#6 and #11 teeth surgery case

[DDS2BE]

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I need your thoughts on this. I’m 25 and still have primary #6 and #11 cuspids. Just in the near resent had x-ray done by my dentist and discovered adult #6 and #11 sitting inside the jaw, in a 90 degree angle. From cosmetic standpoint, my jaws and occlusion look absolutely normal. The thing that bothers me is sooner or later they will eventually fall or wear out and I would need some kind of surgery to pull my adult teeth on place. I would rather have it done now then wait for cosmetic reasons. My dentist has no professional opinion on this and mentioned OMS as they would know what to do. Should I wait and have it done when my d-school starts or don’t bother? I really want to get invisalign but afraid with my baby teeth fall out I would need to pay for invisalign again.

 

[aphistis]

I need your thoughts on this. I’m 25 and still have primary #6 and #11 cuspids. Just in the near resent had x-ray done by my dentist and discovered adult #6 and #11 sitting inside the jaw, in a 90 degree angle. From cosmetic standpoint, my jaws and occlusion look absolutely normal. The thing that bothers me is sooner or later they will eventually fall or wear out and I would need some kind of surgery to pull my adult teeth on place. I would rather have it done now then wait for cosmetic reasons. My dentist has no professional opinion on this and mentioned OMS as they would know what to do. Should I wait and have it done when my d-school starts or don’t bother? I really want to get invisalign but afraid with my baby teeth fall out I would need to pay for invisalign again.

First, just FYI, primary teeth go by letters, not numbers. Your primary canines are #C and #H (yeah, that's actually what they're called. Don't ask me. 😉) If you still have primary teeth at age 25, there's a pretty decent chance they're ankylosed--that is, fused directly to the bone. If that's the case, they won't come out on their own; it would also make orthodontic treatment a lot more difficult.

 

[tx oms]

The sooner you have the procedure the better. Aphistis is right, it's probably too late, but it is worth a shot if you understand the high chance of failure. You need to see an orthodontist first, then an OMFS.

 

[DDS2BE]

Thanks guys 👍 but do you have a price figure in mind on this procedure? I have dental insurance but it only covers 1k per year 🙁 My dental school starts in July so I think I would be able to get this prosedure done using my medical insurance purchased through Case Western and won't probably have to pay.

 

[tx oms]

Thanks guys 👍 but do you have a price figure in mind on this procedure? I have dental insurance but it only covers 1k per year 🙁 My dental school starts in July so I think I would be able to get this prosedure done using my medical insurance purchased through Case Western and won't probably have to pay.

Surgery fee is probably going to run 300-400/tooth plus sedation cost if you want sedation. Just guessing. Then you've got to pay the orthodontist.

Also, medical insurance won't pay for that type of procedure.

 

[predentchick]

tx: He mentioned invisalign. Isn't this the type of case that can't be done with it? Just wanted your opinion...

 

[3rdMolarRoller]

for invisalign, all perm. teeth must have erupted (excluding 3rd molars). You can do it if teeth were extracted, but since your's haven't erupted, probably not.

So I highly doubt you can do invisalign, but I have only had one invisalgin class so far so I could be wrong

 

[tx oms]

Cannot be done with invisalign.

 

[HuyetKiem]

I need your thoughts on this. I’m 25 and still have primary #6 and #11 cuspids. Just in the near resent had x-ray done by my dentist and discovered adult #6 and #11 sitting inside the jaw, in a 90 degree angle. From cosmetic standpoint, my jaws and occlusion look absolutely normal. The thing that bothers me is sooner or later they will eventually fall or wear out and I would need some kind of surgery to pull my adult teeth on place. I would rather have it done now then wait for cosmetic reasons. My dentist has no professional opinion on this and mentioned OMS as they would know what to do. Should I wait and have it done when my d-school starts or don’t bother? I really want to get invisalign but afraid with my baby teeth fall out I would need to pay for invisalign again.

I have seen many of similar cases in the past couple years. It is pretty common. Oral surgeon would do the surgery to expose those teeth into patient's oral cavity. Mechanical wire and bracket are then glued on, in part of orthodontic treatment. Most of the time, the primary teeth are not ankylosed and would be extracted after few months.

 

[toofache32]

I have seen many of similar cases in the past couple years. It is pretty common. Oral surgeon would do the surgery to expose those teeth into patient's oral cavity. Mechanical wire and bracket are then glued on, in part of orthodontic treatment. Most of the time, the primary teeth are not ankylosed and would be extracted after few months.

This is the treatment. It's bascially orthodontics which pull the tooth into position after the OMS removes the baby teeth and cuts away bone to expose the permanent tooth.

Invisalign is really only useful for mild class I malocclusions which may even correct themselves with time. Most of the orthodontists I know use it to get patients in the chair. Then they can explain to them that Invisalign won't work for them and how they need to have their grill wired up the old fashioned way.

As for insurance, it will be well over your yearly $1000 allowance. And medical insurance won't pay for it because this is a dental problem, not medical.

 

[aphistis]

This is the treatment. It's bascially orthodontics which pull the tooth into position after the OMS removes the baby teeth and cuts away bone to expose the permanent tooth.

Invisalign is really only useful for mild class I malocclusions which may even correct themselves with time. Most of the orthodontists I know use it to get patients in the chair. Then they can explain to them that Invisalign won't work for them and how they need to have their grill wired up the old fashioned way.

As for insurance, it will be well over your yearly $1000 allowance. And medical insurance won't pay for it because this is a dental problem, not medical.

What happens once the tooth has been extruded into position? Do you punt them to a periodontist to replace the missing bone? Canines are well-supported teeth, but that's still a lot of aspiring periodontium you have to cut through to reach the suckers in the first place.

 

[tx oms]

What happens once the tooth has been extruded into position? Do you punt them to a periodontist to replace the missing bone? Canines are well-supported teeth, but that's still a lot of aspiring periodontium you have to cut through to reach the suckers in the first place.

Most maxillary canines are impacted palatally. The access is done through the palate and palatal gingiva. As the teeth are pulled into place they bring bone and gingiva with them, much like distraction osteogenesis.

The real challenge is with bucally positioned teeth. If you make your incision in unattached mucosa rather than gingiva b/c the tooth is above the attached gingiva, the tooth will pull down but without the associated gingiva. In this case the surgeon makes his incision in the attached gingiva, raises a flap of gingiva to the level of the tooth, exposes the tooth, and then sutures the gingival flap at the CEJ of the exposed tooth so it will pull attached gingiva with it. Leaves a big ass denuded space in the mouth. Painful.

These are the methods I was taught and use. There may be others/variations. All of these are easier explained with pictures.

Pictures here
Other links here

 

[DDS2BE]

This is the treatment. It's bascially orthodontics which pull the tooth into position after the OMS removes the baby teeth and cuts away bone to expose the permanent tooth.

Invisalign is really only useful for mild class I malocclusions which may even correct themselves with time. Most of the orthodontists I know use it to get patients in the chair. Then they can explain to them that Invisalign won't work for them and how they need to have their grill wired up the old fashioned way.

As for insurance, it will be well over your yearly $1000 allowance. And medical insurance won't pay for it because this is a dental problem, not medical.

I actually have medical and dental insurance with $1000 allowance on dental. How long would it take to get to pull my permanent teeth since my baby teeth removed? And how painful is this process? I don't feel comfortable walking around with my canines pulled out for months

 

[DDS2BE]

I don’t wanna sound sissy, but you guys got me scared 😱 big time. Should I bother getting this done at all?

 

[tx oms]

I don’t wanna sound sissy, but you guys got me scared 😱 big time. Should I bother getting this done at all?

If you undergo the procedure your primary canines aren't removed initially, only as the adult canine moves closer. If you don't get this done you'll eventually have to have something done b/c the primary canines will fall out. You may actually have better success for the same money with other treatments (implants, bridges, partials). Talk to an orthodontist.

 

[DDS2BE]

If you undergo the procedure your primary canines aren't removed initially, only as the adult canine moves closer. If you don't get this done you'll eventually have to have something done b/c the primary canines will fall out. You may actually have better success for the same money with other treatments (implants, bridges, partials). Talk to an orthodontist.

Thanks for advise, tx oms 👍

 

[DBEAR]

DDS2B,
Tx OMS has given you some good advice. In my experience, the older you get the more chance you have of both the primary and permanent canine being ankylosed. Also, sometimes I have just extracted the primary canines and this triggered the permanent canines to erupt withou surgery. However, this is the exception. One technique that is used quite often is to cut a "window" in the palate to expose the canine and remove the bone all the way to the CEJ. Removing bone the the CEJ is important because it helps to trigger the tooth to erupt natually. This will happen is probably 90% of all cases. However, what if you fall in the 10% that the tooth does not spontaneously erupts. So, I like to also place a button and chain onto the tooth. This can be difficult sometimes because in order to bond the bracket to the tooth you need a dry field. So, I do not like to cut a "window into the tissue but rather lay a flap. This technique allows you to have better hemostasis control hence better bonding. You do not want to have another surgery in order to rebond the button
and chain. Also, if you extract the tooth the same day as you expose the canine then you can run the chain through the primary tooth extraction socket. Finally, you need to try to luxate the tooth at the surgery. This will give you a pretty good idea if the tooth is ankylosed. If the tooth does not luxate and I am sure that it is ankylosed then I will extract the teeth that day and may or may not graft the area with bone. Then recommend implants or FPD. Price wise in our area the going rate is around $700 per tooth or #300 at the school. Also, some medical and dental insurances will pay for this procedure. You probably would have to get your dentist to write some sort of narrative on why this procedure is necessary. Hope this helps.

Todd
3rd year perio resident

 

[DDS2BE]

Thanks for educating me, people 🙂 . I will pay a visit to an orthodontist then.

It's nice to know there are people ready to answer pretty much any question here at this forum 👍

 

[Qbankungfumasta]

I don’t wanna sound sissy, but you guys got me scared 😱 big time. Should I bother getting this done at all?

I would get it done...primary teeth are crappy anyway, and there's always local anesthesia. Extracting impacted third molars is a way more risky procedure and ppl have it done all the time.
PJ

 

[texas_dds]

of course it depends on the position of the impacted teeth, but i have read about and assisted a surgery that utilizes the "closed eruption technique" where the canine is accessed, only enough bone is removed to clear a path for its normal eruption, a chain is bonded, and the flap is repositioned with the chain hanging out of it - in that case the patients canine dropped down on its own within 2-3 weeks (chain wasnt yet tied to archwire!) and the tissue looks great. this closed eruption technique gives a better esthetic gingival result than an apically positioned flap writes Kokich.

anyways - hope everything works out with your canines, and PLEASE dont spend your money on invisalign right now - you have much more pressing issues orthodontically and invisalign would be a waste of money for you at this time