The comments
Dr Sylvain Chamberland, Orthodontiste says:
The root will likely become submerge and embed into the bone like in the case of partial odontectomy depicted above. It is often safer to let a residual root than try to dig bone around and take the risk to damage the dental nerve.I would not worry about abcess formation. If it occurs you will need antibiotherapy anyway and the surgeon will be able to manage the complications.
From the written notes of your surgeon, i guees that he did a partial odontectomy on purpose. Chances are that he took the right decision.
Laine says:
My son has an impacted horizontal bottom tooth #27under his bottom, front teeth. The Dentist who did his exam told me that on the X-ray, there is a dark pocket around the tooth. They are concerned about this and have set up an appointment with an oral surgeon. Please tell me anything that would be helpful in informative. He's 15 and being his Mother and only Parent, I of course, am concerned. Please get back to me. Thank-you.
Ms.Maxson
Jack Gilbert says:
Hello Dr Chamberland,Please accept my apologies for the belated response!
The person in your presentation is very similar to myself. I do feel that growth has stopped and probably has been for some time, but I worry that perhaps it could start up again?
My mandibular asymmetry was present long before I developed any 'TMD' symptoms, I just lived with the asymmetry and assumed it was just the way I was.
When I began experiencing 'TMD' symptoms I ended up in the care of a 'TMD Expert' and began an orthodontic treatment that lasted many years and cost over £10,000. At the beginning I totally bought into the reasoning, this was before I began asking questions and doing my own research on 'TMD'.
Unfortunately, it is only since the orthodontics finished that I became concerned with the mandibular asymmetry. I went to see a maxillofacial surgeon on the NHS who told me I would need potentially even more orthodontics if I wanted to have orthognathic surgery to correct the asymmetry. This is something I just can't commit too, so he recommended genioplasty only as a compromise. This I feel is my only option now.
Kade says:
Hi Dr Sylvain,Thanks so much for this excellent article! So informative!
May I inquire, what should I expect after my dentist has left a root behind after removal of my upper right wisdom tooth?
1) Will the root eventually emerge years later and require removal?
2) Is there a risk of abscess formation?
This was her post surgical notes:
Excision of right wisdom teeth; impacted lower and non-functional upper right wisdom teeth
Operation done - Tooth (superficial), unerupted/partially erupted/impacted, excision with removal of bone and tooth division.
Dr Sylvain Chamberland, Orthodontiste says:
There is no free lunch.Depending how far in the palate your tooth is, it may take 6 month to 1 year to get the canine in the space. However, the whole wille not look like a whole as the tooth will be approaching.
No worries, at the end of the treatment, your canine will be nicely aligned.
Best regards
Sarah says:
Hello, I am a 20yo female impending surgery to have my impacted canine exposed. It is in the palette of my mouth. Roughly, how long would I have a gap for once the baby tooth is removed? I am very self conscience about this whole procedure and treatmentDr Sylvain Chamberland, Orthodontiste says:
Condylar hyperplasia
Hi Jack
You are in the age group that can be affected by condylar hyperplasia. You remember it might have developped in your mid teens and you are now a young adult. The hyperplasia might be burnout now (self-limited) but the asymmetry is there. You are like the young adult shown in the keynote on slide 57 to 64 who was 22 when i first saw him. The bone scan revealed increase uptake, so the condyle was actively growing. That is why we did a high condylectomy.
However, at 24, your condyle may have stop growing. It need to be confirmed by a bone scan. In the section questions and answer, there is another case that may look like you. See "asymétrie des masseters" . You will find the translation if you click on the word english in the upper right corner, but there is much more comments in the french version of the page. I have treated this young man when he was 12-14 years old. I have final photos of his face and it was perfectly symmetric at that time. He came back at age 28, because he thought his bite has changed. It did, but there was some compensation so the bite is OK. However, he have a significant deviation to the left. I refered him to the surgeon for a bone scan, but there was no increased activity. The patient decided to not go into a surgery. He accept to live with his asymmetry. I have other patient who would not accept that.
The condylar hyperplasia can be related to a contralateral clicking of the joint. The overgrowth on one side make the contrallateral condyle rotate in its narrow condylar fossa and the disk may displace.
If you are still interested to send me photos and accept that they may be published, il will tell you my email.
Best regards
Jack Gilbert says:
Thank you Dr Chamberland,No history of facial asymmetry in my family. I seem to be the only one affected.
Perhaps you are right and it is unknown what causes overgrowth of one side. It seems to me that more is understood about stunted growth than overgrowth.
I would definitely say my asymmetry is significant. I think it began to develop some time in my mid teens, I am now 24. I am almost certain it is the result of unilateral hyperplasia rather than hypoplasia.
Along with the asymmetry I do also suffer from 'TMD' although perhaps they are not related?
There is so much poor quality and outdated information regarding 'TMD' that it can be difficult to know where to look for answers. It seems many orthodontists and surgeons hold on to out of date beliefs.
If you like I don't mind showing a scan or photo.
Dr Sylvain Chamberland, Orthodontiste says:
Hi Mr Gilbert,That is a good question, but i don't know if the cause of condylar hyperplasia is know. I don't think i could answer this question. If if could make a comparison, i would ask: do we know the cause of scoliosis? May be not, i am not a physician or an orthopedist.
But for TMJs and jaws deformity, chances are it is likely hereditary as often time i would note that the father of the mother or a relative has a facial asymmetry. Condylar hyperplasia is often time self limiting but the the question is, when significant overgrowth is noted and the bone scan reveals an increased uptake, how much more asymmetry are we willing to tolerate before it stop.
I would guess that you are a non growing adult and your condyle is likely non growing. I would recommend that you visit an orthodontist for a better diagnosis of your condition.
Best regards
Jack Gilbert says:
Hello Dr Chamberland,Is it known what causes condylar hyperplasia or hemimandibular hyperplasia?
I suspect this to be the cause of my facial asymmetry.
Thank you so much for your time.
It speaks volumes that you are so willing to communicate with others on your website.
Dr Sylvain Chamberland, Orthodontiste says:
Thank you Goli for sending me the picture of your profile.
I traced an tangent line from the tip of the nose to the tip of the chin. It is obvious that your lips are retruded relatively to this line. Your profile and your lip support DO NOT reprensent a bimaxillary protusion. Moreover, in your profile smile view, we see deep nasolabial fold. Extracting 4 premolars would be disastrous in your face. The lips would be more retruded, the nasolbial fold would appear deeper, the nose longer and the chin more prominent. And yes, in your case, your lips would likely becomme thinner. You are only 33 and you would suddenly look 63.
The intraoral view show a nice class I relationship. Even your 3rd molars are in occlusion. There is nor significant crowding.Frankly, I don't understand why you want an orthodontict treatment and I am amazed than an orthodontist recommended extraction.
En resume, I do not recommend any orthodontic treatment for you.
Goli says:
tnx a billion drCan I send may cephalogram and OPG for you?i want to know your idea if I would be better or worse after that?
Dr Sylvain Chamberland, Orthodontiste says:
Wow! that is quick. Glad it helped. DId you notice I edited a link to the treatment of case #1.Bonne journée
Dr Sylvain Chamberland, Orthodontiste says:
Bimaxillary protrusion
Hi Goli,
Sorry for the delay to answer you question.
Extraction of 4 first premolar won't have an effect on the vertical dimension. It will not increase or decrease. However, in some case with deep overbite and low mandibular plane, it might be ill advice to extraction in the lower arch.
The goal, in a patient that have bimaxillary trotrusion is the reduce that protrusion. Therefore, it is expected that the extraction of 4 firs premolar will permits to rectract the anterior teeth and reduce the dentoalveolar protrusion, hence reducing the protrusion of proclination of the lips. This is somthing we want to happen in such cases. The thickness of you lip will remain about the same, but they will be less protruded.
I would like to show you the result of 2 cases that had 4 first premolar extracted.
You will notice that in case #1, the procumbency of the lower lip was reduced and the relationship with the upper lip imporved. By the way, case #1 is the case shown above with intraoral photos. The detailed treatment is available in french (follow the link).
In case #2, the retraction of the teeth help to reduce the procumbency of both lips and help achieve contact of the lips at repose.
In both cases, the vermillion of the lips is not thinner.
Case 1:
Case #2
Dr Sylvain Chamberland, Orthodontiste says:
Hi NatashaThe first part of this article discuss the effect of breastfeading. The consulsion is:
There were no statistically significant differences between the breastfeeding duration subgroups in any of the occlusal characteristics compared. The authors conclude that prolonged breastfeeding does not show benefits on the prevention of malocclusions compared to a shorter duration of breastfeeding or no breastfeeding at all. Therefore, breastfeeding seems to have little effect on occlusal characteristics of the dentition.
Chances are that the crossbite of both of your children might be explained by something else.
You may need a visit to an orthodontist when they will be 4-6 years old.
Dr Sylvain Chamberland, Orthodontiste says:
Dear Anna,Thank you for the follow up.
This is good news and i agree that you can rely on the expert opinion of Dr Sweenn and Dr Gaboury. They will likely do a 3D treatment planning of your surgery similar to the one showed in my reply of 7 January 2015 at 20 h 55 min .
The picture of you taken some 20 years ago effectively confirm facial asymmetry.
Please keep us informed of your progress. We will be glad to hear form after your surgery. I wish you will accept to show a photo of the ower part of your face after surgery.
Best regards
Dr Sylvain Chamberland
Anna says:
Dear dr Chamberland,It has been a couple of months since our last email contact. I deeply apologize for that. Hope you are doing fine!
I would like to give you an update about my situation.
In February and March I have visited professor Swennen and your former student dr Gaboury 2 times.
Both of them are convinced that my 'problem' has been there for over 20 years. This is also based on several pictures from the past, which I will also send you in a separate email.
On these pictures the deviation of chin to the left is already visible indeed, although it seems to me it is less obvious than at the present moment.
But of course I rely on the expert opinion of dr Swennen and dr Gaboury. No condylectomy is necessary, and orthognathic surgery is planned on June the 3rd.
In these coming weeks 2 more consultations are planned as a preoperative work-up.
I am excited about the surgery, and also a little nervous of course.
Hopefully everything will go right....