth. An impacted tooth is one that is improperly positioned underneath the gums, making it unlikely that the tooth will grow in correctly without surgical intervention.
To achieve the successful uncovering of impacted teeth, I employ an apically positioned flap technique. During this procedure, I am sensitive to the integrity of the mucogingival junction and keratinized gingiva in my surgical exposure of the tooth surface. In other words, I ensure that the gum tissue around impacted teeth remains strong and healthy during the process of making an incision to uncover the tooth.
To perform this procedure, I first locate the impacted tooth by 3-d imaging or palpation. I then make an incision in the gum line that is covering the tooth, and I apically reposition the gum tissue to expose the impacted tooth. By manipulating the keratinized gingiva towards the apex of the tooth instead of simply cutting away and removing the gingiva, I maintain the patient’s thickness and health of the gum tissue so that after returning to her orthodontist, she will not have to undergo a soft tissue graft in the future.
After uncovering the impacted tooth, I can place a bracket and, when possible, use a chain to attach the bracket to the orthodontic wire closest to the area. This procedure must be performed carefully since it is essential that the keratinized gingiva be positioned to the appropriate spot to both expose the neck of the tooth and maintain the vitality of the gingiva. The apically positioned flap technique to uncover impacted teeth is a procedure that I enjoy performing for patients so that they experience successful orthodontic treatment and healthy teeth and gums.
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