Most Common

Impacted Canines (Upper Eye Teeth)

The maxillary canines — the upper “eye teeth” — are the second most commonly impacted teeth after wisdom teeth. They are also among the most important teeth in the mouth: canines have the longest roots of any tooth, anchor the corners of the smile, and play a critical role in guiding the bite. Losing a canine or leaving it impacted is not a minor matter.

Upper canines typically erupt around age 11 to 13. If they haven’t appeared by age 14, early evaluation is warranted. Palatal (roof-of-mouth) impactions are more common than labial (lip-side) ones and generally carry a better prognosis for successful orthodontic traction.

Less Known, Equally Important

Impacted Second Molars (Lower 7s)

Mandibular second molar impactions are less discussed than canine impactions but can be equally complex. The lower second molar (the tooth just in front of the wisdom tooth) sometimes becomes tipped or blocked during eruption — often due to pressure from an overlying wisdom tooth or simply insufficient arch space — and fails to erupt fully upright into the bite.

When caught early, tipped or impacted second molars can often be uprighted orthodontically, preserving the tooth and avoiding extraction. In select cases, we recommend early removal of the wisdom tooth (third molar) to relieve pressure and allow the second molar to self-correct or respond to orthodontic traction.

Diagnosis & Imaging

Panoramic X-rays confirm the position of the impacted canine. In complex cases, we assess the exact labial or palatal location and proximity to adjacent roots. Early diagnosis — ideally before age 12 — dramatically improves treatment outcomes.

Space Creation

Before traction can begin, sufficient space must exist in the arch for the canine to erupt into. For palatal impactions, a palatal expander is often used to widen the upper arch and create the room needed. Baby teeth (primary canines) may also be extracted to remove obstructions and encourage eruption.

Surgical Exposure

An oral surgeon uncovers the impacted canine by removing the gum tissue overlying it. At the same appointment, a small gold chain or bracket is bonded directly to the tooth. The gum tissue is then repositioned, leaving the chain accessible for orthodontic traction to begin.

Orthodontic Traction

Using the gold chain bonded to the exposed tooth, we apply gentle, controlled forces through the braces to slowly guide the canine into its correct position in the arch. This process typically takes 12 to 18 months depending on the starting position of the tooth and the patient’s growth stage.

Final Alignment

Once the canine is in the arch, full orthodontic treatment continues to align all teeth into their ideal positions. The canine is finished like any other tooth — fitting naturally into the bite and smile. The result is a complete, stable, fully functional dentition.

Real Patient Case

Bilateral Impacted Canines — Before & After

The panoramic series shown here illustrates a patient with bilateral maxillary canine impactions — both upper canines trapped above the roots of the lateral incisors. The orange arrows mark the canine positions on the pre-treatment film.

Treatment began with palatal expansion to create arch space, followed by surgical exposure and gold chain attachment by our coordinating oral surgeon. Orthodontic traction then guided both canines down and into their correct positions in the arch simultaneously.

Cases like this are a clinical specialty at Elate Orthodontics. The coordination between orthodontic mechanics and surgical timing is what determines the outcome — and it requires an orthodontist who has managed this sequence many times before.

Panoramic series: bilateral impacted canines before and after orthodontic traction with gold chain

Real patient case: bilateral impacted second molars successfully uprighted while correcting severe crowding — no wisdom tooth extractions required in this case

When We Recommend Early Wisdom Tooth Removal

In many second molar impaction cases, the overlying wisdom tooth (third molar) is the primary obstruction. When this is the case, we coordinate with an oral surgeon for early wisdom tooth removal — creating the space needed for the second molar to either self-correct or respond to orthodontic uprighting forces. Timing matters: the earlier this is done, the better the second molar’s eruption potential.

Orthodontic Uprighting

When the second molar is tipped but not fully impacted, orthodontic mechanics can upright the tooth without surgery. Using TADs (temporary anchorage devices) or specialized springs, we apply controlled forces to rotate the second molar to an upright position and bring it into full function in the bite. This is one of the more technically demanding orthodontic movements — and one of the most rewarding when it succeeds.

Surgical Exposure for Second Molars

In fully impacted second molar cases where the tooth is submerged below the gumline, surgical exposure followed by orthodontic traction — similar to the canine impaction approach — may be required. We assess each case individually and recommend the most conservative effective approach that preserves the tooth and the surrounding bone.

Why Timing Is Everything

The single most important factor in impaction treatment outcomes is how early the condition is identified. A canine impaction detected at age 10 or 11 — before root formation is complete and while the jaw is still growing — responds dramatically better to treatment than the same impaction identified at 16 or 18. The tooth moves more readily, the surrounding bone is more responsive, and the risk of root resorption to adjacent teeth is lower.

This is why the American Association of Orthodontists recommends every child have an orthodontic evaluation by age 7. We are not looking to start treatment at 7 — we are looking for early signs of impaction, crowding, and skeletal discrepancy that are far easier to manage when identified early.

What Happens If an Impaction Is Left Untreated

How do I know if my child has an impacted canine?

Often there are no obvious symptoms until damage to adjacent teeth has already begun. The most reliable indicator is that the baby canine is still present past age 13 or 14 with no sign of the adult canine erupting. A panoramic X-ray taken during an orthodontic evaluation will reveal the position of all unerupted teeth — this is one of the most important reasons for the age-7 evaluation recommendation.

Does the surgical exposure hurt?

The procedure is performed under local anesthesia and is well-tolerated by most patients. There is typically some soreness for a few days afterward, managed with over-the-counter pain medication. The vast majority of patients — including teenagers — find it much more manageable than they expected. The oral surgeon we coordinate with performs this procedure routinely.

Can an impacted canine always be saved?

In most cases, yes — especially when identified early. Exceptions include cases where the tooth is severely ankylosed (fused to the bone), where root resorption of adjacent teeth is already advanced, or where the impaction position is extremely unfavorable. We evaluate each case honestly and will tell you when traction is likely to succeed and when extraction followed by an implant or space closure is the more realistic path.

How long does canine impaction treatment take?

Total treatment time — from the start of orthodontic preparation through full alignment — is typically 18 to 30 months depending on the starting position of the tooth, patient age, and how much of the overall treatment involves general alignment. The traction phase alone (moving the canine into the arch) usually takes 12 to 18 months after surgical exposure.

What is a gold chain in orthodontics?

A gold chain is a small, flexible ligature chain bonded to the impacted tooth at the time of surgical exposure. It serves as an attachment point for the orthodontic traction force — essentially a handle on a tooth that is otherwise completely inaccessible to orthodontic mechanics. The chain is tied to the braces wire and gradually shortened over time to pull the tooth into position.

Should my child’s wisdom teeth come out to help an impacted second molar?

In many cases, yes. When a wisdom tooth is directly blocking the eruption path of a tipped second molar, early removal of the wisdom tooth can allow the second molar to self-correct or makes orthodontic uprighting significantly more effective. The decision depends on the specific anatomy of the case — we evaluate this on panoramic films at your consultation and give you a clear recommendation.

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West Frisco

5605 FM 423, Suite 600
Frisco, TX 75036

FM 423 & Lebanon Rd — next to the UPS Store

The Colony

4713 Highway 121, Suite 304
The Colony, TX 75056

FM 423 & Hwy 121 — next to Ross

North Frisco

2155 University Dr, Suite 110
Frisco, TX 75033

On 380 across from Cook Children’s Medical Center Prosper