Surgery for Unerupted Teeth?

My six-year-old son lost his upper front teeth almost one year ago. The adult teeth have still not erupted. His dentist wants to perform a "surgical exposure" as he believes that the gums are calloused and the teeth are having difficulty coming down. He did an x-ray which shows the roots developed. Do you think this procedure is necessary?

Question:

There are several possible reasons why the permanent teeth have not erupted yet. Inadequate space in the arch, cysts, tumors, or ankylosis (fusion of the tooth with the bone) may be some reasons. The radiograph (x-ray) would show a cyst, tumor or fused tooth. If the gum tissue has excess keratin, the teeth can have a difficult time erupting. Sometimes, a simple incision in the gum tissue will allow the eruption of the teeth. This is more likely if some root formation is still yet to occur as the root formation is partially responsible for tooth eruption. Occasionally, orthodontic intervention is also necessary to help extrude the teeth from their impacted position.

If the teeth are ankylosed, further surgical intervention may be necessary. The cause of ankylosis may be impossible to determine. Trauma and infection are the most common reasons teeth fuse.

Two surgical techniques can be helpful to overcome ankylosis. The first one involves making incisions through the gum tissue on both sides of the alveolar bone (bone which surrounds teeth) and removing some bone on either side of the tooth. The second procedure involves incisions through the gum tissue and bone. The whole segment, including the tooth, is then moved into proper alignment with the rest of the arch. Obviously, careful planning and assessment of adjacent teeth and structures must be considered before and during this surgery.

Again, the simple "surgical exposure" you mention may aid in eruption of these teeth. First, it should be determine that no other cause, such as a cyst or tumor, is impeding eruption. While the above-mentioned surgeries may not be necessary, I wanted you to be aware of them if a more conservative approach is not successful. I hope these options provide you with some points to open a discussion with your dentist.

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