Confusion in the treatment

Question :

Hello Doctor,

My son is 13 years old. In 2008, he was diagnosed with maxillary endognathia.

In July 2012, he started a treatment with the installation of Damon® brackets. In March 2013, he underwent a surgical procedure to expose the crowns of the impacted canines. Followed by the treatment with Damon® brackets. On October 20, 2013, a disjunctor was installed. 15 days of activation.

On November 3, his doctor’s diagnosis was: “It does not work!” (the disjunctor was pushing the left molars outward). He asked to extract the #24. I went to see another doctor who suggested to me either to remove the brackets and restart a one-year treatment including 9 months with elastics immediately, or to perform a surgery later at 16 years of age.

I must say that I am a Frenchman from Paris who never found a practitioner who, like you, gives as many indications on how he works! I would trust you!

I would come with my son to your office for his treatment, but it is a little bit far away from Paris! What do you suggest for the rest of the treatment, I am a little bit lost?

Thank you in advance for your response.

And congratulations on your very much communicating internet website.

P.S.: We quite often come to Canada since my son’s grandparents are Canadians.

Réponse :

I must admit that the description provided is rather confusing.

I understand that the treatment started in March 2013, that there are impacted canines, that a palatal expansion occurred but did not go as planned, that extracting a premolar was suggested to you, that another orthodontist suggested to remove the appliances and start all over again, that a surgery is recommended toward 16 years of age.

It is rather rare, even exceptional, that a palatal disjunctor does not work on a 13-year-old boy and it appears to me that it is rather normal to see a disjunctor push the teeth outward. However, your words may not express well what your orthodontist intended to tell you.

The suggestion to extract a tooth is not impossible, but I question the fact that only one extraction is recommended, although I acknowledge having conducted a few treatments where the extraction of only one premolar was indicated.

If an orthodontist suggests a surgery toward 16 years of age, I imagine that there is a discrepancy between both jaws. It is probably the reason why wearing elastics was suggested.

It is hard for me to tell you what to do or what could be done for your son. I wish that you will meet an orthodontist who will take the time to perform a good analysis and sit down with you to talk about the best solution, the best treatment.

Either the explanations that were provided to you were bad, either they were provided to you, but you did not understand at all, or the treatment is forever changing, like the weather.

I hope that you will find an orthodontist that will know how to reassure you. I cannot tell you more on what should be done and I find that the situation is already confusing enough with 2 orthodontists without my two cents thrown in remotely, even if I knew what to do if I saw him in consultation.

Good luck with the rest.

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