The comments

Dr Sylvain Chamberland, Orthodontiste says:

I forwarded your request.
Will get back to you if they reply.
Best regards.

Ellena says:

Thank you very much indeed for your reply! I will follow your advice.

I would be very grateful if you could enquire from your friends if they could recommend specialists that are good with treating this condition in the Gauteng area. I live in Pretoria.

Kind regards

Dr Sylvain Chamberland, Orthodontiste says:

Hi Elena

You may have had condylar resorption prior to your fist surgery and you may have had progressive condylar resorption after surgery that may explain the relapse and the open bite.

Hormone replacement therapy may have pay a role, but i doubt it would make a significant difference at 58 yrs.

Wolford protocol may be a solution to consider. If your condyle are destroyed, it may be a case of total joint replacement.

I receommend that you visit an orthodontist and get a comprehensive treatment plan. He will likely recommend you a surgeon that is aware of condylar resorption.

There is very good orthodontist in South Africa. I know a couple of friends who leaves in Canada but are south african. They may recommend me good names.

Best regards

 

Ellena says:

Hi
Your input will be greatly appreciated.

I am 58 yrs old. I had orthognactic surgery 5 years ago to correct an openbite. There were complications. The surgeon bust my jaw into small bits. My upper and lower jaw were fastened for 6 weeks. The alignment was wrong so agter 6 months a second oprration was neededmto correct it. I have significant hardware left in my bones.

Progessively over the years the prosthodontist has had to file away at my back teeth to correct my occlusion. (All teeth are crowned). No more filing can be done. I discovered the condition progessive idiopathic condylar resorption myself and know it explains what is going on. I am very frightened.

I was on HRT (hormone replacement therapy) for years (including this period). I stopped it 2 months ago because I was estrogen dominant. I take bioidentical progesterone now.

Do you think the HRT could be the cause of all this? What are the chances of remission now?

What is the long term outlook if this condition continues? A joint replacement?

I woukd also like to know whether you think Wolford and Cardenas protocol which includes the Mitek anchor would be a solution to consider?

Kind regards
Ellena

Dr Sylvain Chamberland, Orthodontiste says:

It is a big mistake to maintain the upper left primary canine (63) and planning to remove the permanent canine later (23).

I would not hesitate in this situation to extract both primary canine (53 and 63) and because he is 13 years old, i would also extract both primary first molar (54, 64).

Please note that the permanent upper right canine (13) is likely located palatally because we can see the superimpostion of the root of the lateral incisor over the crown of the permanent canine.

If they don nothing, like not extracting the upper left primary canine, they increased the risk of impaction.

Self eruption of a high canine

The picture above show the effect of the extraction of a primary canine on an impacted permanent canine. You can see that the follow-up radiograph depict self eruption of the permanent canine over a total of 29 months.

Of course, the upper left canine of your son is higher and more horizontal, the pronostic of self eruption is not has good, but it will likely move in a more favourable position if the primary canine and 1^st primary molars are extracted.

In conclusion, i would extract teeth 53, 54, 63, 64 and reassess in 6 and 12 months. I would tell you that surgical exposition and ligature will likely be initiated in 12 months or so.

I hope that help.

.

Birgitta Bower says:

Hi again, my son's lower canine emerged immediately after the PEIR was mended with glassionomer. #6 didn't move, so we tried apicotomy of the dilacerated root(according to what Dr Edela Puricelli in Brazil recommends in her work concerning the 'inverted Y of Ennis'). Traction was delayed for 2 weeks because the orthodontist and surgeon didn't communicate, and the tooth didn't move.

Faced with either an implant at 17, that might get submerged, or living with a retainer for several years, I've researched auto transplantation which seems to be quite a succesfull solution in Europe, India, Australia... but isn't practiced a lot/at all in the US, I was wondering if you have any experience about it, or if it is in clinical practice in Canada.
(Would motivate us sending Sam to University of British Columbia which we visited this summer, very nice.)

Karen says:

Thank you for your reply.
My son will turn 13 in a couple of weeks. I've been told he has an underdeveloped mouth for his age-more like that of a 10 year old. He still has many baby teeth.
They want to leave the baby canine below the impacted one in case they remove the permanent one later, remove the baby canine from the other side, and remove the tooth behind the canine on both sides.
They then want to do nothing and wait a year to see if the impacted canine moves at all on it's own. I worry about another year going by and not attempting to aid the movement of the canine. I'm afraid if the root grows more, it will anchor in and not be able to turn.
Is there a way I can send his X-ray for you to see?

Dr Sylvain Chamberland, Orthodontiste says:

1- Yes. If you remove one semi-impacted lower 3rd molar, you should removed the upper third molar.
2- The bone heal and you won't have facial change.
3- You should avoid chewing hard food in the area of the removed teeth during healing.
4- The bone grow back.

Dr Sylvain Chamberland, Orthodontiste says:

Yes,I was successful bringing this high canine into occlusion. The case is presented in the keynotes Treatment and management of impacted canine with SPEED appliance slide 40 to 56.

This patient was 13-14 but I have treated patients in their early 20s with same success. The older they are, the longer it takes.
You are right that canines are important teeth and even if I elected to recommend extraction of some impacted canine, it is rare.

This is the exemple of a 17 years old man when I begun his treatment. The progress panogram is after 3 ½ years of treatment. It is 3 years longer than the 14 years old boy. But I got it done. I will finish by Christmas.

Dr Sylvain Chamberland, Orthodontiste says:

It is unlikely that a condyle would disengage whn doieng expansion. I don't know if you are an adult, but be aware that a schwarz appliance do not do skeletal expansion. It does only do buccal tipping of the posterior teeth which will likely be very unstable.

mark says:

hi dr, i just have a few questions
i'm 19 years old, and planning to get 4 wisdom teeth removed. 2 are partially erupt, all 4 cause discomfort, however.. they're still growing.

1st, I was wondering, if i remove one wisdom teeth do i have to remove the opposing one?


2nd, i know when you remove a tooth, bone resorption occurs, so when you remove wisdom teeth, it happens to the back of your jaw as well. a lot of doctors claim there is no facial changes, but through my research i see many ppl saying they've noticed it. and apperently it takes about 18 months to start really noticing changes. so i was wondering if you can truthfully tell me is it possible that your face does collapse a bit?


3rd, is there irritation when chewing hard food, in the spots where the teeth are removed

4th, does bone grow back in the spot where the teeth is removed or is it just pure gum?

thanks for your time, hope you can reply.

Karen says:

Under impaction and ectopic eruption, you have an X-ray of a horizontal permanent canine labeled 2. Were you successful in getting this tooth in position and erupting?
My son's X-ray has one canine in that same position and they are saying it can't be moved and needs to be permanently removed.
This worries me since the permanent canine is an important tooth.
I don't want to remove it unless I'm positive it can't get into position.

Verna says:

Hello Dr Sylvain,

A schwarz appliance I wore to correct a unilateral posterior crossbite created a maxillary cant and has caused asymmetry/lopsidedness in my face. Is it that the condyle has disengaged on one side? Can this be corrected by orthodontics alone?

Please advise.

Thanks.

Dr Sylvain Chamberland, Orthodontiste says:

Hi Anna, I am glad to receive good news. I am sure that the outcome is nice. When you feel you are ready to send update picture, I will make a composite of before and after.

Yours truly.

Anna says:

I have visited dr. Swennen on Tuesday the 30th of June, and Martin Gaboury was also there. They are both very good doctors.
It has been 5 weeks since the surgery now, and these last 2 weeks I am finally starting to feel a little better. I have to admit the surgery has been more heavy than I had expected.
The swelling and stiffness of my face with loss of my own facial expression, the scars in my mouth, the difficulty in talking, the lack of energy due to the inability to eat and the loss of weight: I know it is all temporary but it really came down on me.
But..... I am already starting to see the results of the surgery and that makes me very happy :-)
It is too early yet to send you pictures (my face is still swollen especially on the right side), but of course I will do this later!!!

Dr Sylvain Chamberland, Orthodontiste says:

Thank you for sending me the xray of the impacted canine of your 15 years old son.

It is quite deeply impacted and horizontal. Moreover, it seem to cross the midline as i can see the crown in front of the lower left incisors.

It is difficult to assess what would be the best approach.

If there is moderate to severe crowding of his occlusion, i would consider the extraction of the canine and 3 other premolars.

If there is no crowding, I would consider surgical exposure and ligature and orthodontic traction. However, the mechanics may be challenging. I used a removable appliance to begin with of most of the case, but in this case, i would consider miniscew and a system of cantilever beam fixed onto the screw to get bone anchor.

That is all I can say. I would visit your orthodontist first or get his opinion if the surgeon elect to extract the canine which would be my last choice if no other extraction are necessary.

My first would be to design the adequate mechanical plan and get the best surgeon which is easy here.

Case exemple

This is an exemple of a canine that was pulled from its impacted position. It took about 7 month to see the toth into the mouth. The second xray show the progress at 12 months at the end of the first phase of treatment. Other exemple are shown in the french version of this page.

Dr Sylvain Chamberland, Orthodontiste says:

Hi Jack,

I think you are form UK. Dr Mercuri has provided me a list of oral surgeon he know personnaly and that you can consult:

They are THE TMJ surgeons in UK and are well versed in management of ICR cases.

In London – Mr. Robert Hensher
In Birmingham – Mr. Bernard Speculand
In Nottingham – Mr. Andrew Sidebottom
In Oxford – Mr. Nadim Saeed
In Bradford – Mr. Stephen Worrall

Chances are that if they know well about idiopathic condylar reseorption, they know well in hypercondyle and facial asymmetry.

Laine maxson says:

I have the X-ray please give me the link or E-mail
to send it so you can tell me what you think. I appreciate your help very much.
Laine

Jack Gilbert says:

Thank you for all your answers Dr Chamberland, they have been most helpful.

Over the years I have developed a real interest in TMD, Occlusion, Facial Growth etc.

If you can point me towards any resources on these I would be most grateful!

Dr Sylvain Chamberland, Orthodontiste says:

I am not familiar with numbering system adopted by the ADA, so I had to search to understand whcich tooth are you talking about.

In Canada and most other countries of the worl utilze the Fedreation dentaire internationale numbering system. Therefore tooth #27 is the upper left second molar, but in the ADA system tooth #27 is a lower right canine.

The dark pocket is likely a follicular cyst that surround every crown of an unerupted tooth. If the tooth is impacted this follicular cyst may enlarge. The question now would be if it is possible to do a surgery to bond a ligature and try to bring the teeth into the mouth. I recommend that you consult an orthodontist to get his opinion.

Do you have a panogram that we could share in the page. If so, i will get you a link to upload the xray.