An impacted tooth is a permanent tooth that has failed to erupt fully into its proper position in the dental arch by the expected time. This phenomenon most commonly affects the maxillary canines, often called the “eye teeth,” which are the second most likely teeth to become impacted after the wisdom teeth. The canine plays a prominent role in both the aesthetics of a smile and the function of the bite, making its rescue a high priority in orthodontic treatment. The process of bringing an impacted canine down with braces is a careful, multi-stage procedure requiring collaboration between an oral surgeon and an orthodontist.
Understanding Impaction and Exposure
The initial phase involves a detailed assessment to determine the exact location and angle of the buried tooth, often using three-dimensional imaging like a Cone-Beam Computed Tomography (CBCT) scan. Impacted canines are categorized based on their location: labial (toward the lip or cheek) or palatal (toward the roof of the mouth). Palatal impaction is the more common occurrence.
Once the tooth’s position is confirmed and space is created, a minor surgical procedure called “exposure and bonding” is performed. During this surgery, the overlying gum tissue is lifted, and sometimes bone is removed to uncover the crown. An orthodontic attachment, typically a small bracket with a metal chain, is then bonded to the exposed surface of the tooth.
The gum tissue is either repositioned and sutured back over the tooth (closed eruption technique), or it may be trimmed to leave the tooth partially exposed (open eruption technique). The closed method is often preferred for palatally impacted teeth to ensure a healthy gum contour develops as the tooth moves. This surgical step prepares the tooth for the application of controlled orthodontic force.
The Active Movement Phase and Timeline
The active movement phase begins once the surgical site has healed, involving the application of light, continuous traction to the chain attached to the impacted tooth. This chain is connected to the main orthodontic archwire or other anchoring mechanisms to apply a gentle pulling force. The goal of this traction is to encourage the impacted tooth to move through the bone along a carefully planned path into the dental arch.
The rate of tooth movement must be exceptionally slow and deliberate to prevent damage to the tooth root, surrounding bone, or the roots of neighboring teeth. This slow, biological process relies on the body’s natural response, where bone is resorbed on the side of pressure and deposited on the side of tension. The overall duration for the active movement of the impacted tooth from its buried position to visibility in the arch can range widely.
Patients can expect this specific phase of movement to take anywhere from six to eighteen months, though complex cases may require two years or more of traction. The orthodontist adjusts the tension on the chain at regular appointments, typically every four to six weeks, to maintain the necessary continuous force. The total orthodontic treatment time includes this phase plus the time needed to create space and perform final alignment.
Key Factors Determining Treatment Duration
The variation in the active movement timeline is directly related to several patient-specific and biological factors. The single most important factor is the initial location and severity of the impaction. These variables are assessed at the beginning of treatment to provide the most realistic estimate of the eventual duration.
Location and Severity
Canines positioned high in the jawbone, closer to the midline, or those with a severe horizontal angulation (more than 30 degrees from the vertical) require longer treatment times due to the greater distance and complex path. The distinction between palatal and labial impaction also strongly influences the duration; palatally displaced canines often take significantly more time to emerge than those impacted toward the cheek side.
Patient Age and Bone Density
The age of the patient is an influential variable, as the bone structure in older adolescents and adults tends to be denser and less biologically responsive. This density consequently slows the rate of tooth movement.
Tooth Condition and Pathology
The condition of the tooth itself plays a role; movement is slower if the root is fully formed compared to a tooth with an incompletely developed root. Any associated pathology, such as a large follicular cyst surrounding the tooth crown, or the presence of root resorption on adjacent teeth, introduces complications that necessitate more cautious and time-consuming movements.
Post-Movement Stabilization
Once the impacted canine has been successfully guided into the dental arch, the active traction phase concludes. The tooth is now held securely in its new position by the orthodontic archwire and bracket system for an extended period. This post-movement stabilization phase is necessary to allow the surrounding tissues to adapt to the canine’s final placement.
The alveolar bone and the periodontal ligament fibers, which anchor the tooth to the bone, must reorganize and mature to solidify the tooth’s new position. This biological process ensures the long-term stability of the canine and prevents it from shifting back toward its original impacted location. The duration of this stabilization period is typically several months and is integrated into the overall time the patient wears braces.
After the canine is stable, and the entire arch alignment and bite correction are complete, the transition to a retainer phase begins. Retainers, which may be removable or fixed, serve to maintain all teeth in their corrected positions indefinitely. This final step is crucial for preserving the successful result achieved from the complex, multi-stage process of bringing the impacted canine into the smile.