Teeth that are impacted should ideally be moved into the dental arch or given enough space to encourage natural eruption at their “normal” eruption times. The latter is because during the stage of root formation, teeth have potential to erupt. Upper canines usually erupt at 11 – 12 years and upper incisors approx. 6 – 8 years of age. If these teeth are delayed in eruption and are suspected to be impacted, an assessment by an orthodontist is mandatory.
When early treatment results in eruption of the impacted tooth, surgical treatment is avoided. In a case of impacted upper canines and crowding, early expansion with a RME is helpful. This creates space to encourage the canines to descend towards the arch. However, if the impacted tooth fails to erupt, a combination of surgical exposure and orthodontic traction can be applied to move the tooth into the arch.
In cases of severe impaction and if dental extractions are required to make space for crowding, the surgical removal of the impacted tooth is indicated.