- Erupted primary predecessors may be extracted.
- A flap is raised in the manner described above.
- Any unerupted supernumeraries or buried teeth are extracted.
- The bony impaction is relieved and the widest diameter of the crown exposed. At
this stage it may be possible to place an orthodontic bracket to aid eruption, although
this is by no means essential. - A pack, for example, Whitehead's varnish on 1/2-inch (about 1.25 cm) or 1/4-inch
(about 0.63 cm) ribbon gauze or a periodontal dressing, is then placed around the
tooth and the flap replaced around the pack. It is not always necessary to sacrifice soft
tissue if the tooth is exposed, and the pack can be placed via primary tooth sockets.
Alternatively it is possible in some cases (such as the exposure of a palatally placed
canine) to incorporate a periodontal pack on to the acrylic of an upper removable
orthodontic appliance to maintain exposure during healing. - The use of non-resorbable sutures to maintain the pack is recommended, although
other parts of the incision can be closed with resorbable sutures. - In cases in which the removal of soft tissue from the palate or crest of the ridge is
all that is required to expose a tooth then it is unnecessary to raise a full flap. All that
is needed is to sacrifice the overlying tissue and pack the wound (1052HFig. 15.25 (a) and
(b)). Occasionally this can cause excessive bleeding in the palate. This is controlled
by passing a non-resorbable suture across the full thickness of the palatal
mucoperiosteum just posterior to the wound edge to ligate the greater palatine artery. - When an unerupted tooth, classically a canine, is palpable high in the buccal sulcus
under reflected mucosa it should not be exposed by sacrificing the overlying soft
tissue. This would result in the cervical collar of the tooth being surrounded by non-
keratinized mucosa. To overcome this problem a flap containing keratinized gingiva
must be raised coronal to the impacted tooth, bone removed if necessary, and the flap
replaced in a more apical position to allow a collar of attached gingiva around the
tooth at eruption. - The pack and any remaining non-resorbable sutures should be removed after 7-10
days.
Bonding of orthodontic appliances to unerupted teeth
When it is impossible to reposition a flap apically around an unerupted tooth an
alternative is to bond either a gold chain or a magnet to the buried tooth (1053HFig. 15.26
(a) and (b)). When performing this technique the tooth is localized as described above
and the gold chain or magnet attached to the tooth using composite resin and a
bonding agent. When a gold chain has been attached (1054HFig. 15.26 (a)) the chain is
brought through the edges of the wound in the area of natural eruption of the tooth.
The free end of the chain is then either bonded to an erupted tooth or sutured to the
mucosa during the healing period before orthodontic activation. When a magnet is