Expose & Bond

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Preoperative Considerations


  • Devitalization of adjacent teeth



  • Imaging: CBCT, to plan access (buccal or lingual/palatal) accordingly
  • Ensure patient has follow up planned with their orthodontist


  • 1-2% Lidocaine w/ 1:100,000 epi , syringe and 27 gauge needle
  • Minnesota
  • 15 blade
  • #9 periosteal elevator
  • Electric drill with round carbide bur
  • Irrigation
  • Dental curette
  • Dry angles, cotton rolls, 4x4 gauze
  • ViscoStat 20% Ferric Sulfate or similar hemostatic agent
  • Gold button and chain
  • Dental etchant
  • Bonding adhesive
  • Ortho cement
  • Cure light
  • 4-0 silk
  • 3-0 chromic gut suture
  • Needle holder
  • Pickups
  • Scissors


  • Inject lidocaine (nasopalatine and greater palatine nerve blocks for palatal impaction)
  • Sulcular incision with 15 blade
  • Using #9 reflect full thickness mucoperiosteal flap
  • Remove bone overlying crown of impacted tooth. DO NOT remove bone all the way to CEJ
  • Confirm mobility of impacted tooth, if no mobility gently luxate
  • Apply viscostat, wait 2 minutes, then rinse with saline
  • Etch enamel (30 seconds), rinse with saline, dry
  • Obtain isolation with gauze, dry angles
  • Bond and cure
  • Cement gold button and chain, cure 2 cycles. Gently pull on gold chain to ensure adequate bonding
  • Pass 4-0 silk through end of gold chain and tie to ortho wire
  • Thoroughly irrigate under flap
  • Closure of flap with 3-0 chromic

Postoperative Considerations


  • Soft Diet
  • Postop antibiotics not indicated

Follow Up:

  • FU with orthodontist

Operative Note

Surgeon(s): ***

Assistant Surgeon(s):  ***

Preoperative Diagnosis: ***

Postoperative Diagnosis: Same

Procedure(s): ***

Anesthesia: General

Implants: None


Drains: None

Fluids: See anesthesia record

EBL: Minimal

Complications: None

Counts:  Correct x2

Indications: ​***

Findings: As expected

Procedure in Detail:

The patient was seen in the preoperative holding area with a H&P was updated, consents were verified, surgical site marked, and all questions and concerns related to the proposed procedure were discussed in detail.  The patient was transferred to the operating room by the anesthesia team.  The patient underwent general anesthesia with endotracheal intubation. Tegaderms were placed over the eyes. The patient was prepped and draped in the standard fashion for maxillofacial procedures.  A time-out was performed and the procedure began.

2% lidocaine with 1:100,000 epinephrine delivered via GPNB, NPNB, and infiltration. 15 blade used to make sulcular incision from second premolar to second premolar. Full thickness mucoperiosteal flap raised on palate with perioseal elevator. Bone removed with surgical handpiece overlying the crown of impacted tooth. Mobility confirmed with elevator. ViscoStat 20% Ferric Sulfate applied for 2 minutes. Rinsed with saline. Dental etchant applied to enamel of impacted tooth. Rinsed with saline after 30 seconds. Isolation achieved with 4x4 gauze. Bonding agent applied to crown of impacted tooth and cured. Gold button and chain cemented and applied to crown of impacted tooth. Cured x2 cycles. Gold chain gently pulled to confirm adequate bond. Chain affixed to ortho wire with 4-0 silk. Copious irrigation under flap. Closure with 3-0 chromic in interrupted fashion. Hemostasis was achieved.

The patient's face was then cleaned and the posterior pharynx was suctioned. An OG tube was used to suction out the contents of the stomach. Tegaderms were removed from the eyes. Dressings were placed. The patient was then transferred back to the care of the anesthesia team for extubation and recovery.


  • D7280 surgical access of an unerupted tooth An incision is made and the tissue is reflected and bone removed as necessary to expose the crown of an impacted tooth not intended to be extracted.
  • D7282 mobilization of erupted or malpositioned tooth to aid eruption To move/luxate teeth to eliminate ankyolosis; not in conjunction with an extraction.
  • D7283 placement of device to facilitate eruption of impacted tooth Placement of an orthodontic bracket, band or other device on an unerupted tooth, after its exposure, to aid in its eruption. Report the surgical exposure separately using D7280.