The comments

Dr Sylvain Chamberland, Orthodontiste says:

I might be too late to reply, but why extract one canine and nont the other. What will happen if only one permanent tooth is extracted?

Dr Sylvain Chamberland, Orthodontiste says:

I am skeptical. At 8 years old, it might be to young to diagnose impacted canine,but not too young to diagnose lack of space and recommend serial extraction.
If ther is lack of space enough then extraction can be indicated. Later, extraction of the 1st primary molar can be indicated follwed by extraction of permanent premolars.
I don’t know what would be best for your son, becaus I did not see him. Yes you can send the panogram at the above email.

Anna says:

Hi. I do not know if you still respond to these comments but I hope to hear from you.
My son is 8 years old and he has very crowded teeth and has a little bit of overbite.
I talked with 2 orthodontists and they have different opinions.
One of them suggested expanders for upper and lower jaw if I did not the extraction of adult teeth later. He did not mention anything about the extraction. I am concerned if extraction itself is enough and the expanders can wait or unnecessary. His lower jaw is receding in my opinion and do you think the expanders will help his lower jaw grow?
The other doctor recommended to extract 4 of baby canines asap to prevent impacted teeth, come back in 10 months and take CBCT. I am afraid if it will be too late after we wait 10 months and he will have no space for permanent canines(I was told there will be no space maintainer) because I think once baby canines are extracted crowded front teeth will take their place to align themselves.
Which plan do you think is better?
Is it ok if I send his x-ray to

Thank you

T. Kuhn says:

Dear Dr. Chamberland,

Our 12-year old daughter does also have two impacted upper canines.
One of them is going to be extracted.
I've sent you some x-rays to

It would be very nice if you could have a brief look at it!
Thanks in advance.

Best regards,
T. Kuhn

Dr Sylvain Chamberland, Orthodontiste says:

Sorry for the late reply. I use one 8oz elastic per side. That make 2 elastic total. however, you can use higher fore or 2 leastic per side if the patient can tolerate. But it is rare that I increase the force with PFM.

Dr Sylvain Chamberland, Orthodontiste says:

Voici un autre exemple:

Dr Sylvain Chamberland, Orthodontiste says:

SI vous avez une protrusion dentoalvéolaire bimaxillaire, et que votre dentition et vos lèvres sont proéminentes, je n'aurais aucun problème à procéder à des extractions et rétracter votre dentition.
Voici un exemple sur ce lien:

Diambote says:

Je suis actuellement un traitement orthodontique avec des bagues, cependant j’ai une protrusion bi maxillaire et tous les orthodontistes que j’ai consulté refusent l’extraction pour mon cas car selon eux il y’a un risque avec ma boîte à langue.
Qu’avec l’extraction ma langue n’ait plus de place, donc en ce moment mon traitement ne sert qu’à refermer les espaces entres mes dents et je pense que cela ne permettra pas de reculer l’arch dentaire afin d’avoir « un bon profil »

Ari Pillar says:

An extraoral force is applied through two (2) 8-oz elastics attached to hooks mounted on a fixed intraoral appliance (the most often a palatal expander) toward an adjustable bar attached to the vertical framework

**Do you mean 2/side or 1/side??** I have always applied two/ side and am wondering if that is too much force? thanks!!

- Ari Pillar (orthodontist in New York) :)

Dr Sylvain Chamberland, Orthodontiste says:

I recommend that you consult a certified orthodontist in your area. If you want to travel to Quebec, for a consultation, I would be able to provide an opinion. After, I can help you find an orthodontist in your area.

Alonso Lira says:

Hi Dr. Chamberland,

I am not sure if this post is still active. but what are the first steps necessary to start the treatment of a facial asymmetry? Who should I consult first? I believe I have a hemimandibular hyperplasia that started on my adolescence and now has stopped on my 30s. My TMJ clicks on the larger side of my jaw, I feel pain if I press on the area just in front of my ears and I have a deviation of my face to the unaffected- side. One side of my face looks thin and proportional and the other more curved, with more tissue making my appearance disproportional. I am not sure where to start and who I should look to begin a treatment plan. I currently live in Montreal and I would be grateful if you can help me with this. Thanks for your time!

Dr Sylvain Chamberland, Orthodontiste says:

I overcorrect. Then I follow up until phase 2 tx. Before initiating phase two, I validate a check list as recommended by Dr David Musich.
Checklist at phase II for class III patients

Dr Sylvain Chamberland, Orthodontiste says:

I would recommend Dr Marco Caminiti. He is a good friend and is currently Head and program director of Oral and Maxillofacial Surgery at the University of Toronto.
Best regards

Brenda says:

Salut Dr. Chamberland,

I was recently diagnosed with ICR after visiting a TMJ specialist and doing some CT scans. I've had jaw pains since I was in high school (I am now 25). Since I was diagnosed, I read many articles on PubMed on ICR and also came across your Three case reports. The information you have on ICR has been very helpful for me to learn more about this disease.

I was wondering if you knew of any maxillofacial surgeons or specialists in this field that are in Toronto?

Thank you in advance for taking your time to reply!


Mohan Irina says:

Excellent article, Dr Chamberland!
I am interested to know, do you have a retention period after achieving correct overjet with the facemask and, if so, what does it imply?

Looking forward to your answer, thank you!

Dr tantawy says:

Great dr chamberland

Dr Sylvain Chamberland, Orthodontiste says:

yes this is possible in some situation, howeverI don't know if it would be ok for you.
Both situation protracting maxillary posterior teeth or extracting 2 lower premolar could be considered. Don't know which one would be best for you.

Dr Sylvain Chamberland, Orthodontiste says:

We could plan a video consult, but it would be simpler if you send me photos and xray via my professional FB account, I can tell you a few things. If you send xray, it means you give me the permission to publish it as an answer to your question in this blog. Be sure that you remain anonymous except for your nickname.

Dr Sylvain Chamberland, Orthodontiste says:

Definitely that a functional genioplasty would be a much better and definitive solution for you than a chin on-plant.
You need to find the right surgeon who can follow the described surgical protocol in the paper.