Impacted canines and root resorption of the incisors
Hello Dr Chamberland,
My 12-year-old daughter Lorène has both impacted upper canines. After consulting an orthodontist, she recommended the removal of both deciduous canines to make room for them to erupt but they did not come out. The treatment started a few years ago already. They first tried to make room for the canines with an appliance.
After a panoramic picture, here is what she proposes (she is talking to my dentist):
“We must make a decision for little Lorène concerning the impacted teeth #13 and #23.
Of course and this is beyond a doubt, generally, if traction can be used on canines, the adequate treatment is de-impaction and traction of these teeth.”
With Lorène, we have already discussed it with doctor XXX (stomato), the situation is different and quite delicate. Indeed, and you will see it on the pano, the follicular envelope of teeth #13 and #23 (but mostly teeth #13) has resorbed the root of teeth #12 and #22 with teeth #12 that is mobile and really in a risky situation.
Our question is: in this very particular case, wouldn’t it be wiser, to avoid more trauma on the laterals, to extract teeth #13 and #23 and perform a loss of anchorage and coronoplasty of teeth #14 and #24 with aiming for having the group of premolars act as canines?
We went to see another orthodontist who confirms that the impacted canines indeed resorbed the lateral incisors and even the central incisors… and who confirms the diagnosis.
What do you think? Is it really the best solution?
Thanks in advance,
Good Sunday morning Mister Lacasse,
It is true to say that the situation is quite bothering and that damage to the permanent teeth is present.
You daughter is 12 years old and you say that the treatment started “several years” ago. This confuses me.
I think that there is a strong iatrogenic cause to the resorption of your daughter’s incisors. The problem should have been handled way before and differently. It would have been better to de-impact the canines first (exposure surgery, traction metal ligature and removable appliance with a cantilever spring) WITHOUT using fixed appliances. When traction was performed on the canines, it would have been simple to make the decision to undergo a major orthodontic treatment and to proceed with the removal of premolars to solve the problem of the lack of space. All of this assumes that the canines were accessible by the palate.
But the damage is done. The same option can be considered. I would certainly remove the fixed appliances to free up the lateral incisors during the traction of the canines. As soon as the crown of the canines will be moved away from the root of the lateral incisors, the root resorption will stop, healing will follow and the treatment with fixed appliances will be able to start again.
The option to extract both canines is a good choice. It is probably what is simplest mechanically and as soon as the canines are gone, resorption will stop. The first premolars (#14, #24) can fill out the role of the canines with or without coronary modifications. I am thus in favor.
Note that the removal of the lateral incisors would not be a bad choice, but the duration of treatment will be longer, because the canines need to be brought into the mouth and this can take one year or even more. By seeing how the canines were managed up to now by the orthodontist, I would be careful…
What calls to my mind is that nobody talked to you about the definitive relationship between the upper and lower teeth. Indeed, there will be 2 fewer teeth in the maxilla and a complete dentition in the mandible. A treatment with the extraction of 2 teeth in the maxillary arch is valid if the molar relationship is in Class II. If the molar relationship is in Class I, we have to consider the removal of 2 lower premolars to obtain an acceptable functional occlusion.
I introduce you to a case of a patient who comes to my office and who has 2 impacted canines that cause resorption of the incisors. Any traction attempt on the canines would have meant a more important damage to the incisors. The patient had a Class II malocclusion. I thus proposed a treatment including the removal of 2 permanent maxillary canines, but without any removal in the mandible. Notice that the treatment was initiated in the mandibular arch while waiting for the upper canines to be extracted. The treatment in the maxillary arch started in March a few weeks after the extraction surgery. Notice the resorption of teeth #21 and a little bit of teeth #22. Teeth #12 and #11 are less damaged.