Surgical exposure of a tooth, explained.

The surgery uncovers the impacted tooth and attaches the hardware. The movement itself is orthodontic work, done afterwards by your orthodontist. Neither half works without the other, which is why the timing is agreed between the two practices before anything starts.

It is most commonly needed for upper canines, though any tooth can become impacted.

A radiographic examination at the initial consultation confirms the position and location of the embedded tooth and the tissues around it. That matters — the approach depends on which way the tooth is lying and how deep it sits. In most cases your orthodontist or dentist will already have referred you to us specifically for this assessment.

You do not need to fast or change your diet beforehand. The exception is sedation or a general anaesthetic: stop eating and drinking at least six to eight hours before, and arrange a lift both ways, since the medication makes driving unsafe.

Discuss your chronic medication and supplements with us beforehand, particularly omega 3 and omega 6, so we can rule out an excessive bleeding risk.

1. Once the area is numb, an incision is made in the gum and a flap of tissue is gently lifted to expose the bone and the tooth. In some cases only a small window is cut in the gum, just large enough to bond to.
2. Any bone or tissue lying over the tooth is removed to expose the crown.
3. A small bracket and chain is attached to the tooth.
4. The gum flap is repositioned and sutured, leaving either part of the tooth or just the chain visible.
5. We review healing at two weeks, after which you return to your orthodontist to have the chain activated and the tooth brought into position.

One tooth usually takes about an hour. Several teeth, or teeth in different parts of the mouth, take longer — the position of each in the jaw makes more difference than the number.

You are numb during the procedure. Afterwards, expect bleeding, swelling and discomfort on the first day, with swelling continuing three to four days and possible bruising. Most people are back at work or school within one to two days. Avoid exercise, heavy lifting and strenuous exertion for at least the first week — they raise your heart rate and bring on more discomfort, bleeding and swelling.

The one rule people find hardest: do not pull on the chain, and do not fiddle with it with your tongue. Debonding the bracket and chain means repeating the surgery.

The full post-operative instructions for a surgical exposure set out the first day, the first week and the second week, and we give you the same sheet before you leave.