Exodontia.Info
Exposing & Bonding of Brackets to
Teeth
Explanation & Warnings
The objective of exposing +/- bonding a bracket on to
an unerupted tooth is to move the tooth into a good
functional & aesthetic position.

Exposure of a tooth at its simplest, consists of removing the
gum overlying the crown of the unerupted tooth under
Local
Anæsthetic
.  Most unerupted teeth are deeper within the
jaw and require the removal of bone as well as the gum to
expose and disimpact them; as a consequence, this may be
done under
General Anæsthetic.

The application of
traction (using the chains attached to
braces) to stimulate and guide the eruption of buried teeth
is necessary as the teeth are unfavourably angled (and
spontaneous eruption is inhibited), where buried teeth are
obstructed from eruption by other teeth & where teeth are
exposed long after their root development is complete.

Teeth most likely to be exposed and bonded are the upper
canines / eye teeth, upper central incisors, molars and the
occasional
premolars.
Picture of a Gold Chain & Bracket
This list is not exhaustive nor is it predictive.  The most pertinent warnings
have been included here.

You are to have a
tooth exposed +/- bracketed.  You can expect the
following:

Exposing +/- Bracketing of Tooth Specific Warnings:

Stitches.  The extraction site will often be closed with stitches.  These are
dissolvable and ‘fall out’ within 10 – 14 days.  If a pack has been sewn in or
the chain is ‘parked’ high up in the sulcus, non-dissolving stitches are used,
that will need to be removed at some point.

Brackets.  These are small golden plaques with chains attached.  These are
stuck onto the teeth that need to be moved.  Sometimes, the cement
sticking the chain onto the tooth can break after traction is applied to the
tooth; if this happens, the bracket will need to be re-cemented on.  
Occasionally, the chain itself breaks and this will mean that the chain and
bracket have to be replaced.

Gauze Pack.  Sometimes, it is not possible to stick the chains onto the
teeth.  If this is the case, a gauze pack impregnated with an antiseptic
(
BIPP) is placed over the exposed tooth and sewn into place.  The pack is
removed after approximately a week and the chain will be stuck on at this
point.

Ankylosis of Tooth.  Occasionally, even if the tooth has traction applied to
it, it still refuses to move.  If this happens, it is sometimes necessary to
explore the area – there may be a lip of bone preventing the tooth from
moving or the tooth has fused with the surrounding bone.

Repeated Operation.  The gum can easily grow back over the exposed
tooth.  If this is the case and the tooth doesn’t have a bracket stuck on it,
the tooth will need to be re-exposed, hence another operation.

General Surgical Warnings:

Pain.  As it is a surgical procedure, there will be soreness after the tooth
removal.  This can last for several days.  Painkillers such as
ibuprofen,
paracetamol, Solpadeine or Nurofen Plus are very effective.  Obviously,
the painkiller you use is dependent on your medical history & the ease with
which the tooth was removed.

Swelling.  There will be swelling afterwards.  This can last up to a week.  
Use of an icepack or a bag of frozen peas pressed against the cheek
adjacent to the tooth removed will help to decrease the swelling.  Avoidance
in the first few hours post-op, of alcohol, exercise or hot foods / drinks will
decrease the degree of swelling that will develop.

Bruising.  Some people are prone to bruise.  The bruising can look quite
florid; this will resolve but can take several weeks (in the worst cases).

Limited Mouth Opening.  Often the chewing muscles and the jaw joints are
sore after the procedure so that mouth opening can be limited for the next
few days.  If you are unlucky enough to develop an infection in the socket
afterwards, this can make the limited mouth opening worse and last for
longer.
Photos, from the front and side, of an Upper Left Canine
that has had a Bracket & Chain bonded on to it
Tooth that has had a Bracket & Chain attached to it
Last Updated 11th August 2010