Expert: Dr. Randolph Myerson - 12/3/2009

Question
Dr im 20yrs old n im under treatment from an orthodontist in my home country since 1yr,i hav upper mildine shift about 1.5mm but it is almost corrected n the dentist says my treatment is almost complete,my upper maxillary right canine was impacted n it was extracted by an inexperienced dentist when i was a child-n that was the cause of the midline shift and lead to class 2 malocclusion on one side and class 3 maloclussion on the other,my problem is that although my midline is correct there is still a space where the canine should hav been i feel that my teeth r gona shift back once the treatment is off,i am being treated with cross elastics in which the 1st runs from my 26 to 33, the 2nd from 23 to 43 and the 3rd from 13 to 46,plz suggest what should be done in this case and whether this treatment would become useless after sometime?,and whether my dentist is doing the right job?and plz suggest what should be done about the gap between my upper lateral and premolar as it is small for a canine to fit in and how will i have to wear my braces to create a gap for a canine bridge?plz help as im in 3rd yr of dentistry myself n im very worried about my teeth.thanku

Answer
Without access to photographs, various x-rays and casts of your teeth both now and at the start of your treatment I would not have sufficient information to comment specifically on your treatment plan and progress.  I can, however, offer a few general comments regarding your orthodontic treatment.  Because of the early extraction of a permanent tooth there now exists an imbalance or mismatch in the number of teeth top to bottom and left to right.  This creates a significant compromise in the potential for an ideal result.  As a generalization I would not favor leaving a space where the missing canine should be.  Either that space should be opened for a prosthetic replacement or closed to create a more stable bite relationship.
If you would like to have a comprehensive review of your situation I suggest you gather duplicates of your original pre-treatment records as well as current x-rays and/or study models and have a second opinion with another orthodontist.  In all fairness you should have a complete discussion of your treatment status with your current orthodontist and ask your questions and express your concerns as well.