The comments

Dr Sylvain Chamberland, Orthodontiste says:

Hi Mark,
There is many ways to bring an impacted canine into occlusion and the one you describe is one of them. However, engaging a Niti wire to the attached chain is likely to cause side effect of intrusion and canting the occlusal plane even if the tooth in not ankylosed. The figure on the left show the force system and what occurs in picture A and B. The recommended approach is to use a main rigid archwire and an auxilliary wire (picture C). The main arch wire will prevent side effect and the auxilliary wire will assist the forced eruption.

My preferred approach is to use a removable appliance so there is almos no side effect on the adjacent teeth. Once the canine has moved and is visbile in the mouth, then i will finish the cases with braces.

I have limited experienced with luxation of an ankylosed tooth since often time it reankylose as it healed and it may undergo external root resorption. Therefore this is not my preferred option, but i know some orthodontist did it.

A more complete answer would take me 1 hour to write, but all my materials is availables in keynotes. I recommend that you look at the keynote palatally dispaced canine in my slideshare site.

I was lecturing at NYU College of dentistry last Firday (May 1^st)  and the first 15 minutes of the lecture was on mechanics to extrude high canine. Most slide are in the above mentionned keynote

I hope that help.

Best regards

 

Goli says:

Hello doctor
I'm goli from Asia
At first Please forgive me if my English is not good.
I have a question ,I'm 33 with bimaxillary prutrosion ,
my doctor told me for correction I have to extract 4 first premolars ,
can you please tell me that my facial height specially my lower anterior facial height would be changed after that (shorter or longer?)and what happened to my lips ,do they become thinner or thicker?
And what about my nose I would be appeared bigger and prutoded ?
Thank you

Dr Sylvain Chamberland, Orthodontiste says:

Of course you should go for it. It may take 6 to 12 month to bring the canine into occlusion.

Treament time is dependent of the initial position of the impacted canine, the exposure approach, the mechanics that is used and the skills of your orthodontist.

Mark says:

Hi Dr. Chamberland.
I reside in NYC. I am a 34 y/o undergoing ortho treatment 18mos and traction on an upper right canine for 4mos.
A periapical taken recently didn't show any noticeable canine movement. It is sitting in a vestibular position, but the very tip of the crown is out of the bone labially, where the oral surgeon attached the bracket and chain.
My Ortho currently has a Niti wire going through the arch up through a link in the attached chain.
I feel soreness constantly but can't feel or see any visible results.
If it is ankylosed, I want someone knowledgeble to definitively diagnose it radiologically (PDL juncture), and/or using the percussion method.
Also, if we can determine how much of the tooth surface is fused, and if it's a small percentage, if subluxation would be an option.
If it's not ankylosed, I am concerned if my ortho understands why it got impacted in the first place, as I had an over-retained baby canine until I was 25, and if he is applying the right force or understands the anchoring demands to move this tooth.
My last visit 2wks ago, he noticed some intrusion of arch. He said that's a bad sign :( I am desperate to have this tooth come in, because of the time, cost, possible risks with extraction, grafting, and implant.
I have xrays and photos if you wish to see them. I would appreciate some advise. I am grateful for your thoughts and ideas!

riya says:

I have impacted canine abv my lateral incisor my orthodontic is telling me for surgical exposure should I go for it? How long it will take to erupt

Dr Sylvain Chamberland, Orthodontiste says:

No, I would not worry. Braces will bring your teeth in alignment assuming adequate treatment plan and mechanotherapy is used.

Dr Sylvain Chamberland, Orthodontiste says:

Face mask therapy and open bite

Hi Dr Ashrafi

Sorry for the delay to answer your question. I need a moment to find the appropriate case.

Vaughn et al (AJODO 2005) published a randomized clinical trial on the effects of maxillary protraction therapy with and without RPE. The conclusion say that PRM therapy produce equivalent changes with or without RPE. Correction results from a combination of skeletal and dental changes that produce an improvement in the skeletal, dental and soft tissue relationship. Skeletal change was a combination of anterior and vertical movement of maxilla and posterior and downward movement of the mandible,

Therefore i agree with you that there might be a risk of worsening an openbite. But i have treated some case and it was not that bad.

Here are 2 exemple.

Case 1

As you can see, there was no overbite at the beginning, but at the end of phase 1, a positive overbite of 1 mm was obtain.

Case 2

This case show an openbite of 1-2 mm, a posterior crossbite and significant arch length discrepancy. Progress at 6 months show a positive overjet and overbite. Lower canine were extracted to allow uprighting of the lower incisors and alleviate crowding. Follow up at 28 month post phase 1 show an edge to edge incisor relationship. The your boy is now 12 years old and is getting into his pubertal growth spurt. Chances are that class III relationship might worsen. He is under observation. I will likely not recommand phase 2 treatment until the growth has ceased.
The ceph show initial and end of phase 1 therapy.

 

Gregory A. Vaughn, Brian Mason, Hong-Beom Moon, and Patrick K. Turley, The effects of maxillary protraction therapy with or without rapid palatal expansion: A prospective, randomized clinical trial, Am J Orthod Dentofacial Orthop 2005;128:299-309

 

Destiny says:

I'm 25 with two impacted cainines in the roof of my mouth. One is fully erupted and the other is partially erupted. Will the partially erupted tooth be exposed enough to move in place by braces? Or since they have been stuck in this position for about ten years will braces even move them over?

Dr Sylvain Chamberland, Orthodontiste says:

I have never heard that the removal of of wisdom teeth would have any impact on facial profile, nor it may cause skinnier face.

I would trust American and canadian surgeon on this as well as my word.

Removal of wisdom teeth will not affect facial profile.

Claire says:

Thank you, that is most helpful.

Best wishes,

Claire

Dr Sylvain Chamberland, Orthodontiste says:

Hi Claire,

Living in Canada, i don't know UK oral surgeon, but my good friend Dr Louis Mercury does. Therefore I forwarded him your question.
This is his recommendation:

Sylvain:
I know these gentlemen personally. 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

Thank you for the inquiry, i hope this helps this patient.

Hope all is well with you and your family.

Regards,
Lou

Claire, I wish you all the best.

Claire says:

Hello, I have condylar resorption which causes me very severe pain. I am from the UK and therefore wondered if you knew of any UK surgeons who specialise in this area. Thanks

Vic says:

Hi,

I was just wondering if you could clarify a concern I've been having over my extracted wisdom teeth. I have read conflicting opinion over whether their removal causes facial changes and was hoping to get a conclusive answer on this. These are some of the answers I've gotten from dentists and the like so far:

1) Yes, your facial profile will change. A slightly collapsing of the face will occur. (Dentist and Craniofacial expert in London)

2) Yes, bone remodeling will take place and the mandibular angle of the jaw will change. This will all happen over a few years. Also, Korean women commonly get them extracted to get a skinnier face. (Dentist in Korea)

3) Yes, changes can occur. (Customer service employee at the ADA)

4) And finally, no there will be no changes and the wisdom teeth have no affect whatsoever on the jaw and facial contours. (Almost every oral surgeon or dentist I've talked to in the United States)

Just wanted to get your thoughts on who I should trust/who would be correct in this instance..

Thanks so much for your time and expertise,

Victoria

Dr. M. Ashrafi says:

How will face mask effect in open bite cases,
will it worsen the vertical growth pattern patient ?
Thanks

Dr Sylvain Chamberland, Orthodontiste says:

Bonspir Tushar,

I moved your question to this page where it is more suitable with the topic of the page.

I think you should consult an orthodontist and an oral surgeon as soon as you can. At 16 years old, you are near the end of your adolescent growth period. Chances are that you will need orthodontic treatment along prior to maxillofacial surgery.

It is normal that your face became more and more asymmetric from 13 to 16 as you had normal growth on the right side while the left side had impaired growth.

Did you had reduce mobility in term of jaw opening? I wish not. Decrease mobility is a sign of ankylosed joint.

I show you a panogram of an adolescent who had bilateral condylar fracture, fracture of the left maxilla and fracture of the mandible on the right side at 14 years old.She was having an ortho treatment. The oral surgeon call my office to have the photo of the patient to put the pieces together...

She had reduction of the fracture of the left joint only. The growth of the left joint was significantly reduce, but the right joint resume to normal growth with no sequela. The consequence is that she have some faical asymmetry to the left. A bimaxillary surgery was necessary.

This is the panogram post accident



The second panogram show the result after a bimaxillary surgical phase that was necessary to correct the assymmetric facial growth that occur some 5 years after the car accident. One can see the normal growth of the right condyle, but impaired growth of the left condyle.

Tushar says:

hello,
i am a boy age 16 i had an accident at the age of 13 due to which my left jaw joint was fractured .
when i see my face in the mirror i see that my right size is growing normal whereas my left isnt growing ,,
my face is getting assymetric and i am really worried .
i want to know how can i treat it and at which age should i start the treatment

Dr Sylvain Chamberland, Orthodontiste says:

Hi Dr Medhat,

Yes I enjooyed very much my stay in Bruxelles.

Question 1.

Facemask therapy is recommended for young patient, ideally 5 to 7-8 years old, but also 8to 10 years old. At this age, there is usually few if any dental compensation or eversion of the upper incisors.  Therefore, i do not worry that much about increasing dental compensation when  protracting the maxilla at this young age.

Dental compensation in a class III malocclusion will likely appear after the facemask therapy as the cl III growth pattern will continue to express from, let's say, age 7 to 12 assuming the patient was treated at age 6. It is during the pubertal growth spurt that will will know for sure if our interceptive treatment will old and a positive overbite will be maintained.

I have very limited experience of facemask therapy in adloescent patient. Often time, if they have a cl III relatioship at this age, i will let them grow and treate them surgically at 17-18.

Question 2

An impacted canine will likely be diagnose in a patient older than 12-13. I do not do facemask therapy at this age because of poor prognosis. However, Dr DeClerk who is from Belgium and who you likely know well, might use his Bone anchor system where he can pull the bone with cl III elastics and move the teeth in opposite direction. I can not say more. You should ask him.

However, I may be treating a case that would fit some of your description. She is 11 years old. Constricted maxilla, posterior crossbite, blocked out maxillary canine, proclined lower incisors, retroclined lower incisors.



I did RPE , extracted #53 and she wear a protraction face mask since june 2014. The patient and her parents were told that she will likely need orthognathic surgery.

I get some maxillary protraction but i still have no room for the canines. Of course, i will not put braces in the upper arch until i get enough overjet and class I molar relationship. Putting braces would move incisors into collision with impacted 13.

She come back next week. I will take progress records. Wish me good luck. I will need it.

 

Dr Sylvain Chamberland, Orthodontiste says:

It is not impossible that you may have a remaining wisdomme tooth, but I would recommend that you visit a dentist and get a panoramic xray to confirm or infirm. It might be many other things that you could have. The wisdom tooth is likely the least probable.

gloria karabinakis says:

Question: I am a70 year old female with full dentures. I have a small hard, white eruption at the site of where a wisdom tooth would be. Swelling and tenderness evident.

Is it possible to actually have a tooth erupt at this age?

Medhat says:

Hallo Dr. Chamberland, i hope you did enjoy your stay while lecturing in Belgium. Unfortunately i could not attend, hopefully next time.
I have some questions regarding using the face mask:
1- Does the commonly seen eversion of the upper anterior teeth (i.e. compensation class III) influence your decision using the face mask?
As you start treatment from an already compensated situation, this will make the labioversion of the upper incisors worse after using the face mask.
2- what about cases with impacted canines, do you combine the face mask with a protrusion utility arch. Or prefere afouding the risk of root resorption of the lateral incisors?
Thank you,
Best regards,