Expert: Dr. Randolph Myerson - 10/23/2008

Question
My daughter (12 years) has a front top adult tooth that is  not coming down.  The orthodontist has been working on it for two years and it hasn't budge.  The baby tooth never came out - the oral surgeon removed it and attached a gold chain to the tooth and the orthodontist tried pulling it down the normal routine way. A second attempt was made by removing what they thought might have been a small piece of bone that was holding it back - it was back to the oral surgeon again for this.  The oral surgeon at that time said the tooth was now loose and he was 99% sure that it would move and come down.  Again everything was hooked to the gold chain for pulling.  Nothing moved. Instead her other teeth got pulled out of line.  The third attempt, he tried putting some brackets behind the tooth to pull from that direction.  Again nothing has moved but the other teeth are being pulled out of line.  He is now proposing to put on new brackets around the top teeth, hooked to the molars and somehow pull from that direction - he is not too hopeful that this will work any better but it is the only thing he can think off as a last resort.  Should we just give up and have the tooth extracted and an implant put in when she reaches adulthood (his final option)?  Should I go get a second opinion from another orthodontist?  How many ways are there to pull a tooth down?

Answer
Usually an impacted tooth will respond to surgical exposure and forced orthodontic eruption.  On occasion it may not.  Failure to respond after repeated efforts, surgical exposures and distortion of the anchor teeth positions constitute a clear indication that this tooth will not respond.  In my opinion the prognosis here is poor and further attempts will probably result in additional distortion of the alignment.  A reasonable alternative would be to have the impacted tooth removed, the remaining teeth corrected to acceptable alignment and function, place a retainer with a replacement tooth and have an implant done at the appropriate age.