An impacted tooth is a permanent tooth that has failed to fully erupt into its correct functional position within the dental arch, remaining partially or entirely trapped beneath the gum tissue or jawbone. This condition most commonly affects the third molars (wisdom teeth), but the maxillary canine, the pointed tooth near the front of the mouth, is the second most frequent to be affected. When a canine is impacted, it can be stuck against the roots of adjacent teeth, preventing it from emerging at the proper time, typically around age 11 to 13.
The purpose of orthodontic treatment is to apply gentle, controlled forces to guide the tooth into the space prepared for it. Leaving the tooth impacted can lead to complications such as damage to the roots of neighboring teeth, cyst formation, or chronic discomfort. Through a collaborative effort between the orthodontist and an oral surgeon, the goal is to successfully recover the tooth and restore its intended role in biting and chewing function.
Initial Orthodontic Setup and Surgical Exposure
The process of bringing an impacted canine down begins with creating adequate space within the dental arch. This involves using braces on existing teeth to shift them into their final positions, clearing a path for the unerupted tooth. This preparatory stage often takes several months, as the surrounding teeth must be moved slowly to establish a clear eruption corridor.
Once space is ready, a minor surgical procedure known as “exposure and bonding” is performed, usually by an oral surgeon. During this step, the gum tissue overlying the impacted tooth is carefully lifted, and sometimes a small amount of bone is removed to expose the tooth’s crown. A specialized orthodontic bracket with a thin gold chain attached is then cemented directly onto the exposed tooth surface.
The surgical exposure uses one of two methods: an open technique, where the tooth remains exposed, or a closed technique, where the gum tissue is repositioned over the tooth after the chain is attached. The end of the chain is secured to the main orthodontic archwire, providing the anchor point for the subsequent application of continuous force. This preparatory phase concludes when the patient returns to the orthodontist to begin the active movement.
The Active Eruption Timeline and Variables
The active eruption phase begins once the gold chain is engaged with the orthodontic archwire, initiating the slow, controlled movement of the impacted tooth toward the arch. This phase is highly variable, but the traction process—from surgical exposure until the tooth first appears in the mouth—can average around 14 to 15 months.
The most significant factor influencing this timeline is the tooth’s location and depth. Canines impacted on the cheek side (buccally) generally emerge much faster, with an average time of approximately six and a half months until they are visible. In contrast, canines impacted on the roof of the mouth (palatally) take considerably longer, often requiring more than 16 months for initial emergence, essentially doubling the time required for the active movement.
The angulation of the impacted tooth also plays a substantial role in the overall duration. A tooth that is severely tilted, such as one inclined greater than 30 degrees from the midline, will require a longer period of traction before it can be brought into the arch. This complex path of movement means that the tooth must be uprighted while simultaneously being pulled down, extending the required treatment time.
Patient age is another variable, as the prognosis for successful movement decreases as a patient gets older. Treatment is generally more successful and faster in adolescents compared to adults over 30, whose teeth are less responsive to movement and have a higher risk of fusing to the bone (ankylosis). The health of the roots of adjacent teeth is also a consideration, as pre-existing root resorption may necessitate a slower application of force to prevent further damage.
The success of the active eruption relies heavily on patient compliance, which includes maintaining meticulous oral hygiene and attending all scheduled appointments for force adjustments. The orthodontist must precisely control the direction and magnitude of the force applied to ensure the tooth moves along the path of least resistance without damaging surrounding structures. This frequent monitoring and adjustment is necessary to keep the process moving efficiently and minimize the risk of complications.
Post-Movement Alignment and Final Treatment Duration
Once the impacted canine has been guided into the dental arch and is visible, the finishing phase of treatment begins. The goal of this stage is to meticulously align the newly erupted tooth with the rest of the existing teeth and refine the overall bite. This alignment process includes detailed adjustments to the tooth’s rotation, height, and precise position to ensure functional harmony.
The time spent on this finishing and bite refinement phase ensures the long-term stability and aesthetic outcome of the treatment. While active movement may take over a year, the total duration from the start of orthodontic treatment until ideal alignment is achieved averages around 27 months. This overall duration encompasses the initial space creation, the active eruption, and the final detailing of the bite.
For patients with an impacted canine, the total treatment time is longer than standard orthodontic care, often requiring two to three years of appliance wear. This additional time results from the complex mechanics needed to recover the unerupted tooth and integrate it into the final arch form. Following active treatment, a retention phase is initiated, requiring custom-fitted retainers to hold the newly positioned tooth and surrounding bone stable for the long term.