| Exodontia.Info |
| Exposing & Bonding of Brackets to Teeth Explanation & Warnings |
The objective of exposing ± bonding a bracket on to
an unerupted tooth is to move the tooth into a good
functional & aesthetic position.
Exposure of a tooth at its simplest, consists of removing the
gum overlying the crown of the unerupted tooth under Local
Anæsthetic. Most unerupted teeth are deeper within the
jaw and require the removal of bone as well as the gum to
expose and disimpact them; as a consequence, this may be
done under General Anæsthetic.
The application of traction (using the chains attached to
braces) to stimulate and guide the eruption of buried teeth
is necessary as the teeth are unfavourably angled (and
spontaneous eruption is inhibited), where buried teeth are
obstructed from eruption by other teeth & where teeth are
exposed long after their root development is complete. An
example of an exposed tooth being dragged into its correct
position is shown here.
Teeth most likely to be exposed and bonded are the upper
canines / eye teeth, upper central incisors, molars and the
occasional premolars.
an unerupted tooth is to move the tooth into a good
functional & aesthetic position.
Exposure of a tooth at its simplest, consists of removing the
gum overlying the crown of the unerupted tooth under Local
Anæsthetic. Most unerupted teeth are deeper within the
jaw and require the removal of bone as well as the gum to
expose and disimpact them; as a consequence, this may be
done under General Anæsthetic.
The application of traction (using the chains attached to
braces) to stimulate and guide the eruption of buried teeth
is necessary as the teeth are unfavourably angled (and
spontaneous eruption is inhibited), where buried teeth are
obstructed from eruption by other teeth & where teeth are
exposed long after their root development is complete. An
example of an exposed tooth being dragged into its correct
position is shown here.
Teeth most likely to be exposed and bonded are the upper
canines / eye teeth, upper central incisors, molars and the
occasional premolars.
| Picture of a Gold Chain & Bracket |
This list of warnings might seem excessive to some however the legal ruling in
the case of Chester vs Afshar (2004) would suggest that it is quite prudent /
necessary to list them. Others might say that there isn't enough information but
where do you stop?
The following list of warnings regarding tooth exposure & bonding is neither
exhaustive nor is it predictive. The most pertinent warnings have been included
here.
You are to have a tooth exposed ± bracketed. You can expect the following:
Exposing ± Bracketing of Tooth Specific Warnings:
Stitches. The extraction site will often be closed with stitches. These are
dissolvable and ‘fall out’ within 10 – 14 days. If a pack has been sewn in or the
chain is ‘parked’ high up in the sulcus, non-dissolving stitches are used, that will
need to be removed at some point.
Brackets. These are small golden plaques with chains attached. These are stuck
onto the teeth that need to be moved. Sometimes, the cement sticking the chain
onto the tooth can break after traction is applied to the tooth; if this happens, the
bracket will need to be re-cemented on. Occasionally, the chain itself breaks and
this will mean that the chain and bracket have to be replaced.
Gauze Pack. Sometimes, it is not possible to stick the chains onto the teeth. If
this is the case, a gauze pack impregnated with an antiseptic (BIPP) is placed
over the exposed tooth and sewn into place. The pack is removed after
approximately a week and the chain will be stuck on at this point.
Ankylosis of Tooth. Occasionally, even if the tooth has traction applied to it, it still
refuses to move. If this happens, it is sometimes necessary to explore the area –
there may be a lip of bone preventing the tooth from moving or the tooth has fused
with the surrounding bone (ankylosis).
Repeated Operation. The gum can easily grow back over the exposed tooth. If
this is the case and the tooth doesn’t have a bracket stuck on it, the tooth will need
to be re-exposed, hence another operation.
General Surgical Warnings:
Pain. As it is a surgical procedure, there will be soreness after the procedure.
This can last for several days. Painkillers such as ibuprofen, paracetamol,
Solpadeine or Nurofen Plus are very effective. Obviously, the painkiller you use is
dependent on your medical history & the ease with which the tooth was exposed.
Swelling. There will be swelling afterwards. This can last up to a week. Use of
an icepack or a bag of frozen peas pressed against the cheek adjacent to the
tooth removed will help to decrease the swelling. Avoidance in the first few hours
post-op, of alcohol, exercise or hot foods / drinks will decrease the degree of
swelling that may develop.
Bruising. Some people are prone to bruise. The bruising can look quite florid; this
will resolve but can take several weeks (in the worst cases).
Limited Mouth Opening. Often, the chewing muscles and the jaw joints are sore
after the procedure so that mouth opening can be limited for the next few days.
Useful Articles:
Dental Update 1999. The Apically Repositioned Flap in Tooth Exposure
Dental Update 2000. Modified Apically Repositioned Flap in the Treatment of
Unerupted Maxillary Central Incisors
Cochrane Review 2008. Open versus closed surgical exposure of canine teeth
that are displaced in the roof of the mouth
RCS England Guidelines 2011. Management of the palatally ectopic maxillary
canine
Oral Surgery 2011. Case Report. The Trouble with Ectopic Maxillary Canines – A
Cautionary Tale of 2 Cases
the case of Chester vs Afshar (2004) would suggest that it is quite prudent /
necessary to list them. Others might say that there isn't enough information but
where do you stop?
The following list of warnings regarding tooth exposure & bonding is neither
exhaustive nor is it predictive. The most pertinent warnings have been included
here.
You are to have a tooth exposed ± bracketed. You can expect the following:
Exposing ± Bracketing of Tooth Specific Warnings:
Stitches. The extraction site will often be closed with stitches. These are
dissolvable and ‘fall out’ within 10 – 14 days. If a pack has been sewn in or the
chain is ‘parked’ high up in the sulcus, non-dissolving stitches are used, that will
need to be removed at some point.
Brackets. These are small golden plaques with chains attached. These are stuck
onto the teeth that need to be moved. Sometimes, the cement sticking the chain
onto the tooth can break after traction is applied to the tooth; if this happens, the
bracket will need to be re-cemented on. Occasionally, the chain itself breaks and
this will mean that the chain and bracket have to be replaced.
Gauze Pack. Sometimes, it is not possible to stick the chains onto the teeth. If
this is the case, a gauze pack impregnated with an antiseptic (BIPP) is placed
over the exposed tooth and sewn into place. The pack is removed after
approximately a week and the chain will be stuck on at this point.
Ankylosis of Tooth. Occasionally, even if the tooth has traction applied to it, it still
refuses to move. If this happens, it is sometimes necessary to explore the area –
there may be a lip of bone preventing the tooth from moving or the tooth has fused
with the surrounding bone (ankylosis).
Repeated Operation. The gum can easily grow back over the exposed tooth. If
this is the case and the tooth doesn’t have a bracket stuck on it, the tooth will need
to be re-exposed, hence another operation.
General Surgical Warnings:
Pain. As it is a surgical procedure, there will be soreness after the procedure.
This can last for several days. Painkillers such as ibuprofen, paracetamol,
Solpadeine or Nurofen Plus are very effective. Obviously, the painkiller you use is
dependent on your medical history & the ease with which the tooth was exposed.
Swelling. There will be swelling afterwards. This can last up to a week. Use of
an icepack or a bag of frozen peas pressed against the cheek adjacent to the
tooth removed will help to decrease the swelling. Avoidance in the first few hours
post-op, of alcohol, exercise or hot foods / drinks will decrease the degree of
swelling that may develop.
Bruising. Some people are prone to bruise. The bruising can look quite florid; this
will resolve but can take several weeks (in the worst cases).
Limited Mouth Opening. Often, the chewing muscles and the jaw joints are sore
after the procedure so that mouth opening can be limited for the next few days.
Useful Articles:
Dental Update 1999. The Apically Repositioned Flap in Tooth Exposure
Dental Update 2000. Modified Apically Repositioned Flap in the Treatment of
Unerupted Maxillary Central Incisors
Cochrane Review 2008. Open versus closed surgical exposure of canine teeth
that are displaced in the roof of the mouth
RCS England Guidelines 2011. Management of the palatally ectopic maxillary
canine
Oral Surgery 2011. Case Report. The Trouble with Ectopic Maxillary Canines – A
Cautionary Tale of 2 Cases
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
| Photos, from the front and side, of an Upper Left Canine that has had a Bracket & Chain bonded on to it |
| Tooth that has had a Bracket & Chain attached to it |
| Last Updated 10th February 2012 |