An impacted tooth is a tooth that has not come into the mouth at the age it was expected to, and remains within the bone or gum. In this situation, where orthodontics and surgery work together, the goal is often to bring the tooth into place rather than to extract it. The upper canines and wisdom teeth are the teeth that most often stay impacted. The treatment route depends on the position of the tooth, age, the condition of the neighboring teeth and the bone structure. This page gives a general outline of how the process works for impacted teeth and how clear aligners relate to it. This is general information; the decision for you is made after an examination.
What is an impacted tooth, and is it the same as an embedded tooth?
In everyday language, the terms impacted tooth and embedded tooth are mostly used to mean the same thing. Both describe a tooth that has not come into the mouth even though its eruption time has passed. What shapes the treatment is whether the tooth lies fully within the bone or partly under the gum, and at what angle it sits. For wisdom teeth that stay impacted and their removal, you can also read our article on impacted teeth; this page focuses on the orthodontic approach aimed at bringing a tooth into the mouth.
Which teeth most often stay impacted?
Some teeth have a clearer tendency to stay impacted. The list below is a general picture; every mouth is different.
- Wisdom teeth (third molars): They often become impacted because the jaw does not provide enough room. They are usually not pulled into the mouth; depending on the situation they are monitored or extracted.
- Upper canines: They most often stay impacted on the palate side. Because they matter for facial expression and chewing, they are kept if possible.
- Lower premolars and lower canines: These are seen less often.
- Extra (supernumerary) teeth or tooth-like growths: They can block the eruption of the permanent tooth beneath them.
- Permanent front incisors: Eruption can be delayed if a baby tooth was lost early, if there is an extra tooth, or if there is a lack of space. For the causes, our article on why permanent front teeth do not come in may help.
How can you tell why a tooth has not come in?
An impacted tooth often causes no pain, so it may be noticed late. The signs below call for a check by a dentist:
- The matching tooth on the opposite side has come in, but one tooth is still missing
- A baby tooth is still in place and has not fallen out even after age 13-14
- Shifting, spacing or tilting of the neighboring teeth
- Firmness or a bump in the gum
- An impacted tooth found by chance on a routine X-ray
Having a child's first orthodontic check done early allows impacted teeth to be noticed in good time. For details, see our page on early orthodontic treatment.
How is an impacted tooth detected?
Diagnosis is made through a clinical examination and imaging. The first step is usually a panoramic X-ray, which gives an overall view of all the teeth and the jaws. The exact position of the tooth, meaning whether it lies on the palate or cheek side, how close it is to the neighboring teeth and the shape of its root, is clarified with a three-dimensional CT scan if needed. A CT scan is not taken for every patient; it is requested only when the doctor considers it necessary. For more, you can read our article on dental tomography. Knowing the position precisely directly affects the plan of both the surgeon and the orthodontist.
How is an impacted tooth brought into position orthodontically?
In cases considered suitable, the process generally follows the order below. The number and duration of the stages vary from person to person.
- Making space: If there is no room for the tooth to fit, space is first prepared orthodontically. At this stage, fixed brackets or, in suitable cases, clear aligners can be used.
- Surgical exposure: The surgeon opens the gum, and if needed some of the bone, over the tooth to expose its surface. This procedure is usually done under local anesthesia.
- Attaching an anchor: A small bracket or button is bonded to the surface of the tooth and connected with a thin chain or wire to the appliance in the mouth. In some cases the gum is stitched back into place, in others it is left open.
- Controlled traction: With light, steady force, the tooth is guided along its path through the bone toward the mouth. This stage is usually the longest part.
- Alignment and finishing: Once the tooth has come into the mouth, it is brought into harmony with the other teeth, the bite is fine-tuned and retention is planned.
To learn what wires and brackets do, you can look at our pages on archwires and types of brackets.
How do age and duration affect this procedure?
A tooth's ability to be pulled into place is generally higher at a young age, because the bone is more adaptable and root development may still be ongoing. Treatment may also be possible in adults, but not with the same likelihood for every tooth. The duration varies with the depth and angle of the tooth, age and bone density. In most cases it can range from a few months to nearly two years, and in more complex cases it may take longer. For this reason, rather than a firm promise about timing before treatment, progress is expected step by step.
Can every impacted tooth be pulled into the mouth?
No. In some situations the tooth cannot be pulled, and a different plan is made:
- If the tooth is fused to the bone (ankylosis), it will not move even when force is applied.
- If the root is curved or short, or the position is very unfavorable, the risk of traction increases.
- If there is a high chance of damaging the roots of neighboring teeth, the approach may change.
- If the lack of space is very great, extraction or another restorative method may come into question.
In these cases, the options include monitoring the tooth, extracting it, or, after extraction, considering the gap with approaches such as an implant, a bridge or orthodontic space closure. The decision is made according to the bone condition, the smile line and the structure of the surrounding teeth. Our pages on clear aligners with a missing tooth and congenitally missing teeth may also help for missing-tooth situations.
What happens if an impacted tooth is not treated?
Not every impacted tooth causes problems; some are monitored for years. However, some impacted teeth left untreated can press on the roots of neighboring teeth and lead to root shortening, set the stage for complications such as cyst formation, and cause teeth to drift or space to be lost. Whether these risks are present is assessed with imaging. For this reason, seeing a dentist without delay once it is noticed keeps your options open.
Can an impacted tooth be treated with clear aligners?
Clear aligners can play a part in this process, but they are not enough on their own at every stage. An aligner cannot apply force directly to a tooth that is still impacted, because there is not yet a tooth surface that something can be bonded to and that the aligner can grip. A measured view is therefore needed:
- During the stage of making space and aligning the neighboring teeth, clear aligners can be used in suitable cases.
- For the traction stage after the tooth has been exposed, a small bonded bracket or button and an elastic or chain are generally needed. Whether this is used together with an aligner depends on the doctor's plan.
- In some cases the whole process is carried out with fixed wires, and once the tooth has come in, treatment can switch to clear aligners for the finishing stage.
So for some patients a combined route is followed. Which route is chosen depends on the position of the tooth and the direction of traction. For general suitability, you can look at our pages on who clear aligners are suitable for and crowding.
A general overview by situation
| Situation | General approach | When to see a dentist |
|---|---|---|
| Upper canine has not come in although its counterpart has | Panoramic X-ray, CT if needed; plan for making space and exposure | If some time has passed since the matching tooth came in |
| Child in the mixed dentition stage, canine cannot be felt in place | Early check; in selected cases, baby tooth extraction may come into question | A check is generally recommended around age 9-11 |
| Wisdom tooth impacted | Usually monitored or extracted; pulling it into the mouth only in selected cases | If there is pain, swelling or decay in a neighboring tooth |
| Obstruction by an extra tooth or cyst | The obstruction is removed first, then eruption is monitored or orthodontic support is given | If the permanent tooth is delayed |
| Suspected ankylosis | The plan changes for a tooth that does not move; alternatives are discussed | If there is no progress despite force |
| Impacted canine in an adult | Traction or an alternative method is evaluated depending on the condition of the tooth | As soon as it is detected |
What should you pay attention to during and after treatment?
After surgical exposure, mild swelling and tenderness may be seen for a few days; this is usually managed with the care and eating routine your doctor recommends. Oral cleaning is important throughout the process, because plaque that builds up around the bracket and chain in the mouth can lead to gum inflammation. At check-ups, the direction of the force and the condition of the gum are monitored regularly. When treatment is finished, a retainer is needed to hold the tooth's new position; for details, see our page on retainers. The gum line of a tooth that has newly come into the mouth may look slightly different from its neighbors at first; this is treated as a matter of fine-tuning in the finishing stage.
How is an impacted tooth assessed at the clinic?
At the Funda Sarıkaya Oral and Dental Health Polyclinic, Funda Pekyılmaz Sarıkaya, specialist orthodontist (Uzm. Dt.), examines the condition of the teeth clinically at the first visit, evaluates the necessary images and, when needed, plans surgical collaboration. The clear aligner treatment offered at the clinic is the Invisalign system. Bringing your existing X-rays and any earlier notes from a previous dentist makes the assessment easier. The clinic is located in Park Oran Ofis in Oran, Çankaya, and is open Monday–Saturday, 09:00–20:00. To make an appointment, you can call 0312 911 60 36 or write on WhatsApp. To prepare questions before your visit, our orthodontic consultation question list may be useful.