Nickolas S. Maskas DDS, MD
Expose & Bond
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My orthodontist referred me for “expose and bond.” What is “expose and bond?”
Expose and bond refers to a procedure used to help bring an impacted (one that isn't coming in) adult tooth into its proper place in the mouth. The procedure usually involves uncovering of the tooth and then the attachment of a metal bracket to the tooth. This bracket has a small chain attached to it. After attachment of the chain to the tooth, your orthodontist can then use the chain to help pull the tooth into its proper location in your mouth.
What is an impacted tooth, and why does this happen?
An impacted tooth is a tooth that does not come into the mouth at the proper time and stays stuck under the gums. A tooth can become impacted for multiple reasons, but most of the time it has to do with either developmental reasons or lack of space in your mouth due to crowding of other teeth.
Which teeth are most commonly impacted?
The most commonly impacted teeth are third molars (wisdom teeth) which are usually extracted. The second most commonly impacted tooth is the upper canine (eye) tooth. Canine teeth are very important, and most of the time it is preferable to attempt to bring them into their proper position. The third most common impacted tooth is a lower premolar (bicuspid) tooth.
What are the treatment options for an impacted tooth?
After you are diagnosed with an impacted tooth, there are 3 options.
The first option is to do nothing and simply observe the tooth throughout your life with periodic x-rays to monitor for problems.
Option 2 is to extract the tooth. This will eliminate the risk of future problems with the tooth but will leave you without this tooth in your mouth.
The third option is expose and bond which attempts to bring the tooth into its proper place through a combination of surgery and orthodontics (braces).
Which dentists are involved in the treatment of an impacted tooth?
A general dentist may be the first dentist to recognize that your tooth is impacted and may require treatment. This will be recognized through a combination of x-rays and clinical exam. Your dentist may then refer you to an orthodontist to discuss treatment options for the impacted tooth. If the orthodontist determines that the tooth can be predictably brought into proper position with expose and bond, he or she may then refer you to an oral surgeon to have the procedure. After the chain is attached to your tooth, you will then return to your orthodontist who will use their expertise to properly bring the tooth into the mouth.
Are braces required for expose and bond of impacted teeth?
Yes. Braces are necessary to have in place before expose and bond procedure because the chain which is placed during the procedure must be attached to the braces after the procedure to avoid it floating free in your mouth. In addition, the braces are necessary for the orthodontist to be able to move the tooth properly.
What are the risks of not treating an impacted canine (leaving it in place)?
Leaving an impacted tooth in place is an option; however, this can place you at risk for several issues later in life. Impacted teeth are at risk for cyst and tumor formation at unpredictable times and require lifetime monitoring with periodic x-rays if left in place. The impacted teeth can also cause issues with damage to other tooth roots or pain in some cases.
Can every impacted tooth undergo expose and bond?
Not every tooth is a good candidate for expose and bond. Your orthodontist is well-trained to understand when expose and bond will be predictable and successful. There are several factors he or she will consider when deciding whether to attempt to save the tooth or extract the tooth. Some teeth can predictably be brought into the proper position. In other situations, the patient may have tooth crowding or severe tooth malposition which decreases the chances that the expose and bond will be successful. In these instances, extraction may be recommended.
What are my options for anesthesia during expose and bond?
Please refer to the “anesthesia options” section of the website for extensive information regarding this topic (link below).
Are there risks to undergoing expose and bond?
As with anything in life, there are minor risks associated with expose and bond. These will be discussed during the informed consent process. Briefly, there is a risk the bracket could fall off after the procedure and require re-attachment. There is also a small risk that despite expose and bond, the tooth may not be successfully repositioned (rare). In extremely rare instances, the impacted tooth can be very close to the roots of other teeth which places them at risk for damage during the procedure.
What can I expect after expose and bond?
As with any minor surgical procedure, you can expect some mild to moderate discomfort and possibly some swelling after the procedure. You will also be able to feel the attached chain in your mouth with your tongue which is normal. You will be provided with written postoperative instructions list after your procedure.