Conventional wisdom and the surgical exposure of impacted teeth

Objectives-To provide evidence against the notion that direct contact between the crown of an impacted tooth and alveolar bone is an impediment to orthodontically assisted eruption of teeth. Key words: closed surgical exposure; impacted teeth; orthodontic traction Setting and Sample Population - The Department of Orthodontics at the Hebrew University-Hadassah School of Dental Medicine, in Jerusalem, Israel, and the private practices of the authors. Materials and Methods - Patients reported were those affected by impacted teeth, including individuals who were normal healthy patients, with and without resorption of the adjacent incisor roots, as well as individuals suffering from Cleidocranial dysplasia and increased bone density, and individuals with autogenous and synthetic bone grafts. A closed eruption surgical technique was used in which only a small window was opened into the dental follicle of the impacted tooth, leaving a maximum amount of bone covering much of the crown surface. Orthodontic extrusion forces were then applied. Results - For all teeth, enamel-to-bone contact did not prevent a rapid response to the extrusive forces. Conclusion - Radical removal of bone during the exposure of an impacted tooth is unnecessary and potentially may be harmful in terms of the periodontal prognosis of an otherwise successfully treated outcome.