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Friday, December 6, 2013
Braces and ankylosed teeth
My 12 year old son had a supernumerary tooth (about the size of a deciduous canine) positioned between #8-9 three years ago and my son`s othodontist recommended extracting it. It was done and then we were instructed to wait until more permanent teeth were erupted before bands were placed. Bands were placed in Dec 08 and now we have found out that the extraction of the supernumerary caused damage to the mesial side of #9 and there is no periodontal ligament and the tooth is ankylosed. My question to you is, what can be done now? They have mentioned to me that the tooth may have to be extracted but this is, I feel, should be a last resort. They have also mentioned reimplantation, and I don`t really understand that. He also has #24 and #25 congenitally missing which we know will have to be extracted and then have an implant placed in his early 20`s. I am asking that you please share advice and new technology that you may have heard about.
This is a complex situation that will require personal attention by both an orthodontist and an oral surgeon.
I would recommend getting a 3D volume view of the area to determine the extent of the damage. 3D volume images can be obtained of dental structures with minimal radiation dose. Depending on where you live you might have to travel to an imaging center as these machines are not found in all dental offices.
Since your son has multiple missing teeth, I would recommend waiting until all of his permanent teeth are in his mouth before beginning treatment. Your options for the ankylosed tooth are:
- Do nothing about it.
- Try to subluxate (break the attachment between the tooth and the bone) the tooth to allow movement. This absolutely needs to be done in conjunction with the application of orthodontic forces, subluxation alone should not be done.
Extraction of the tooth at this time is not an option.
Hope this helps.
Mark G Hans, DDS, MSD
Professor of Orthodontics
School of Dental Medicine
Case Western Reserve University