The comments

Aileen Blok says:

If possible, I would really appreciate your advice.
We moved country (UK to NL) and my 11year old daughter was suddenly told she needed (and rather urgently) orthodontic treatment and was prescribed a twin block.
We never got specific measurements from the Dutch orthodontist (just that she had an overjet and lower jaw with potential for overcrowding) but he did suggest that one of the aims was to grow her lower jaw.
She has been wearing it about 2 weeks, but when we were back in the UK recently I sought a 2nd opinion.
Seems her IOTN score is 2 i.e. overjet about 3.5mm but competent lips, with some contact point misalignment 2mm.
The UK orthodontist implied the treatment was for cosmetic reasons (something we were never worried about) rather than medical.
We have an appointment with the NL orthodontist shortly where we will discuss these things, but we are considering stopping her treatment.
Will there be any problems, if we do i.e. her incisor position and bite has already changed, would we expect that to change back to "normal" if she stops treatment and if so how long might it take?
We are concerned that we've already started on the treatment with the twin blocks, that she'll need to complete the full treatment (twin blocks and fixed appliance) when we may wish to stop.
I appreciate that you may not have time or be able to respond to my query.
Thanks for any help you can advise.

HLM says:

I recently started using an adult size pacifier while on a cpap machine (nasal) because it helps tremendously to prevent mouth air leak. I use a chin strap too. Overtime can this change my occlusion?

Robyn says:

I have an impacted canine upper front jaw. I also have braces, my oral surgeon stated I should get the impacted canine remove, once my ortho start moving teeth, my front won't get damage and possibly losing them. So I had the surgery done two days ago, my surgeon only remove half of my impacted canine. The other half won't move. The surgeon kept pulling but it won't move. So he decided to leave the half in.
He said I should be fine, the piece he remove was near my front teeth. I should be fine when my ortho start moving teeth.
My question is it safe to leave half of an impacted canine in????

Melanie says:

Hello! My 15 yr old son has "one" impacted maxillary canine that is palatally impacted; primary tooth is gone.

His situation has been called the best case scenario (angle of impaction, no roots resorbed, straightforward impaction). However, with no decidious canine remaining, the lateral and centrial incisor have been drifting and the gap for the canine is only @2-3 mm at this point.


What would be your recommended first step?

1. Braces first; see oral surgeon months later to expose the impacted tooth

2. Or, see the oral surgeon first and then, a few weeks later, have braces installed

Thank you for your time!

John says:

Hello, i have a asymmetric face and saw this article could i maybe send a picture to see what maybe cuses it?

Aya says:

Hi doctor,
I think i also have protruding mouth since i cannot close my lips properly. i am currently wearing braces and had 4 teeth extraction to fix it, it's 2 years now. However, i am not quite sure whether it is a correct procedure or not. My overbite has become deeper after that (completely cover my lower teeth) and gum becomes more prominent when smiling.
My question is, is this just a matter of time? Do i have to wear this braces longer? Can my teeth be fixed by just using metal braces?

Marie-Paule says:

Bonjour Dr Chamberland,
À Montreal depuis peu, je suis une adulte avec une polyarthrite rhumatoïde juvénile avec résorption condilaire très sévère. Je dois faire un traitement orthodontique pour ma malocclusion. Auriez-vous des confrères orthodontistes (et même chirurgiens maxillos) à référer à Montréal? Je recherche désespérément des personnes qui ont l'expérience de ce genre de pathologies pour un traitement adapté.
Merci de votre aide.

Hayley says:

My 14 yr old daughter has been undergoing treatment for impacted canines. One has descended into place but the other has moved only slightly and is now stuck against and reabsorbing the root of the lateral incisor. I was alarmed by the opinion of the oral surgeon who advised that a root canal on the reabsorbed incisor would have to be done. I declined and insisted on a team consult (the work is being down in a NYC teaching hospital) so for now, some other maneuvers are being attempted by the ortho team to bring the tooth down. Needless to say I am anxious; however I am confused about the long-term health of the reabsorbed lateral incisor. The extent of reabsorption is considered to be minimal. Is is common to offer a root canal for the reabsorbed incisor? Are these teeth at high risk for subsequent problems later?

Dr Sylvain Chamberland, Orthodontiste says:

I hope you will NOT accept the removal of a maxillary lateral incisors to aligne the other front teeth.

You may need palatal expansion or extraction or 4 premolars to resolve the crowding along with comprehensive orthodontic treatment. I recommend that you visit an orthodontist or at leat a dentist, but not a doctor.

Dr Sylvain Chamberland, Orthodontiste says:

At your age, 17 y, or any age, expansion alone will not bring the maxilla forward.

The goal of maxillary expansion is to correct the maxillary transverse deficiency, not the AP deficiency. Other means will be necessary to correct the AP position of your maxilla and a face mask won't help at 17 years old.

shashank says:

Hi doctor my age is 24 and i had crowded my upper 2nd incisor lie little behind my 1st incisor and i had little bit narrow arch and when i visited doctor he said that he will remove one 2nd incisor to allign teeth and i dont want to loose my teeth. so please tell me that palate expander will be helpful for me or not

L says:

Hello again

Thank you for your response. Along with widening the mouth/ opening the suture, will a palatal expander help bring out a deficient maxilla? For example, to achieve midfacial balance. My midface is a bit sunken in. I'm not sure why yet, but if it's because of an underdeveloped maxilla, will an expander help? Or are expanders only for braces? Would I need some sort of headgear? Sorry for the many questions and thank you for your help!

Dr Sylvain Chamberland, Orthodontiste says:

Merci Madame
I am sure you will find the answer to your question about your daugther.
If you want to share with us the final treatment plan, it will be much appreciated by me and the internaut in general.
Best regards

Carolyn says:

Hi Dr. Chamberland,
Thank you so much for taking the time to give your advice and also for contacting your friend in Ontario. If only we lived in Quebec City, we would definitely work with you. We will get a second opinion here.
Thank you!

Dr Sylvain Chamberland, Orthodontiste says:

Vestibular impacted canine

Merci Mme Marchenko for sending me the xray of your 13 years old daughter.

This confirm the very high position of the canines above the roots of the maxillary incisors. It shows retined deciduous canines, a missing lower left 2^nd premolar (#45), retained lower left 2^nd primary molar (#75) and a lower lingual arch.

You said that your daughter was followed by your orthodontist since the last 5 years.

One may question why the primary canine were not removed 2-3 years ago and why a panogram was not take when she was 11-12. But it does not give the solution to apply at this moment.

I show the panogram to a friend orthodontist in Ontario. He also ask which orthodontist missed this. However, we both know your orthodontist and we both believe he is a good orthodontist.

About the treatment plan, my friend provide the same alternative.

1- If it is an exo case, we both agree that it would be nice to extract 13, 23, 45 and lower left E (#75)

2- The prognosis of the primary teeth #75 is poor. We should deal with that now.

3- Extraction of upper canine and protraction of the posterior teeth is feasible is miniscrew is used (temporary anchorage device or TADs).

If it is not an extraction case, I would try to bring those canine into the arch. I would not palce braces on the front teeth and would pull the canine with a removable appliance and a cantilever spring. I have done several traction of high canine with this technique without arming the root of the incisors (see mecanotherapy). In the case of your daughter, there is no root resorption. This is an advantage. It is not like the 2 case in the comment of February 4.

I need more information to tell you what I would do or what should be done. I need photos, ceph, clinical exam. There are many good orthodontists in your area. It is your decision if you want to have a second opinion.

Before leaving you, I have a recent case that I took progress panogram yesterday after 10 months of treatment.



Note that the direction of pull is distally and the canine that was horisontal is now vertical and no damage was done to the incisors. I can see the bonded button through the mucosa. The tooth wil be in the moth within the next 2 months.

I hope tthat will help you.

 

 

 

Dr Sylvain Chamberland, Orthodontiste says:

Bonsoir,

Chances are that I would recommend the same thing. If the maxillary canines are vestibular and high above the central incisors, likely causing root resorption of the incisors, the safest tx plan might be extraction of the impacted canine and closing the space by protraction the posterior teeth. I hope your daughter has some class II relationship in her malocclusion. This would help. If you look at my answer of February 4, 2017 above, you will see an exemple of one of my case in the 2^nd xray. This 1^st xray is the case of the internaut.

Do not worry about the position close to the nose, oral surgeon are very good to do surgery without damaging anything.

However, if the canine were palatal, I would likely try to bring them in occlusion.

I hope that help.

Carolyn Marchenko says:

Hello Dr. Chamberland,
Thank you for providing such an informative website.
My daughter is 13 years old and she has two impacted upper canine teeth. They are both sitting high above the four front teeth, quite horizontal and in the vestibular position.
Our orthodontist recommends to extract both the impacted and baby canines, and to move all the upper molars forward to close up the space.
We are concerned about losing the canine teeth and also concerned about the risks of the surgery to extract the impacted canines from their position close to the nose area.
The other option is to try to reposition the canines, but our orthodontist says there is a high risk of damaging the roots of the front four teeth.
What do you think would be the best course of action?

Dr Sylvain Chamberland, Orthodontiste says:

Skeletal expansion can be done non surgically  at your age if you have abone anchor skeletal expander. The fact that you have crowding does not mean that you have a narrow maxilla.  Extraction may be indicated instaed of maxillary expansion. I can't tell without seeing you.

It will not be that much painful at your age. I would not worry.

Have a consultation with a certifed orthodontist to learn more.

Livia says:

Thank you for your response! I know that there may be another article for this, but I'm just going to ask under the already existing thread.
Can I wear a palatal expander and expect successful results?
I'm 17 and I have crowding in my teeth because I have a small mouth (maybe because I have an underdeveloped maxilla??).
If I wanted braces, would I have to wear an expander first?
Would it be effective for someone my age, and would it be more painful?
Thank you.

Dr Sylvain Chamberland, Orthodontiste says:

Chances are that I would wait until he is 17 and plan a surgical orthodontic treatment.