The comments

Jason says:

Hello,

I'm a 29-year-old male from Australia and I recently came across Dr. Chamberlands study on "Functional Genioplasty in Growing Patients".

I had a silicone chin implant placed intraorally although it was removed a year later. Before this my lower lip competence and lip seal was excellent.

After removal, I noticed some moderate lower lip ptosis/lip incompetence.

Just wanting to know if this is something Dr. Chamberland feels he could help me with as it appears a functional genioplasty might be the solution.

Thanks,

Jason

Carly Drummond says:

Hi. I'm 33. I have two deciduous upper canines ( had the adult impacted upper canines removed when I was 16 ). I would like to get a brace and wonder if they were to remove the deciduous canines and bring the pre molars forward would they need to remove teeth from my lower jaw as well ? So that my bite is still correct ?

Chris says:

Hello. I was wondering if you could help me.

I think I may have sleep apnea. I have a small mandible and a weak profile and I'm looking to do something about it. What does a video consultation involve...?

I am 33 years old from Britain.I am willing to travel overseas for treatment.

Would all questions be answered and an assessment be performed as to whether I qualify for surgery or not..?

I look forward to your reply.

Thank you

Dr Sylvain Chamberland, Orthodontiste says:

I recommend Dr Jason Cope, Dr David Hime or Dr Vishnu Raj

Dr Sylvain Chamberland, Orthodontiste says:

There may be an indication to extract permanent teeth. It could be the impacted canines, but it could be the 1st premolars. But you definitely need braces. I do not recommend a false tooth.

Dr Sylvain Chamberland, Orthodontiste says:

It is the role of the surgeon to explain you the risk of the extraction. My concern is that the primary teeth may not remain stable troughtou your life. At 21 years old, the prognosis of bringing this impacted canine into occlision is usually very good altough it may take 1-2 years.

Maria says:

Hello Doctor,

I truly appreciate all of your responses to the previous commentators. Anyhow, I am 21 years old and I have an impacted canine on the left side of my mouth and it is completely horizontal and possibly fused to the roof of my mouth. I don’t have photos at this current moment. Bringing the tooth down via chain and braces method is a long shot according to the orthodontist. My issue is with the impacted extraction surgery itself, what are the surgical risks? Is it possible to remove the canine and keep the baby canine tooth?

Abigail says:

I am 13 years old and my orthodontist said that because of the fact that he couldn’t bring my permanent canine down he would give me two options. The first was to get the permanent canine removed along with the milk tooth, have a false tooth and use braces to straighten the teeth. The second was to remove the permanent canine and the milk tooth along with some molars and use braces to straighten the teeth. I have minor crowding in my lower jaw and severe crowding in my upper jaw because as a result of my impacted canine one of my incisors has grown in my palette instead. If you could not bring the canine down would this be the course of action you would take?

Erika Wheaton says:

Hi, are there any doctors that have your expertise in America? I have had an MRI and one doctor said I have an osteochondroma, another doctor said my condyle is larger on one side. Despite excruciating pain, he didn't think it was significant enough to treat. Fast forward a year and now my face is becoming rapidly crooked. I am in Texas. Any doctors near here?

Dr Sylvain Chamberland, Orthodontiste says:

I think you should consider a comprehensive orthodontic orthognatic surgical treatment. The type of treatment you need CAN NOT be order online.

Dr Sylvain Chamberland, Orthodontiste says:

Your situation need carefull evaluation. One of them, is it feasible to bring your canine into the arch?
Is it deeply impacted? If you can feel it with your tongue, it may not be that deep.
I can't give you a good advice without seeing the panogram and doing a clinical exam.

Dr Sylvain Chamberland, Orthodontiste says:

I found out that I did not answer your question. The answer is Yes, you should remove the primary canine.

Dr Sylvain Chamberland, Orthodontiste says:

Thanks for sending the photo. You have a cross bite of your upper right lateral incisor with the lower right canine. I understand that the radiography that you sent me was flip horizontally. I thought it was your left maxillary canine, but in reality, it is the right maxillary canine.
From the pircture I saw, it seems that the crossbite extend to the 1st and 2nd upper right premolar. If true, how will it be manage?
I agree that the lateral incisors should not be bonded nor engage into the main archwire until the palatally impacted canine is not displaced. Will you have a surgical exposure and orthodontic ligature of the canine?

Dr Sylvain Chamberland, Orthodontiste says:

Dear L,

You need to comprehend that the teeth that shifted toward the missing canine have to be recentered. Therefore you will likely need comprehensive orthodontic treatment. This may include extraction of premolars if there is not enough space.

However, it is possible that you don't need extraction. I can't tell because I don't have enough information.

If you choose to extraction the impacted canine only and get space close, the teeth deviation may only get worse.

Dr Sylvain Chamberland, Orthodontiste says:

Q1- If the midline did not changes, chances are that the overgrowth has stopped.

Q2- To assess with certainty that the growth has stopped, you will need a scintygraphy with Tc-99. I am assuming that you had one when it was noted that your condyle was actively overgrowing. Usually, when a scintigraphy is positive, a new one should be done 6 month to 1 years after to assess if the growth/overgroth situation came back to normal.

Q3- If you don't have any significant TMJ problem beside one condyle being larger than the orther one, there would be no reeason to do a condylectomy. Particularly if the scintigraphy is negative.

Q4- I can't comment on this. I am a clinician. So far, the high condylectomy were that my patient has were safe and unventfull. I know that one patient of a collegue had continued overgrowth during the next following 10 years. It was explained by the fact that the surgeon could not removed all the affected portion of the condyle.

Dr Sylvain Chamberland, Orthodontiste says:

Claudia, yes it will help because I am getting confuse. The flow of answer does not indent orderly and it get me lost to whom am I answering.

Dr Sylvain Chamberland, Orthodontiste says:

There is a possibility that the roots of the incisors already have some damange.

There is a possibility an orthodontic traction of an impacted canine could damage the root of the incisors, but the direction of traction is very important as one should pull the canine away from the roots from start.

I don’t know your age, but I usually try to bring the canine although there are some circumstance I will decide or have to extract the impacted canine.

I apologies for not uploading an exemple. It seems that there is a blocage in the system.

Dr Sylvain Chamberland, Orthodontiste says:

There is no magic. If your gums/ teeth/ lips looks protruded chance are that you need extraction and full comprehensive orthodontic treatment.

If you have excessive showing of gum at rest and on smile, chances are that you have a vertical maxillary excess, hence you need orthognathic surgery and a comprehensive ortho treatment with or without extraction.

That is likely your choice.

Dr Sylvain Chamberland, Orthodontiste says:

There is a possibility that the roots of the incisors already have some damange.

There is a possibility an orthodontic traction of an impacted canine could damage the root of the incisors, but the direction of traction is very important as one should pull the canine away from the roots from start.

I don't know your age, but I usually try to bring the canine although there are some circumstance I will decide or have to extract the impacted canine.

I apologies for not uploading an exemple. It seems that there is a blocage in the system.

 

Dr Sylvain Chamberland, Orthodontiste says:

Yes I do perform MSE technique. It work very well altough some age limitation (35 y and older).