Impacted Canine Exposure Surgery
 Impacted canine exposure surgery is a procedure that helps a canine tooth that is stuck under the gums (or in the jawbone) become accessible so it can be guided into its proper position—most often as part of orthodontic treatment. If you or your child has been told a canine is impacted, this page explains what the surgery is, why it’s recommended, how it works with braces, what recovery looks like, and what results to expect.
What Impacted Canine Exposure Surgery Is
An impacted canine tooth is a canine that has not erupted into the mouth when it should, usually because it is blocked by other teeth, lacks space, or is positioned at an angle that prevents normal eruption. The tooth may be trapped under gum tissue, within the jawbone, or both.
Canine exposure surgery means creating a small access point to the impacted canine so your orthodontist can guide it into the dental arch. Many patients hear this described as canine exposure and bonding, because the surgeon often places a small orthodontic attachment (a button or bracket) on the canine during the exposure so the orthodontist can apply gentle traction.
Canine exposure is different from extraction. Extraction removes the tooth, while exposure is typically done to save the natural canine. Canines often play a key role in:
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Bite function - Canines help guide the bite during side-to-side movement and can reduce stress on other teeth.
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Smile aesthetics - Canines influence the shape and support of the smile and lip contour.
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Long-term stability - A well-aligned canine can support balanced chewing forces and orthodontic results. |
A simple way to visualize the procedure is to imagine the canine sitting above or beside its intended spot. The surgeon gently opens the gum over the tooth (and sometimes removes a small amount of bone if needed), then places an attachment on the canine. The orthodontist uses that attachment to guide the tooth into alignment over time.
Signs, Symptoms, and How Impacted Canines Are Diagnosed
Some impacted canines cause obvious changes, while others cause no pain and are discovered on routine orthodontic evaluation. Common signs include:
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Missing adult canine - The canine never appears when expected.
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Retained baby canine - The primary (baby) canine stays in place longer than usual.
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Delayed eruption - Other teeth erupt, but the canine does not.
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Crowding or unusual spacing - The arch does not have room for the canine, or space patterns look atypical.
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Bulge or swelling - A firm bump in the gum may be present where the canine is positioned.
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Discomfort - Some people feel pressure or tenderness, but many feel nothing at all. |
Impacted canines often don’t hurt because the tooth is enclosed in bone and gum tissue and may not be infected. Pain tends to be more likely if there is inflammation, pressure on adjacent roots, or associated pathology.
Diagnosis typically involves a clinical exam plus imaging. Depending on the case, clinicians may use panoramic imaging, targeted views, and three-dimensional imaging when needed to understand the canine’s position.
Imaging helps the dental team evaluate:
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Position and depth - How far the tooth is from the gumline and its exact location.
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Orientation - Whether the tooth is angled, rotated, or displaced.
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Relationship to nearby roots - How close the canine is to adjacent teeth and whether there is risk of root effects.
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Follicle and surrounding structures - The tooth’s soft tissue sac and any signs that require attention.
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Space in the arch - Whether orthodontic space creation is needed before traction begins. |
Why Exposure Surgery Is Recommended
When a canine is impacted, exposure surgery is often recommended to preserve the natural tooth and support predictable orthodontic alignment. Canines are frequently worth saving because they contribute strongly to bite guidance and smile appearance.
Benefits of surgical exposure of impacted canine teeth commonly include:
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Preserving the natural canine - Keeping the tooth can simplify long-term function and aesthetics compared with replacement strategies.
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Improving orthodontic outcomes - Exposure creates a controlled way to guide eruption into the correct position.
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Reducing future complications - Leaving a canine impacted can increase the chance of issues that become more complex to treat later. |
Timing matters. Your dental team may recommend treatment based on factors like age, root development, the canine’s location, and whether the orthodontist has created enough space to guide the tooth safely.
Untreated impaction can be associated with risks such as:
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Effects on adjacent roots - In some cases, pressure or contact may affect neighboring teeth.
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Cystic changes - Some impacted teeth develop changes in the surrounding follicle that need monitoring or treatment.
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Worsening crowding - The arch can become harder to correct as teeth shift.
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Bite problems - A missing canine in the arch can contribute to functional imbalance. |
In many plans, orthodontic space creation comes first, followed by the impacted canine exposure procedure once the tooth can be guided into the arch with better predictability.
Treatment Options and When Each Makes Sense
Treatment depends on predictability and risk. Your orthodontist and oral surgeon evaluate whether the canine can be guided into place safely, and whether alternatives offer a better long-term outcome.
Common options include:
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Exposure and orthodontic traction - Often the preferred approach when the canine can be brought into the arch predictably.
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Monitoring - Considered in select cases when eruption may still be plausible and risk to other teeth is low.
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Extraction of the impacted canine - Considered when the tooth’s position, anatomy, or associated risk makes guided eruption unreliable or unsafe.
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Alternative strategies if extraction is needed - May include orthodontic substitution (using another tooth to function like a canine) and/or restorative options as part of a broader plan. |
Factors that influence “impacted tooth removal vs exposure” include:
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Tooth position and angle - Severely displaced or unfavorably angled teeth may be harder to guide.
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Depth and access - Deeper teeth can require more complex exposure.
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Proximity to other roots - Close contact may increase risk to neighboring teeth.
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Available space - Orthodontic room is often required before traction.
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Presence of pathology - Certain findings can change the best option.
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Patient age and orthodontic plan - Biology and biomechanics influence predictability. |
The Team Approach: Oral Surgeon and Orthodontist Coordination
Successful outcomes typically rely on close coordination between the orthodontist and the oral surgeon.
Roles commonly include:
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Orthodontist - Plans space creation, determines traction direction, and applies controlled forces over time.
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Oral surgeon - Performs the canine exposure surgery, and when appropriate, places and secures the attachment used for traction.
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Shared planning - Both teams align timing and technique choices to support gum health and predictable movement. |
A common sequence is:
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Orthodontic consultation and imaging review
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Space creation (often with braces or aligner-based mechanics)
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Exposure surgery with attachment placement when planned
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Orthodontic traction appointments to guide the canine into place |
Patients and parents can help coordination by ensuring the surgical team has relevant imaging and the orthodontic plan, and by sharing timing details about when appliances are placed or adjusted.
Types of Exposure Techniques
There are two main categories of techniques used in impacted canine exposure surgery. The best technique depends on anatomy, where the tooth is positioned, and how the orthodontist plans to guide it.
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Open eruption approach - The surgeon exposes the canine and leaves it uncovered so it can erupt or be guided from an open access point, when appropriate.
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Closed eruption approach - The surgeon exposes the canine, bonds an attachment (often with a small chain), and repositions the gum tissue over the area so traction occurs beneath the gum as directed by orthodontics. |
Technique selection may be influenced by:
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Tooth depth - Deeper teeth may favor a closed approach in some plans.
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Position - Palatal (roof-of-mouth side) vs labial (lip side) location affects access and gum considerations.
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Gum tissue quality - The goal is healthy, stable gum support around the final tooth position.
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Orthodontic biomechanics - The planned traction direction and force management can affect the surgical plan. |
Both approaches aim for controlled movement and healthy gum architecture around the canine once it is aligned.
What to Expect Before Surgery
Before surgery, a consultation typically reviews imaging, health history, and the orthodontic plan. The team explains the recommended approach and how it integrates with braces or other orthodontic appliances.
Comfort options vary by patient and procedure complexity, and may include local numbing and additional sedation options depending on medical history and preference. The goal is a safe experience with appropriate anxiety management.
General preparation topics often include:
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Medical history - Conditions that affect healing, bleeding, or anesthesia planning.
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Medications and supplements - Including blood thinners and non-prescription products.
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Allergies - Especially to antibiotics, anesthetics, or adhesive materials.
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Prior anesthesia experiences - Any previous side effects or concerns.
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Eating and drinking guidance - Based on the planned anesthesia type.
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Transportation - Often needed if sedation is used.
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Smoking/vaping considerations - Nicotine can interfere with healing and is commonly discussed in planning. |
If canine exposure and bonding is planned, bringing orthodontic instructions (or ensuring the teams have exchanged details) can help ensure the correct attachment and traction plan are used.
Step-by-Step Overview of the Procedure
While details vary by technique, many impacted canine exposure surgery appointments follow a similar overall flow.
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Numbing and comfort plan
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Creating access to the impacted canine through gum tissue (and sometimes minimal bone management when necessary)
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Preparing the tooth surface for bonding if an attachment is planned
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Placing the orthodontic attachment (button/bracket), often with a small chain for traction
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Repositioning gum tissue and/or placing sutures depending on technique
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Protective dressing if needed, plus post-op instructions |
“Bonding” refers to attaching a small orthodontic component to the canine so the orthodontist can apply gentle traction. Orthodontic pulling usually begins according to the orthodontist’s schedule, which can depend on the surgical approach and how the site is healing.
Recovery, Aftercare, and Healing Milestones
Recovery experiences vary, but many patients have manageable soreness and swelling for the first few days. It can be normal to notice:
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Swelling - Often peaks early and improves over several days.
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Mild bleeding or oozing - Small amounts can occur initially.
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Soreness or tenderness - Especially when chewing or brushing near the site.
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Limited mouth opening - Temporary jaw stiffness can happen.
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Localized sensitivity - Near the surgical area or along the gumline. |
Aftercare commonly focuses on comfort, cleanliness, and protecting the surgical site while it heals. Typical guidance may include:
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Pain management - Using the provider’s instructions and medication safety guidance tailored to the patient.
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Oral hygiene - Gentle rinsing and careful brushing around the area to keep it clean without disrupting healing.
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Diet - Soft foods and hydration; avoiding hard, crunchy, or sharp foods near the site.
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Activity - Limiting strenuous activity initially if advised, then resuming normal routines as comfort allows.
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Habits to avoid - Actions that can disturb the area, such as aggressive spitting or using a straw if advised against it. |
If a chain/attachment is present, it’s usually important to avoid snagging it on food or toothbrush bristles. If the chain feels loose, pokes, or seems displaced, the surgical or orthodontic team typically wants to know promptly so the plan stays on track.
Risks, Complications, and How They’re Managed
All surgeries carry risks, and impacted canine exposure surgery is no exception. Many risks are temporary and manageable with careful planning and follow-up.
Common risks include:
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Swelling and discomfort - Usually improves over time with normal healing.
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Bleeding - Mild oozing can occur early; persistent bleeding needs evaluation.
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Infection - Uncommon when aftercare is followed, but possible with any oral surgery.
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Delayed healing - More likely when irritation, poor hygiene, or certain health factors are present. |
Procedure-specific considerations may include:
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Attachment loosening - The bonded button/bracket or chain can detach and may need replacement.
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Gum tissue changes - The surgical approach aims to support healthy gum architecture, but recession or uneven gum contours can occur in some cases.
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Tooth response variability - Not every impacted canine moves at the same pace, and some may be resistant to traction.
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Risk to nearby roots - Rare but important; imaging and careful mechanics help reduce this risk. |
Clinicians reduce risk through imaging-based planning, sterile technique, individualized surgical approach selection, and coordinated orthodontic forces designed to be gentle and controlled.
A practical “call us if” list often includes:
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Fever - Especially with increasing pain or swelling.
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Worsening swelling after initial improvement - A reversal in the healing trend.
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Uncontrolled bleeding - Bleeding that doesn’t slow with appropriate measures.
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Foul taste or odor - Especially with increasing tenderness.
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Severe pain not improving - Pain that escalates rather than gradually easing.
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Chain/attachment dislodgement - Anything that looks or feels detached or out of position.
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Allergic reaction signs - Such as rash, swelling, or breathing-related symptoms. |
Results and What Happens After Exposure Surgery
Exposure surgery is usually one part of a longer orthodontic process. After the canine is accessible, the orthodontist guides it into the arch with orthodontic traction using gentle forces. Follow-up commonly involves:
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Surgeon follow-up - Monitoring healing, sutures if present, and attachment stability.
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Orthodontic follow-up - Activating traction as planned and adjusting mechanics over time. |
Progress depends on factors such as the original tooth position, depth, biology, orthodontic mechanics, and consistent attendance at orthodontic appointments. Timing varies widely by case and should be discussed based on imaging and treatment goals.
Final outcomes often aim for:
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An aligned canine in the arch - Positioned for function and aesthetics.
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Stable gum health - Healthy, maintainable soft tissue around the tooth.
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Improved bite function - Better guidance and contact patterns as orthodontics completes alignment. |
In some cases, additional steps may be needed, such as re-exposure or attachment replacement if traction hardware loosens.
FAQs
Does impacted canine exposure surgery hurt?
During the procedure, the area is numbed and comfort options are used based on the treatment plan, so pain is typically controlled while surgery is performed. Afterward, soreness and swelling are common for a short period and are usually managed with provider-recommended aftercare and medication guidance tailored to the patient.
Will I be asleep for the procedure?
Some patients have canine exposure with local numbing alone, while others use additional sedation options depending on medical history, anxiety level, and procedural complexity. The safest and most appropriate approach is determined during the consultation.
What’s the difference between exposure and extraction?
Exposure creates access to the impacted canine so it can be guided into the arch with orthodontic traction. Extraction removes the canine and is typically considered when the tooth cannot be predictably or safely guided into place or when other risks outweigh the benefit of saving it.
What if the tooth is on the palate vs the lip side?
Palatal (roof-of-mouth side) and labial (lip side) impactions can differ in access, gum tissue considerations, and technique selection. Imaging helps determine the exact location and the approach that best supports controlled traction and healthy gum support around the final tooth position.
When can I eat normally again?
Many patients start with softer foods and gradually return to a more typical diet as tenderness improves. The exact timing depends on the surgical technique, the healing response, and whether an attachment or chain is present. Your care team provides specific guidance to protect the site and avoid disrupting healing.
What if the gold chain or attachment comes loose?
If the chain or bonded attachment loosens or detaches, it often needs evaluation and possible replacement so orthodontic traction can continue safely and predictably. Avoid pulling on the chain and contact the dental team for instructions based on your situation.
Will the tooth always come in after exposure and bonding?
Many impacted canines can be guided into position, but outcomes depend on factors like the tooth’s initial location, depth, angulation, and biology. Imaging-based planning and coordinated orthodontic forces improve predictability, but no procedure can guarantee a specific movement timeline or result for every case.
Can adults have impacted canine exposure surgery?
Adults can be candidates for impacted canine exposure surgery, though treatment planning may differ because tooth movement and bone response can vary with age. The most accurate guidance comes from imaging and an orthodontic plan tailored to the individual.
Why Choose an Oral Surgery Practice for Impacted Canine Exposure
Choosing the right team for oral surgery for impacted canine treatment often matters because the outcome depends on precise access, attachment stability, gum management, and coordination with orthodontic biomechanics. An oral surgery practice may emphasize:
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Imaging-guided planning - Technique selection based on tooth position, depth, and nearby root relationships.
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Precise surgical technique - Controlled access designed to support healing and orthodontic traction.
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Coordination with orthodontists - Clear communication on attachment type, traction direction, and timing.
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Comfort options - Individualized approaches to anxiety-aware care and procedural comfort.
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Post-op support - Clear aftercare guidance and access for recovery questions. |
Every case is individualized based on anatomy and orthodontic goals. If insurance or coverage questions arise, a direct conversation with Oral & Facial Surgery can clarify benefits, estimates, and available options.
Consultation and Next Steps
A consultation for impacted canine exposure surgery typically focuses on confirming the canine’s position, reviewing the orthodontic plan, and determining whether canine exposure and bonding is appropriate. Many visits include discussion of:
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Imaging review - Understanding location, depth, and proximity to adjacent roots.
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Orthodontic readiness - Whether space has been created and the intended traction pathway.
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Technique selection - Open vs closed exposure considerations and gum health goals.
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Comfort planning - Numbing and sedation options based on medical history and preference.
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Recovery expectations - Typical healing milestones and how orthodontic traction proceeds afterward. |
Helpful items to bring or share include orthodontic referral details, recent imaging when available, and a current medication list. For office contact information at Oral & Facial Surgery, the primary phone number is (509) 330-5020. If insurance is part of the planning process, coverage and financial options are best reviewed directly with the office after the case details are assessed. |
