The comments

Dr Sylvain Chamberland, Orthodontiste says:

At what age a canine may be considered impacted

Thank you Mama for sending me the panogram of your 9 years old daughter.

This xray show a normal development of her dentition. Yes, you read well. I said NORMAL.

The 2^nd thing I see is that she has spacing between her upper and lower incisors. Therefore she is not missing space that would justify extraction of the primary canine to help to align her front teeth. She has extra space. Extracting the primary canine will make it worse and increase the spacing between each teeth.

I would reassess the developement of her dentition with a new panogram taken in 18-24 months. She will then have 11 and if canine show signs of impaction, it will still be time to intervene. In my opinion, chaces are that the canine will erupt normally.

I would like to show you a similar case of a 9 years old girl who seek treatment for her protruded incisors and spacing.

You can see that the space between the incisors were closed by retracting the incisors. In the mean time, the canine did erupt normally.

I admit that the dental age is different bewteen the 2 girls, likeley 1 or 2 years. Your daugther barely have root formation of her lower 2^nd premolar while my patient may have near half of the roots of the 2^nd premolars that are formed. This explain why in 10 months, we see that the canine has moved favorably.

This means that we should wait before any intervention. Being patient is the key.

I hope that help.

Best regards

Dr Sylvain Chamberland

shweta says:

Thank you sir...
sir i have a lot of spacing actually in my anteriors both upper and lower...

NYCMama says:

I was surprised when the pediatric dentist asked us to see an orthodontist for my 9 year old child (never had dental issues, all very good exams for many years) because of TWO "impacting canines" on top.
The orthodontist though said that we need to have ALL FOUR baby canines PULLED as soon as possible and expensive SPACE maintainers ($1800) placed for the BOTTOM teeth after they are pulled (bottom teeth would crowd together and not leave room for canines to come out....top row would be fine without any space maintainers).
Theoretically, doing it this early...space opened up by extracting baby teeth will then (somehow???) persuade adult canines to MOVE automatically into place (without mechanics necessary now to pull top or bottom adult canines into position, chains/levers etc.)
Have you seen that in your practice?
The orthodontist would not give any percentages...like what is the percentage of chance this would actually work if we have baby teeth pulled immediately, versus waiting 1-2 years to see if they come out naturally on their own.
After all this is a bit of trauma for a 9 year old to go through...from NEVER having ANY dental procedures in her life to suddenly needing shots in the mouth, blood seen after pulling teeth, swelling afterwards, days of healing (not being able to chew easily etc.) and risking possible complications/infections...going from never having a fear of dental visits to possibly being scared.
Of course, we would like to do anything now that we have to do to avoid any future surgery requiring cutting gum or bone...or worse, pulling permanent teeth/having implants etc.
Also, orthodontist said the next panoramic x-ray would be at age 11 for my daughter, that it would be too much radiation to do it before then...but that it's OK we won't see for 2 years if extractions are successful, since teeth move very slowly.
And that she may require braces to fix canines between age 11-13 (costs like $10,000 here in my city in the U.S.!!! no one in my family has ever afforded braces and our teeth, we're told, look great), since there's no guarantee pulling 4 baby teeth now will fix alignment.
If you look at the panoramic x-ray, could you please give me a second opinion.
I do NOT have a Facebook account, but I would be more than happy to send you the panoramic x-ray via email if you email me from any account that you or your staff uses or if you direct me to a web page on your site that allows uploading of an image (since this form doesn't seem to have that option).
Thanks so much!

Dr Sylvain Chamberland, Orthodontiste says:

There was two fold in your question. I might have missed one of them.

1- Unilateral crossbite

This can be corrected via surgically assisted rapid palatal expansion and I have done a lot of SARPE. However, there is a new technique calle MSE (maxillary skeletal expansion) that use an expanding device that is fixed by four 11 mm miniscrew to the hard palate. This can do skeletal expansion in a non growing patient. I have a case that I plan to post soon. This is the best advance in thechnology I have seen in years.

2- Facial asymmetry

If after expansion, your still have facial asymmetry, then you need orthognathic surgery.

Joshua says:

So you are saying it's the best solution?

Dr Sylvain Chamberland, Orthodontiste says:

Realistic expectation

If you have some crowding and bimaxillary protrusion and want to solve both problems, extraction of 4 premolars is likely the most realistic treatment plan. Lingual orthodontics may not be the best appliance to close extraction space.

If you don't want extraction, then you don't have other choice but to remain with bimaxillary protrusion.

Dr Sylvain Chamberland, Orthodontiste says:

If your complain is facial asymmetry, an orthodontic treatment that will include orthognatic surgery is likely the best solution to improve facial esthetics.

Dr Sylvain Chamberland, Orthodontiste says:

Bonjour Madame,

It has been a while since our first conversation. Thank you for coming back. You can send the xray via my professional facebook account: facebook.com/drsylvainchamberland.

It seems that the canine is impacted labially if I read you well.

 

Joshua says:

Hi doctor, I'm 20 year old male and have posterior unilateral crossbite. I'm unhappy with my facial asymmetry and was wondering if surgery would help with my facial appearance

Karen says:

We finally found an orthodontist willing to try and bring the canine down. The oral surgeon we used was first concerned after looking at the 3D X-ray that the tooth was laying on the root of the adjacent one but when he went in to place the bracket and chain said it was actually positioned in front of the root. We saw movement after 8 weeks but the following 8 weeks was very minimal. The orthodontist is creating additional space to hopefully get it turning down. Can I send you the X-rays and get your opinion?

Shweta says:

Hello sir,
I am a 28 yr old female and i wanted to know if lingual orthodontics is a suitable option for bimaxillary protrusion ..which is my case. Also i dont want any pm extraction.

Dr Sylvain Chamberland, Orthodontiste says:

I may be able to give an opinion if you send a panogram to my professional page: facebook.com/drsylchamberland. If you send the xray, it means uou accept it will be published.
Write the detailed question following this comment on the site.

Idris says:

My daughter has impacted lower canines....can u pls give your opinion.

Marie-Paule says:

Un grand merci pour votre réponse.
Au plaisir.

Dr Sylvain Chamberland, Orthodontiste says:

Yes you can, but your orthodontist should understand why. Is he a certified orthodontist or a general dentist who do orthodontics?

Kal says:

The expansion was to correct the cross bite and for space because she didn't want to extract 23.

Do you think I can still opt for extraction of 23 now that my daughter has had the expanders fitted for over a week?

Dr Sylvain Chamberland, Orthodontiste says:

Hum! It is worse than I expected...

I can't imagine doing an orthodontic treatment and tell to my patient (or the parents) that I would not be able to fit the maxillary midline with the facial midline. This is non sense!

What is the indication of maxillary expansion? Was there a posterior cross bite or was it for gaining space?

You are good for a thorough discussion with the orthodontist and tell him/her that you will not accept unfitted midline to the facial midline. If not, I would recommend that you ask a 2^nd opinion to a certified orthodontist.

Kal says:

Hi thank you for your prompt and comprehensive reply. Regarding the maxillary crowding the treatment plan we have been given is:
A)Fitting of a Rapid Palatal Expander
B)Extraction of 13 only
The orthodontist is not in favour of extracting the canine on the opposite side as she believes my daughter is having too many extractions already.
She has informed us that the discrepancy in the midline will not be corrected.

However after reading your advise I believe the extraction of both maxillary canines or 1st premolars would have been a better option. I'm a bit stuck now as my daughter has had the expanders in for over a week now!

Thank you
Kal

Dr Sylvain Chamberland, Orthodontiste says:

Bilateral mandibular impacted canines

Thank you Kal for sending the xray.

Your daughter has impaction and transposition of both mandibular canines (33 and 43),  retained primary canines (73, 83), maxillary crowding as I can see the the upper canines are ectopic and vestibular near the 1^st premolars.

I agree with the extraction of both lower impacted canines and lower primary canines. In order to obtain a class I occlusion, normal overjet and normal overbite, I suggest the extraction of the upper 1^st premolars (14, 24), but one could extract both maxillary canines intead of the 1^st premolars since in the mandibule, it is the canines that will be extracted.

Conclusion

I would agree with the following treatment plan:

1-extraction of 4 permanents canines + 2 lower primary canines

Or

2- extraction of upper 1^st premolars and lower permanent canines + 2 lower primary canines.

 

Dr Sylvain Chamberland, Orthodontiste says:

You can send me the panogram via my Facebook professional page. I will reply here and post the panogram with my comments.

I am bias toward bringing the permanent canines in, but the situation of you daughter may be different. We will see.