When a tooth fails to erupt at the proper time, it must be exposed surgically. Dr. Silberg will lift the gum, expose the tooth, then manage the gum tissue to ensure it heals well and properly supports the new tooth.
It is most important to determine the exact location of the teeth. Dr. Roll will use several digital x-rays to determine if the location is on the outside surface or the inside surface of the bone. Then, she will numb the area, lift the gum, expose the teeth and properly manage the gum tissue. If possible, he will also bond the orthodontic bracket onto the teeth.
After one year of orthodontic treatment two permanent teeth had not yet erupted into Ricky’s mouth. The orthodontist felt that it was not in Rickys best interest to delay treatment waiting longer for the teeth to come down. Ricky was referred to Dr. Silberg to have the two teeth surgically exposed and brackets bonded onto them. This first picture shows that the teeth were still under the gum.
This picture was taken two weeks after the teeth were exposed. You can see that the gum tissue is still a bit red but is healing well. Also, please note that all of the gum tissue was preserved and raised above the teeth. This is critically important so that the teeth have enough gum once they reach their final positions. A bracket has been bonded onto one of the teeth. The orthodontist will attach an elastic cord to the brackets and guide the teeth into position.
This last photo shows the teeth in final position at the completion of the orthodontics. Note the amount and the blending of the gum tissues.
When a tooth is removed the remaining socket can be grafted. Note how the placement of the graft materials in this socket plumps out the ridge.