Dental Fenestration

Dental fenestration is the surgical procedure that removes the overlying bone and mucosa from an impacted tooth —which has not erupted— to allow the orthodontist to place a bracket and pull the tooth into its correct position in the arch using orthodontics.

Discovering that a tooth, especially a canine, has not erupted at the expected age causes uncertainty for patients and their families. Fenestration, correctly indicated and coordinated between the surgeon and orthodontist, is the solution that allows for the recovery of that tooth without the need for extraction, avoiding the functional and aesthetic consequences that its loss would entail.

At Asensio Dental Clinic, Dr. Lucía Asensio Romero (Registration No. 46002287) coordinates fenestration treatments between our oral surgery team and orthodontics specialists. The first visit is completely free. This specialty is part of our oral medicine area in Valencia.

What is dental fenestration?

Dental fenestration is a procedure in which the bone and mucosa around an impacted tooth —one that has not yet emerged— are removed, allowing the orthodontist to place a bracket to bring it into its proper place in the arch. It differs from extraction in that the goal is not to remove the tooth but to release it so it can be orthodontically guided to its correct position.

The most frequently affected tooth is the upper canine, which, due to its position in the maxillary bone and its long eruptive path, has the highest rate of impaction after wisdom teeth. Canines are fundamental pieces: they guide the lateral movements of the jaw, distribute masticatory forces, and have an especially long root that gives them exceptional durability. For all these reasons, preserving the impacted canine through fenestration is always preferable to its extraction.

When is fenestration indicated?

Fenestration is indicated when a permanent tooth —usually the upper canine— has not erupted by the age it should have, and radiological diagnosis confirms it is impacted in the bone in a position that does not allow for spontaneous eruption. Orthopantomography and 3D dental CT scans allow for precise determination of the tooth’s three-dimensional position, its distance from the occlusal plane, and its relationship with the roots of adjacent teeth.

Usually, the upper canine erupts around the age of 13. It is advisable to perform an orthopantomography between the ages of 8 and 9 to check that development is correct and, if an anomalous position is detected, initiate preventive orthodontic treatment to create space and guide eruption before surgical intervention is necessary. Fenestration should be considered when preventive measures have not been sufficient or when the diagnosis is made late.

How is dental fenestration performed?

Fenestration requires coordinated treatment between the oral surgeon and the orthodontist, and this coordination is key to the result. The process begins with the prior orthodontic phase: the orthodontist creates the necessary space for the tooth in the arch using fixed appliances, so that when the tooth is surgically released, there is space to receive it.

In the surgical phase, the surgeon makes a small opening in the gum —the fenestration itself— that exposes the crown of the impacted tooth. A bracket or traction hook is placed on that crown, connected to a metal ligature that joins the orthodontic appliance. From that moment, the traction phase begins: the orthodontist applies gentle, controlled forces that guide the impacted tooth toward its correct position in the arch over several months.

The surgical intervention itself is short —between 30 and 45 minutes— and is performed under local anesthesia. Postoperative care requires a soft diet for 2 or 3 days and careful hygiene of the area. For patients with anxiety about surgery, we offer conscious sedation with nitrous oxide to ensure maximum comfort during the procedure.