How to Fix an Impacted Tooth: Causes, Treatment Options, and Cost
An impacted tooth is one that fails to erupt into the mouth because bone, gum, or another tooth blocks it. Upper canines are impacted most often after wisdom teeth. Treatment usually combines a minor surgical procedure to uncover the tooth with braces that guide it into position over several months.
Dr. Jenée Kaplan, DDS
Orthodontic residency and a Master’s degree at Loma Linda University. Member of the American Association of Orthodontists, the American Dental Association, and the California Dental Association.
What is an impacted tooth?
Teeth erupt along a path. An impacted tooth is one whose path is blocked — by a neighboring tooth, by a retained baby tooth, by insufficient space, or by the tooth being angled wrongly from the start — so it stays buried in bone or under gum past the age it should have arrived.
After wisdom teeth, the upper canine is the tooth most commonly impacted. That matters more than it sounds: the canine has the longest eruption path of any tooth, travelling from high in the upper jaw down into the arch, and it is the cornerstone of the bite and the smile. It is also one of the last front teeth to arrive, typically around eleven to thirteen, by which time crowding may have closed its space.
The defining feature of impaction is that it is silent. An impacted canine can press on and resorb the root of the incisor beside it without ever causing pain, and by the time anything is noticeable that damage may be permanent. This is the condition on this site most dependent on being found by examination rather than reported by the patient.
What causes a tooth to become impacted?
- Not enough space in the arch
- Crowding closes the space a late-erupting tooth was going to occupy. The canine, arriving last among the front teeth, regularly finds its place taken and diverts.
- A retained baby tooth
- A baby canine or molar that does not shed deflects the adult tooth behind it. Removing it at the right time is sometimes enough on its own to let an off-track canine correct its path.
- An abnormal eruption path or tooth position
- Some teeth are angled wrongly from the outset, or develop in a position from which normal eruption is impossible. This is a matter of development rather than anything that was done or not done.
- Extra teeth and growths
- A supernumerary tooth or a cyst physically obstructs eruption. Extra teeth near the midline are a recognized cause of an upper central incisor failing to appear.
- Early loss of a baby tooth
- Losing a baby tooth long before its successor is ready lets neighboring teeth drift into the space and close it, so the permanent tooth has nowhere to erupt when its time comes.
Why does an impacted tooth matter?
- Root resorption of the neighboring teeth. An impacted canine pressing on the root of a lateral or central incisor can dissolve it. The damage is painless, invisible without imaging, and not repairable — at worst the affected tooth is lost.
- Cyst formation. The follicle around an unerupted tooth can develop into a cyst that expands and destroys surrounding bone, again without symptoms in the early stages.
- Bite and space collapse. While a tooth is missing from the arch, neighbors tip and drift into the space, so the eventual correction is longer and more complex than it would have been.
- Appearance and function. The canine guides the bite during side-to-side jaw movement and supports the corner of the lip. A baby canine substituting for it wears down and eventually fails.
- Timing. Treatment started at twelve is routine and predictable; the same tooth at twenty-five is harder to move, more likely to be fused to bone, and more often extracted instead.
How is an impacted tooth treated?
Interceptive extraction of a baby tooth
When imaging shows a canine straying off course in a child of roughly ten to thirteen, removing the baby canine at the right moment often allows it to redirect itself and erupt normally. Creating space with an expander at the same time improves the odds further.
Who it suits: Children caught early, which is the whole argument for the age-seven evaluation and for the imaging that goes with it. It is the least invasive option by a wide margin and it is only available inside a narrow window.
Surgical exposure and orthodontic traction
An oral surgeon or periodontist uncovers the impacted tooth and bonds a small attachment with a gold chain to it. Braces then apply gentle continuous force through that chain, walking the tooth into the arch over months. Space is created first so the tooth has somewhere to go.
Who it suits: The standard treatment for an impacted canine at any age where the tooth is judged movable. Slow by nature — six to eighteen months for the tooth alone — and in adolescents the tooth is brought into the arch in the large majority of cases.
Creating space first
Where crowding caused the impaction, widening the arch or otherwise regaining space is the first step and sometimes resolves the problem by itself. An impacted tooth pulled into an arch with no room simply displaces the crowding elsewhere.
Who it suits: Growing patients with a narrow or crowded arch. Also part of planning in adults, where space is created orthodontically rather than by expansion.
Extraction and space management
When a tooth is fused to bone, badly positioned, or already causing damage that outweighs the chance of saving it, it is removed. The space is then closed orthodontically or held for an implant or bridge.
Who it suits: A minority of cases, and more common in adults than adolescents. Offered as a considered judgement with the imaging shown, not as a default when traction looks difficult.
When is an impacted tooth treated, and at what age?
Children, seven to ten
This is when an off-track canine can be spotted by feeling for the bulge above the baby canine and confirmed with imaging. Intervention here is small — remove a baby tooth, make some space — and it prevents the larger treatment entirely in a meaningful share of cases.
Teenagers, eleven to seventeen
The usual age for exposure and traction, and the age at which it works best: bone remodels readily and the tooth responds to gentle force. Most adolescents who go through it finish with the canine in the arch and no lasting sign it was ever impacted.
Adults
Traction still works, but the tooth is more likely to have fused to the surrounding bone, and success rates fall with age. Adults also arrive with the consequences already present — a worn baby canine still in place, or resorption on a neighboring root. Planning starts with three-dimensional imaging.
What does it cost to treat an impacted tooth?
Orthodontic fees are quoted per case rather than per condition, because two people with the same diagnosis can need very different treatment. These are the factors that move the number up or down, so you know what you are being quoted on:
- The surgical exposure, which is performed and billed by an oral surgeon or periodontist.
- Three-dimensional imaging, which is standard for locating an impacted tooth and assessing damage to the roots beside it.
- Treatment length, since traction adds months to comprehensive orthodontic treatment.
- Whether space has to be created first with an expander or other appliance.
- If the tooth is extracted, the later cost of replacing it, which falls to a restorative dentist.
Ask for the fee, the payment schedule, and your insurance benefit in writing at the consultation, before you decide anything. Any orthodontic practice should give you all three without being pressed.
When should you see an orthodontist about an impacted tooth?
- By age seven for a first evaluation, which is when the canine’s path starts to be assessable — first by feeling for it, and with imaging if it cannot be found where it should be.
- If a baby tooth has not come out by the age its neighbors did, or an adult tooth has not appeared within about six months of its counterpart on the other side.
- If one side of the mouth has a baby canine still in place while the other side has the adult tooth.
- An orthodontist checks for the canine bulge in the gum above the baby canine from about age ten — a canine that cannot be found on one side is the usual first sign, and it is a reason to be seen.
Questions patients ask about impacted teeth
How do I know if a tooth is impacted?
Usually you do not, which is the point. Impacted teeth are painless. They are found on examination and imaging — a tooth that has not arrived when its partner on the other side has, a baby tooth that has not shed, or a canine bulge that cannot be felt where it should be.
How long does it take to pull an impacted tooth into place?
Typically six to eighteen months for the tooth itself, inside an overall course of treatment that often runs two years or more. The pace is deliberate: forcing an impacted tooth quickly risks damaging its root and the bone around it.
Is exposing an impacted tooth painful?
The procedure is done under local anaesthetic, often with sedation, and most patients describe the following few days as sore rather than painful, managed with over-the-counter medication. The orthodontic traction afterwards feels like the usual pressure of an adjustment.
What happens if an impacted canine is left alone?
It may resorb the roots of the incisors beside it, silently and permanently, and the follicle around it can form a cyst. The baby canine holding its place wears down and eventually fails. Leaving it alone is a decision with real consequences, not a neutral option.
Can an impacted tooth be treated in an adult?
Often yes, though success rates are lower than in adolescents because the tooth may have fused to the bone. Three-dimensional imaging comes first, and the plan is chosen from what it shows — traction where the tooth is movable, extraction and replacement where it is not.