Oral Surgery for Children & Adolescents

What Does “Impacted Canine” Mean?

Up to 3% of the general population will have an impacted canine. Maxillary (upper) canines are the second most frequently impacted teeth and, if left untreated, can cause significant problems including formation of cysts, ankylosis (fusion with the bone), damage to the adjacent teeth (usually the incisors), displacement of adjacent teeth.

The unerupted canine is usually positioned in the roof of the mouth, but it may also be positioned on the other side of the teeth, beneath the upper lip (buccal side).

Treatment Options for Impacted Canines

1. Surgical exposure and orthodontic traction (expose and bond)

   Exposure and bonding treatment is the most common procedure for impacted canines and can also be used to address impacted incisors and premolars. This treatment is a collaborative process in which the orthodontist and specialist paediatric dentist work hand in hand to guide the adult tooth into place.

   The procedure involves making a cut and repositioning the gum to expose the impacted tooth. Bone removal is often necessary to expose the buried tooth and create a path through which the tooth can erupt. Once exposed, a bracket and gold chain are glued to the tooth and the end of the chain is attached to the existing brace, or temporarily to the adjacent teeth. The gum is then repositioned with dissolvable stitches.

2. Surgical removal

   In some cases, the impacted canine is in an unfavourable position for orthodontic movement or it is fused to the bone and will fail to move.

   Some other patients might choose not to have any orthodontic treatment. In these circumstances, it may be advisable to opt for surgical removal of the impacted canine.

A Day Case General Anaesthetic is usually required for these procedures. Dr Kalkani operates privately at the Portland Hospital, part of HCA Healthcare UK, in London.

Delayed Eruption of Adult Tooth

Delayed eruption of an adult tooth  refers to the situation where the permanent tooth does not come in within the expected timeframe. This delay can occur for a variety of reasons, and it’s important to determine the cause to ensure proper dental development.

• Hereditary Factors:

  • If one or both parents had a delayed eruption, the child may also experience a similar delay. Genetic factors can influence the timing of tooth eruption.

• Overcrowding:

  • In some cases, there is insufficient space in the mouth for the permanent tooth to erupt, which can delay its appearance. Overcrowding can cause teeth to be pushed out of alignment or delayed in erupting.

• Primary Tooth Retention:

  • The primary (baby) tooth may not fall out on time, preventing the permanent tooth from erupting. This is called “retained primary teeth.”

  • In such cases, extraction of the baby tooth may be necessary to allow the permanent tooth to come in.

• Supernumerary Teeth (Extra Teeth):

  • Sometimes an extra tooth (known as a supernumerary tooth) can form and block the normal eruption of the permanent incisor. This extra tooth may need to be surgically removed to allow the normal tooth to emerge.

• Impaction:

  • The permanent tooth may become impacted, meaning it is stuck under the gums or bone and cannot erupt properly. This can occur due to the position of the tooth or because of other obstructions.

• Trauma:

  • Injury to the mouth or teeth can affect the development and eruption of permanent teeth. Trauma to the baby tooth or surrounding tissue can damage the permanent tooth germ, delaying eruption.

• Delayed Root Resorption:

  • The roots of the baby teeth must dissolve (a process called resorption) before they fall out. If this process is delayed, it can slow down the eruption of the permanent tooth.

• Nutritional Deficiencies:

  • Poor nutrition, especially during critical growth periods, can lead to delayed dental development. Deficiencies in vitamins and minerals, particularly calcium and vitamin D, may affect tooth eruption.

• Cysts or Tumours:

  • Rarely, a cyst or tumor in the jawbone can block the path of the erupting tooth. These growths can be           detected through imaging and may require surgical intervention.

Treatment Options:

1. Monitoring:

   • In many cases, delayed eruption is simply a matter of timing. The paediatric dentist may suggest a “wait and see” approach, monitoring the tooth with regular check-ups to ensure it eventually erupts without intervention.

2. Extraction of Retained Baby Tooth:

   • If a baby tooth is preventing the permanent tooth from coming in, the dentist may recommend extracting the baby tooth. This often allows the permanent tooth to erupt naturally.

3. Surgical Exposure:

   • If the permanent tooth is impacted or blocked, the paediatric dentist may perform a minor surgical procedure to expose the tooth and allow it to erupt.

4. Orthodontic Treatment:

   • In cases where there is overcrowding, an orthodontist may recommend braces or spacers to create more room in the mouth, allowing the permanent incisor to come in properly.

   • If the tooth is significantly impacted, orthodontic treatment may include attaching a bracket to the impacted tooth and gently guiding it into position.

5. Removal of Supernumerary Teeth or Cysts:

   • If extra teeth or cysts are blocking the eruption, surgical removal may be necessary to clear the path for the permanent tooth.

Frenectomies

Maxillary Labial Frenum: The maxillary labial frenum attaches the upper lip to the gingival (gum) tissue between the central incisors. In cases of a prominent or hypertrophic labial frenum, it can exert tension causing diastemas (gaps between teeth) or preventing their proper alignment during orthodontic treatment. It can also be associated with trapping of food and accumulation of plaque, chronic inflammation and gum recession.

Frenectomy procedures can be performed using various techniques, including scalpel and/ or soft tissue lasers.

The use of soft tissue laser offers several benefits, including shorter procedural time, reduced use of suturing, a reduced need for the administration of analgesic and/or anti-inflammatory drugs, favourable postoperative healing, and a reduction in postoperative bleeding and complications (in the form of inflammation or haematomas).

Soft tissue surgery & biopsies

Children can present with soft  tissue lesions that require treatment for the best prognosis. In most cases, these lesions are benign and parents have nothing to worry about. It is recommended that these lesions are removed (excised) and the tissue is sent to an oral pathology lab for microscopic diagnosis. 

Some of the most common lesions include lumps on the gums (epulis/ fibroma) , lips (polyp/ mucocele) and floor of the mouth (ranula). 

Soft tissue laser procedures are less invasive, precise, more comfortable and cause significantly less swelling, bleeding, and damage to surrounding tissues.

What Parents of Our Patients Think

My daughter has the most amazing and smooth experience with Dr Maria when she had a procedure for the exposure of two buried canines. Dr Maria was professional, efficient, supportive, focussed, calm and most importantly friendly; both myself and my daughter felt well cared for and safe.

— Mrs M.P.