- The exact position of the tooth is mapped with a 3D CBCT scan
- A canine can often be brought into place with braces instead of removed
- If a cyst is suspected, the tissue is removed and sent for pathology
An impacted tooth is one that stays inside the bone or gum after the time it should have come through. Its path may be blocked by another tooth, by an extra (supernumerary) tooth or by a lack of space; sometimes the tooth developed in the wrong direction from the start. The tooth most often impacted is the wisdom tooth, which we cover separately on the wisdom tooth removal page. This page is about the others: above all the upper canines, then the premolars, extra teeth that stop the front teeth from coming through, and incisors left impacted after an injury.
Unlike wisdom teeth, most of these teeth genuinely matter for your smile and for chewing. So the first question is not "should we remove it?" but "can we bring it into place?"
How is an impacted tooth noticed?
Impacted teeth often cause no symptoms and turn up by chance on a routine X-ray. These signs, however, are worth having checked:
- A baby canine still in the mouth after the age of 13–14
- A tooth that has come through on one side but not on the other
- A gap between the front teeth that does not close, or a lateral incisor that is tilting
- A hard bump you can feel on the palate or on the lip side of the gum
In children, early diagnosis makes a difference. If the bulge of the canine cannot be felt by the age of 10–11, an X-ray is needed; in some children, removing the baby canine early can correct the eruption path of the impacted tooth without further treatment.
Why we take a CBCT scan
A panoramic X-ray shows the impacted tooth but does not tell us whether it lies on the palate side or the lip side. A 3D cone-beam CT (CBCT) scan shows its exact position and angle, how close it is to the neighbouring roots and whether those roots are being resorbed. Upper canines are most often impacted on the palate side; this information shapes both the surgical approach and the orthodontic plan.
The most important harm an impacted canine can do is silent: it can resorb the root of the incisor next to it. This progresses without pain and is only picked up on imaging.
Bring it into place, remove it or monitor it?
| Approach | When it suits | What it involves |
|---|---|---|
| Surgical exposure and orthodontics | The tooth is healthy and its angle and depth are favourable; the patient is usually young | A short surgical procedure and months of brace treatment |
| Extraction | The tooth is horizontal or very high in the jaw, fused to the bone or damaging neighbouring roots, or there is no room in an adult | Closing the gap with orthodontics or filling it with a prosthetic tooth |
| Monitoring | Deep, causing no symptoms, no damage to neighbouring teeth or bone | X-ray checks at intervals |
An impacted canine can be brought into place in adults too, but the older you are, the longer it takes and the less predictable the result. A tooth fused to the bone (ankylosed) will not move under orthodontic force; in that case extraction followed by an implant or a bridge is planned.
How surgical exposure and orthodontic traction work
Usually the orthodontist first opens up space where the tooth is to go, which means starting fixed brace treatment. Then, under local anaesthetic, the gum over the impacted tooth — and a thin layer of bone if needed — is lifted away, and a small attachment with a fine chain is bonded to the crown of the tooth. Either the gum is stitched back with the end of the chain left showing, or the crown of the tooth is left exposed; which approach is chosen depends on the position of the tooth.
A few weeks later the chain is tied to the brace and the tooth is gently pulled into place with light forces over several months. This runs alongside fixed metal braces, and the total treatment time is usually longer than for brace treatment without an impacted tooth. The surgical part usually takes no more than an hour; afterwards there are a few days of tenderness and mild swelling.
Cysts around impacted teeth
The thin sac of tissue around the crown of an impacted tooth can sometimes turn into a fluid-filled cavity, in other words a cyst. The most common type is the follicular (dentigerous) cyst. It usually grows slowly and without pain; but as it grows it can push neighbouring teeth aside, thin the jawbone and, rarely, become large enough to cause swelling of the face. On an X-ray it shows up as a dark area around the crown of the tooth that is wider than normal.
Treatment is usually complete removal of the cyst, and the impacted tooth is often removed at the same appointment. In children, some small cysts can instead be opened and drained so that the tooth can come through on its own. The removed tissue is sent for pathology testing, because some types of cyst tend to come back and the follow-up plan depends on the result. For details, see the dental cyst removal page.
After surgery, and emergencies
Removing an impacted tooth is technically a surgical extraction; the course of healing and the aftercare rules are the same as described on the surgical tooth extraction page. If you develop a fever, swelling spreading towards the eye or neck, or difficulty swallowing or breathing, contact your dentist or go to the nearest emergency department without delay.
If you would like us to assess your own or your child's impacted tooth in İzmir, bring any earlier X-rays you have to the appointment; seeing whether the tooth has moved over the years makes the plan clearer.
Common questions
Does everyone with an impacted tooth need surgery?
No. An impacted tooth that sits deep, causes no symptoms and does no harm to neighbouring teeth or bone can be monitored with X-rays at intervals. Surgery comes into question if the tooth is to be brought into place, if it is damaging neighbouring roots, if there is a cyst around it, or if it stands in the way of an implant or denture plan.
Can an impacted canine be brought into place in an adult?
It can often be attempted, but it is not as predictable as in younger patients: treatment takes longer, and the chance that the tooth has fused to the bone increases with age. If, after a CBCT scan and an orthodontic assessment, the chance of success looks low, removing the tooth and dealing with the gap another way may make more sense.
What happens if the baby tooth over an impacted tooth stays in my mouth?
If the root of the baby tooth is sound, it can last for years; in some adults it is reasonable to leave the impacted tooth where it is and keep the baby tooth. When the baby tooth starts to loosen or is lost, implant, bridge or orthodontic options for the gap are discussed.
How long does brace treatment take after the surgery?
It depends on the position of the impacted tooth and on your age. Pulling the tooth into place takes months, sometimes more than a year; the total treatment is usually longer than brace treatment without an impacted tooth. We discuss the exact timeframe once we have the CBCT scan and the orthodontic plan.
Is a cyst around an impacted tooth dangerous?
Most are benign, but they do not go away on their own, and as they grow they can thin the bone and push neighbouring teeth aside. That is why removing the cyst and having the tissue examined by a pathologist is recommended. Because some types of cyst can come back, X-ray checks are done at set intervals after surgery.
When should an extra tooth blocking the front teeth be removed?
It is usually removed if it is stopping the permanent front teeth from coming through, causing a gap between them, or if a cyst is developing around it. Once the obstruction is gone, the front teeth often come through on their own; if they do not, surgical exposure and orthodontic traction may be needed. An extra tooth that causes no problems can be monitored.
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