Expose and Bond Procedure
Orthodontic treatment typically involves placement of brackets on to teeth and moving them into alignment. Sometimes a tooth may be stuck or buried underneath the gums and require surgery to place a bracket on the tooth to pull it into place over time. This procedure is called an expose and bond because the tooth is first exposed by an incision through the gums, and then a bracket is bonded or glued on to the tooth. During this process, bone covering the tooth may also be removed. Once the bracket is connected to the tooth, a chain is connected from the bracket and secured to a nearby tooth or archwire. The incision is usually closed and only the chain emerges from the surgery site. Over time, the orthodontist expertly places traction on the wire and slowly pulls the tooth into the appropriate space.
An expose and bond procedure is very predictable, especially if the tooth is not fully grown yet. The ideal time to move a tooth is when most of the tooth is formed but the end or apex is not fully mature. This can be evaluated through routine dental x-rays. The length of time for the tooth to settle in the desired position varies upon many factors such as the size of the tooth, degree of impaction, amount of surrounding bone, and maturity of the tooth. The most common tooth that requires an expose and bond procedure is the upper canine teeth (#6 and 11).
Surgery may be performed with local anesthesia or under general anesthesia and usually takes 45 – 60 minutes. Because surgery involves incisions, patients can expect some degree of soreness and swelling. A small amount of bleeding over the first day may occur as well. For pain control, the combination of Ibuprofen and Tylenol seems to work well. In select cases, a stronger pain medication such as hydrocodone or norco may be prescribed. Despite having a chain emerging from the surgical site, there are no dietary restrictions. We simply recommend chewing on the other side of the mouth as much as possible and avoid putting any stress on the chain. Any stitches that are placed around the surgical site typically are self dissolving.
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