The most common impacted teeth are wisdom teeth or third molars. Upper canines and lower premolars are also commonly impacted. Following these teeth is the upper central incisor also called the maxillary central incisor.
Why is my upper front tooth not coming down?
There are several reasons why this can happen.
- Crowding - When there is no space for the tooth to come in
- Trauma - Trauma of the baby tooth or primary tooth
- Root Dilaceration - Curved roots that causes the tooth to erupt in a wrong direction
- Odontoma - Tumor made out of a tooth like structure that can block the eruption passage
- Mesioden - Extra Tooth between the central incisor that can block the eruption passage
Many extra teeth grow upside down and some even erupt through the nose.
What happens if you leave the Supernumerary Tooth or Extra Tooth?
If the passage of eruption is blocked by extra teeth, the central incisor may not be able to erupt on its own. If the extra teeth or supernumerary teeth are discovered early and are removed, the central incisor (upper front tooth) has a chance to come down spontaneously. Just like other teeth the extra teeth become larger. When the roots are longer and the crowns become larger they take up more space in the bone.
Removing larger teeth leave a larger defect in the bone which may require grafting to fill the empty space. The recovery in a larger defect takes longer.
When the extra teeth are touching another permanent tooth root, it can cause resorption of the root of the permanent tooth. If the resorption is severe the patient may lose the permanent tooth. The image on the left shows severe resorption of the left lateral incisor root due to the abutting impacted canine.
What happens if the central incisor doesn’t erupt (come down into the mouth) spontaneously after removal of the Supernumerary Tooth?
Braces may need to be utilized to help the eruption. A gold chain may need to be attached to the impacted central incisor. A rubber band is attached to the chain and anchored to the wire of the braces. This allows the impacted central incisor to slowly move down into the mouth. We work together with our orthodontist as a team to help the central incisor come into the right position.
Early treatment is the key. Central incisors erupt at age 7 - 8 years old. One of the concerns with the impacted central incisors is failure to erupt (come down into the mouth). This happens more commonly when the treatment is delayed. Even if the tooth is orthodontically erupted, it may not maintain its position. If there is bounce back of the tooth that is moved down with the help of braces, and the edge of the tooth is shorter compared to the other central incisor, crowns or veneers may be utilized to created an even smile. We work closely with our restorative dentists to create beautiful and balanced smile.
What happens if the Impacted Central Incisor fails to erupt?
If the Impacted central incisor is ankylosed (stock to the surrounding bone) and cannot move down, extraction is recommended. To fill the missing upper front tooth several different options are available.
Bridge or Fixed Partial Denture (FPD)
A bridge or fixed partial denture (FPD) is when a pontic (false tooth) is anchored to two adjacent crowns. The advantage of a bridge is short treatment time. The disadvantage is that two adjacent teeth need to be cut to seat the crowns. If something happens to one of the supporting teeth the bridge may have to be removed and the missing tooth space needs to be addressed with a different modality.
A Dental Implant is an alternative treatment. A dental implant is a biocompatible screw that is placed in the bone. A crown is placed on the dental implant and it acts like a natural tooth. The advantage of dental implants are numerous. No adjacent teeth need to be cut like a bridge. It feels and looks like a natural tooth and the longevity is proven to be superior. Because of the permanent position of dental implants, placement is not recommended in growing teens. When bone may continue to grow but the implant does not follow the bone growth. When the implant is placed too early it will be in a more palatal (toward the roof of the mouth) after the growth is completed. If the position is not cosmetically or functionally acceptable, the implant may have to be removed and placement in a more ideal position may need to be considered.
Stayplate and Essix Retainer
In growing teens a stayplate or essix retainer is utilized until the growth is completed. A essix retainer looks like a clear invisalign tray or night guard that contains a tooth. A stayplate is a retainer with a false tooth attached to it. Wires wrap around some teeth and the tooth is held on to the retainer.
Usually growth is completed by 18 years of age. There are other modalities that can be used to monitor growth. Changes in the hand, wrist and cervical vertebrae correlate with the growth pattern and these can be monitored to confirm completion of growth.
Please ask Dr. Song and Dr. Um about extra teeth or supernumerary teeth during your consultation.