Oral Surgery Before Braces

[khan6831]

Hello people , here is my situation....

i go to the orthodontist the other day and have x-rays done because i'm now finally prepared and self motiviated to go and do something about my teeth. the ortho shows me some x-rays and tells me that my left canine is unerupted and is sitting horizontally in between my two front teeth (i already knew this). This is due to my left baby tooth still rooted firmly in my gums which prevented my canine from coming out. My right canine came out perfectly but there was no space for my left canine and so it is now horiztonal.

my ortho tells me that before i get braces that i'll have to undergo three tooth extractions. She says my two baby teeth and my unerupted canine must be removed and then she says something that suprises me. She says that it is possible that the oral surgeon can remove your left baby tooth and in that empty slot replace it with the canine that needs to be removed. i've never heard of anything like this before, Is it possible to replace one tooth with the other or am i getting my hopes up for no reason?

Has anyone else been through something similar?

[mikeg]

Hi


As far as I know (not an expert on this), your orthodontist is referring to an Implant which are very common in adults and also very expensive. I have heard of cases of adults in there late 50's that still have a baby tooth or 2 in place that needs to be removed and implant to need to be into the bone.

The reason for the impant is to hold the shape of the surrounding teeth. Since you are getting braces on anyways, I'd listen closely to both your ortho and oral surgeon. As they'll know best on this issue.

Zoso may know more about this topic, so hang out and let's see what the others have to say.

As always it never hurts to get more than 1, 2, or 3 opinions for qualified professionals.

[Zoso]

I've read the stories of many folks who have had baby canines remain in place, and the adult canines sitting impacted somewhere in the palate - it's more common than you'd imagine. And I've seen many where they were able to have the baby teeth removed, and the adult teeth exposed, then a little chain attached which is used gradually to pull the adult tooth down into its proper position. That said, sometimes, for one reason or another, this might not be possible - sometimes it is attempted, but the adult tooth proves to be fused to the bone (ankylosed), or sometimes the docs might feel that it is not possible to make the attempt, since due to the position of the tooth moving it poses a risk to other teeth - although I have heard of this only ever for Sunny (a member here) and just about everyone else whose story I have seen with impacted adult canines has been advised to try the exposure and brining it down into place. And, surprisingly, of the folks whom I have heard of having this done, most have been successful.

Seems to me the options are:

• Extraction of the baby tooth, and exposure of the adult canine to bring it into place with braces - risk is the adult tooth may not come down.
  
• Extraction of both, and replacement of the baby with an implant - risk is you may not be suitable for an implant, or it may fail; plus implants are not as good as your natural teeth.
  
• Extraction of the baby tooth, and close the extraction gap up, so the premolar comes forward into the place of the canine - the problem with this is that the canine is a special tooth, and the premolar cannot function in the same way; also I've seen one or two people have trouble closing similar gaps (including Sunny).
  
• Leave things be, and hope the baby tooth holds up over time - but baby teeth are not "built to last" our adult life, and it is possible the tooth could come out later, requiring work then; also the baby tooth is probably rather smaller than the adult tooth, so getting a good orthodontic result that involves this tooth may be tougher.

I will caveat all of the above with a reminder that I am not a dental professional, and firmly echo Mike's advice that you seek some more professional opinions - see some more orthodontists to see how each feels your case should best be treated, and also see an oral surgeon to what his feeling is about the viability of exposing and bringing down the adult canine - ask the ortho to recommend an oral surgeon who has a lot of experience with canine exposures.

Still, my advice is this: if the pros feel it is possible, in your particular case, that the adult tooth might successfully be brought into place, this is definitely the preferable outcome - having all your natural teeth in their correct places, in a good bite is the best.

[khan6831]

wow, great and very informative posts!!!! thanks guys

[mikeg]

no problem. Keep us posted!

[MCOMarkhamOrthodontist]

There are some situations where they can try to extract the primary tooth and transplant the canine into the socket. The success rate varies and there is a possibility that the tooth becomes ankylosed (stuck in the bone, whereby even braces will not move it). It is more popular in Europe where they are more experimental and likely have fewer lawyers .

If you really wish to keep the tooth, as Zoso described, there is a procedure called a canine exposure whereby a window is made in the gum/bone so that a brace and non-reactive chain can be placed on the tooth to be moved. The is sometimes covered back up and some sort of elastic thread is used to guide the tooth into position.

Speak to your orthodontist about the pros and cons of such a procedure.