Impacted Canine - Exposure - Chain

Jan 2, 2023
Hello everybody,

I have an impacted canine and I fitted clear fixed braces in July 2021.

After creating space between teeth with a coil spring, I had surgery to expose my palatally impacted canine in June 2022. It was a closed exposure with bonding of a chain for orthodontic traction.

On June 10th 2022, I had an online video call and consultation with the surgeon and we talked about the closed exposure and the gold chain. This was my first surgery in life ever. To me it was quite a big deal as I work with my voice, and I told this and made it clear to the surgeon who said I was in ‘good hands’.

The day of the surgery I was asked to sign an electronic consent form at the clinic, but in the consent form there was written ‘extraction’. I made sure to tell them, and that I wrote next to my signature the word ‘exposure’ before signing. The surgeon also told me not to worry as we discussed about the exposure and that was going to happen.

The surgery happened, it went well, and I went back home.

After a couple of days I started checking my palate and the stitches, and I noticed that the chain didn’t have any loops and it was wrapped around the arch wire with composite. So I started to get suspicious as it didn’t look like the gold chains that always appear online if you just google ‘braces traction chain’.

I went to my next orthodontic appointment on July 7th and as soon as my orthodontist saw me she started to tense saying that there was something wrong with the chain. She went to reception to call the surgeon (I could see her from the cameras in the room that she was quite agitated). She came back after several minutes. She didn’t say much about the chain, just that it was not the right one as it didn’t have any loops and it was difficult for her to tie it and use the traction force as she had never worked with a chain like that before for the traction of the canine. She also said about the chance of having another surgery to replace the chain, but in the meantime she managed to do something using an elastic power chain and she wrapped the chain with composite around the arch wire where I have a coil spring to keep the space open for the canine (picture attached as a reference) and I went home.

Nobody told me anything about what was wrong with the chain, but after some online research I found out by myself that what the surgeon attached to my impacted canine during the closed exposure surgery was a retainer. Yes, a fixed retainer wire. I asked the orthodontist and she confirmed.

In the meantime my orthodontist was no longer available until the end of August due to her being on holiday and I had to have an emergency appointment with the principal dentist who wrapped again the chain around the arch wire as the composite worn down. I started to complain about the situation because I wanted to know more about what happened, but the principal dentist said that as soon as the orthodontist would be back they would have had a meeting with herself, the surgeon and the orthodontist.

Summer went by for me with a huge sense of injustice.

End of August I received an email by them saying they had a joint meeting with all staff involved, and would like to offer me a face to face meeting with the surgeon to discuss this with me in person.

During my in-person meeting at the beginning of September the surgeon told me that (below there’s an extract from an email they sent me with the summary of the meeting we had):
“As we discussed, prior to the day of your surgery, I was aware that your procedure was for an “expose and bond”, and this was all checked on the morning of your surgical procedure also. However, due to a miscommunication between myself and the nurse, I had assumed that the gold chain was in the box that he had showed me. As this is a common procedure that I perform in a hospital setting, I had assumed that the same equipment would be available. However, once the tooth was exposed, the nurse handed me an orthodontic wire that I had incorrectly assumed was the material the practice uses, and it was only when I spoke to your Orthodontist after your appointment with her that I realised that this was not the case.”

He told me in person that it was also due to the fact that the clinic didn’t have an ‘exposure’ option to tick in their booking system, and they only had ‘extraction’ so the nurse probably didn’t know what was needed for the ‘exposure’. And thanks to this, they have made sure that now in the system there is an ‘exposure’ option with all the details. So it’s basically nobody’s fault?! But I am left with the suffering.

On January 18th 2023 I will have an OPG to see the position of the canine at the moment - I feel it moved but I need the confirmation from the OPG. My question to you all is: with all your knowledge/experience would you advise me to have the second surgery so they change the chain and the traction could go faster? And if so, would you advise an open or closed exposure at this point? Or would you advise me to wait? Has something similar ever happened to anybody?

I am not very keen on having a second surgery as I feel it was quite traumatic for me what happened and also the fact that I work with my voice makes everything since the surgery and the wrong chain quite challenging, plus I will have to take some downtime again. I am currently wearing also two buttons on the inside part of the left upper arch as one tooth started shifting due to the power chain she applied - the retainer chain with the composite is continuously rubbing against my inner lip and it hurts as being a fixed retainer is not supposed to be bent/wrapped.

Sorry for publishing this as anonymous (cw/braces) but I am still very sensitive and suffering about this, as I kept it quite until today with everyone. This situation is kind of taking a tool on me, weakening me both from a mental and physical viewpoint as I feel a huge sense of injustice and I don't know how to solve this in the best way possible by myself. The only positive thing from this is that hopefully what happened to me won’t happen to anybody else at that clinic.

Thank you so much for reading and for your time in advance, I hope I explained everything right.

C x


  • Picture - Nov 30th 2022.jpeg
    Picture - Nov 30th 2022.jpeg
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Verified Dentist
Mar 18, 2018
Unfortunately, you'll have to do the surgery again. I've never seen a wire used for extrusion. Ideally, the surgeon should've checked the referral from the ortho or rung the ortho rather than blaming it on his nurse if he was unsure. Rather than you talk directly to the surgeon, politely ask the ortho if they would talk to him about redoing it at no fee. I think the ortho will apply the correct pressure to the OS as the OS could otherwise lose further referrals from the ortho, and word spreads easily. I've changed surgeons and endodontists for my patients when they didn't treat my patients properly. The referrals are like an extension of my own treatment.


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