Hopefully, by the time we are teenagers, all our permanent teeth have erupted. On occasion a tooth doesn’t have room to grow due to our jaw not being large enough. When a tooth fails to emerge fully through the gum line, it becomes impacted or trapped between the gun line and jaw bone. Leaving a tooth impacted may cause permanent damage to nearby teeth, gums and bones or even cysts and tumors. Expose and bond is a common procedure that is used for orthodontic patients that have impacted teeth. This procedure is done generally upon the request of the orthodontist to help aid in eruption of the impacted tooth. Oral and maxillofacial surgeons (OMFS) perform the expose and bond procedure.
What is the expose and bond procedure?
The procedure involves the OMFS isolating the impacted tooth, uncovering it from the gum line with an incision tissue flap , not removing it, then drying it so that a bracket can be bonded to the tooth. This bracket that is bonded will allow the orthodontist to guide the tooth to the surface of the gum line safely. You are usually awake or sedated if desired. Typically, a gold chain is attached to the tooth and brought out of the gum tissue and applied to adjacent orthodontic appliances. After the gum line heals, you will return to the orthodontist for traction on the gold chain to guide the tooth into the mouth. Depending on the how deep the impaction is, the tooth is often erupting in just a few months.
Usually after the bonding procedure, you will be given pain medication for the first few days. The sutures are often the ones that dissolve in 5 to 7 days, so you do not need to return for removal of them. Your gums will be very tender and you should not chew on that affected area. To keep the area clean, you will rinse with salt water the day after surgery. You need to follow your surgeons recommendations for after surgery care, which may include ice packs initially then moist heat to the area. The area will feel numb for 2-3 hours after surgery. Brush your teeth as best you can. Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. Your orthodontist should be the only one manipulating the chain to expose the tooth. It will take several months for the tooth to move into position.
American Association of Oral and Maxillofacial Surgeons: http://www.aaoms.org/wisdom_teeth.php
Journal of American Dental Association, Vol 131, No 5, 623-632: http://jada.ada.org/cgi/content/full/131/5/623
Web MD: http://www.webmd.com/oral-health/oral-surgery
Mayo Clinic: http://www.mayoclinic.com/health/wisdom-teeth/DS00679/DSECTION=treatments-and-drugs
The Orthodontic Treatment of Impacted Teeth by Adrian Becker: pages 34-37