The comments

Masouda AgilaTarboush says:

very good page

Ashraf elmessery says:

Thanks

Sveta says:

My daughter had her surgery 3 weeks ago. It seems like everything went well. As I mentioned before, her 12 tooth root was actually damaged by 13 laying position. Now it has an open part of the root. Is it necessary she has to extract its nerve in the future?
I asked a dentist if he could cover it right after the surgery and he said no. How long does it take to place the brackets after surgery?
Is it safe to wear them on a damaged tooth?

Dr Sylvain Chamberland, Orthodontiste says:

An impacted canine may cause damage to the roots of the incisors. A cyst may develop around its crown. I wish you will consider an orthodontic tratment when you will have a more secure financial position.

Dr Sylvain Chamberland, Orthodontiste says:

SARPE is covered by national health care system. There is a cost, but it does not affect the patient directly. We all pay income tax for canadian health care.

Dr Sylvain Chamberland, Orthodontiste says:

Hi Bob,

It is nice to ear from you. It has been a while since we meet. We should try to make it hapen again.

Regarding your granddoughter, if I read you well, the maxilary canines had made eruption in the sites of missing lateral incisors where she had bone graft to repair the bilateral cleft. Therefore, she has a bilateral class II molar relationship, canines substitution for the missing laterals and the 1^st premolars act as the canines, normal overjet and overbite.

This is a valuable treatment outcome and I can not disagree with that. I often do that in patient with patient that have congenitally missing lateral incisors and don't have not necessarily cleft palate.

Regarding the change of brackets systems, this depends on the preference of the practioners. Is Damon brackets better? No, I don't believe so. In my opinion, Damon is the worse SLB availaible in the market, but I know that there are still a lot of users of that system. But that is an opinion. My opinion.

Could the treatment of your grandaugther be completed with the bracket she is wearing. Chances are that it is yes, but some repositionning might be necessary.

Would I change the bracket if she would come in my office?

The answer is yes. I hate working with twin brackets. I hate elastic or ligature ties. It cost me less to rebond a transfer case with my onw SPEED bracket than to continue the treatment with a system that I am not familiar. My brackets are .022 slot, I could not work with .018. this does not mean that .018 is not good. It mean that I learn to work with .022 system.

I think that the change of bracket systems need to be discuss with the orthodontists. Your daughter may try to find an orthodontist that would be willing to continue the treatment with the current system. There is no good or wrong answer. It is a matter of agreement between the patietns/parents and the orthodontists.

Do I have strong feeling about self-ligating brackets?

I think that most current SLB tried to copy SPEED system. They all use a spring clip that work similar to SPEED. However, most SLB kept the twin design. They could not make the paradigm shift that SPEED did since its introduction years ago. SPEED is a single point attachement. One benefit that no other systems has is the niti spring clip that is unique to SPEED. This niti clip maintain its force throughout the treatment. All other system InOvation, Empower, Forestadent Quick has a stainless steel clip that lost about 50% of its strenght during treatment. This means that in the finsihing stage, the SS clip is unable to maintain the archwire thight into the bracket slot.

My feeling: SPEED system is the best.

 

 

Bob Leigh Grossmann says:

Wow! You've really become internationally famous.....when we met each other in Quebec City I knew then that you were an exceptional talent.

I retired in 2005 and thought I was through with orthodontics. I was wrong. I am still in it through my granddaughter who was born with a bilateral cleft lip and palate. She was initially treated in Germany and is developing well. She and her mother moved from Germany to Orlando, Florida, and is now involved with the Arnold Palmer Hospital and it's oral surgeon, Dr. Ruiz.
Isabelle, my granddaughter, is now several years into orthodontic treatment and has had bone implants in the upper lateral incisor areas. She spent last year with her father in Germany and he did not continue her treatment with a German orthodontist so, in the meantime, the upper cuspids have erupted into the lateral grafted areas and the posterior occlusion has shifted to Class II. We are thinking of leaving the cuspids to be used as laterals.....and leave the occlusion Class II.


In an attempt to shorten auto trips for treatment she was evaluated by Dr. Lawton in Oviedo, Florida, whose office is closer. He wants to debond and rebond with the Damon system brackets. Lower treatment is 95% complete so I see no reason to switch brackets. Only limited upper cosmetic anterior positioning is needed and I again question changing brackets (metal .018 brackets). I guess my question to you is your opinion of Damon brackets.

When I practiced, I used several self-ligating systems when they were in their infancy. Visually today they don't look much different. I believe I used SPEED brackets and others. I don't remember which I liked best. They all had problems. Do you have any strong feelings about self-ligating brackets? Should I correspond through your email address?
Greetings from Virginia....Bob and Sibylle Grossmann

Andrew says:

Hi. Just wondering what a ball-park figure of the average cost is for SARPE surgery? Thanks.

Paige says:

I'm 24 years old & I have a impacted "eye tooth" it doesn't bother me (no pain). I have noticed my gap that I have had is getting a little smaller. My dentist said in most cases that tooth will just stay put. Of course I don't have thousands of dollars to under go surgery & when I was little the dentist again told me to not worry about it. I got my wisdom teeth out in May 2015 and tell gave me suggestions just in case I didn't want the gap but didn't seem concerned. Should I not worry about this?

Dr Sylvain Chamberland, Orthodontiste says:

It is not unfortunate to have a class I occlusion. Indeed, it is very fortunate.
Both tx plan can be valid.
1- I mean if damaging further the root of the lateral incisor, it is a reasonbable plan to extract both maxillary canines and 2 first lower premolars.
2- It is also a good option to pulls the canine, make sure it move adequately, then extract 4 first premolars, continue to bring the canines in and close all extraction space.
3- Extracting both upper lateral incisors and lower 1st premolar could be an option, but only if there is severe damage to the root of the lateral incisors.
I have done all 3 options of treatment in my career.
If she is class I and that extraction are necessary in the maxilla, then extraction in the mandible is unavoidable.
Sometimes it is possble to do it non extraction if there is minimal if any crowding in both arches.
I hope that help.

Sveta says:

Hello Dr Chamberland,
My 13-year-old daughter has 13 and 23 canines included, the root of 12 incisor is slightly damaged. We consulted a few orthodontists and came to no real conclusion. Some one them offer extracting 13 and 23 and the premolars in the mandibular arch, others think that traction of the canines with extraction of premolars is the best idea. One of them offered to extract the lateral incisors and track the canines there. My daughter is unfortunately class 1. Does it necessarily mean that the mandibular premolars must be extracted?

Marchaan says:

Hello! I am 32years old and both of my canines are high and impacted. How likely will they both come down? So far, it's been 4 1/2 months of activating the chains. I have xrays to show you. I will post to your professional facebook page. Thank you.

Dr Sylvain Chamberland, Orthodontiste says:

It make sense to do conservative treatment prior to surgery. However, I don't know the nature of your TMJ problem. Is it a degenerative problem?
I ask to a friend of TOronto. He said that Dr B is good with TMJ.. He don't know about Dr R. This does not that Dr R is not good. It mean that my friend simly don't know about him.
Listen to your feeling. Chose the one you are confident with.
I can not tell you which one to go.

Dr Sylvain Chamberland, Orthodontiste says:

It is safe to use a protraction facemask on primary molars. If the fisrt molar are erupted, an appliance anchor on 1st molar is used.

Carolyn says:

Thanks for your response. I am from the North York area of Toronto. The 2 orthodontist I saw weren't experienced with tmd whereas the other 2 I saw were Dr. B and Dr. R. There was some variation of treatment options including braces and jaw surgery to conservative management of tmj first prior to braces. I am concerned about starting braces with preexisting tmj and it possibly making my tmj symptoms worse. However, I know leaving my maloclussion the way it is could further make my tmj worse. How do you approach treating your patients with braces if they have tmj?

dr Vuyani Dubula says:

Is it safe to use a protraction face mask when the patient has no premolars

Dr Sylvain Chamberland, Orthodontiste says:

May be there would be indication of extraction of 4 premolars. it is hard to tell without any relevant clinical information and xray.

Dr Sylvain Chamberland, Orthodontiste says:

I don't know if it is too late, but you can send the pcit and xray to my professional facebook page or upload to a site and write the link here.
I would be very hesitant to recommend extraction of a permanent canie, but yes, in some case, it is a very good option.

Dr Sylvain Chamberland, Orthodontiste says:

If you don't want to get corticotomy, it is fine and just don't get. This procedure is very controversial. Propel has high risk of damaging the roots. You are almost as old as I am and I can tell you that I would never get this done to my teeth to make them move faster. No way. Why is there such hurry? 9,5k is pretty good fee that cover 24-30 months of treatment, minimum.

Dr Sylvain Chamberland, Orthodontiste says:

Empower and Bioquick are copies of Inovation whcih is a copy of SPEED. THey all have stainless steel clip that lose its rigidity by 50% during treatment.
Empower Ceramic and Quickclear are copies of InOvation clear. They have the same SS clip that come loose after a while.
SPEED is the only self ligating bracket that has a Niti clip that maintain the same strenght during the treatment.