Complex Odontoma
.Thank you for sending me the panogram of your 14 years old daughter.
The white arrow indicate a complex odontoma, which mean more than one supernumary tooth in one follicle.
There is absoulutely no doubt that the complex odontoma and the primary canine HAVE to be extracted.
You sent me the writtent reports of your orthodontistQUote:
1- the location of the root of the horizontal canine is positioned
about two teeth BEHIND where it normally would reside.
2-The mechanics of bringing in the canine without damage would involve sliding the tooth horizontally forward through the lower jaw bone and then uprighting it 90 degrees once it passes the roots of the premolar, this is physiologically/orthodontically impossible to do.
I understand his concern and yes it may be very difficult, may be impossible to bring the canine without some damage to the roots of the adjacent premolars.
I understand your concerns about losing the permanent canine and this mean that an implant will be necessary when she turn 18 or so.
The question are:
Is there an orthodontist who will be willing to try to bring this canine in?
Personnaly, I would be willing to try if you accept that I may not succeed. If I succeed, I am a king. If I failed, you were told that it may failed
Are you willing to pay the extra fee for this difficult treatment?
I would likely charge 1,5 to 2 k over the regular orthodontic treatment fee.
How long would it take?
It is a minimum of 12-18 months for the canine. Likely 36-40 months total treatment time.
I understand the surgeon's reason to extract the canine:
1. Association of this tooth with Cyst and tumor,
Yes, this is possible, but he can take the decision "in situ" once he open the field. If he can dissect the odontoma from the canine follicle. He can have access to bond a button to the canine and a chain or a ligature to use for pulling the tooth.
2. Severe deep impaction in the inferior border of the mandible.
A surgeon do not move teeth. He may not know if he did not see an orthodontist who would try.
At such far distance, it is difficult for me to tell you what you should do and more difficult to tell your orthodontist or the surgeon that they should try to bring the canine in.
I would try to bring the canine in, but there is an expression "gérant d'estrade" that means it is easy to say it should be done this way if you are not the one who will do it.
In my area, I would tell to the parents and the surgeon to let me try it. we have very few to loose. We may gain a lot.
It is your call. I am quite sure your orthodontist is a good orthodontist even if I don't know who he is.
I hope that help.
I will watch you reply.
