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Question
My 13 year old daughter has been seeing an orthodontist for several years and has braces. The permanent canine tooth on top right has not come in and she is scheduled for oral surgery to remove this tooth. My question is could this tooth be placed in the correct spot in her mouth or will she have to have an implant? The orthodontist has really done a wonderful job with her teeth and we are pleased with the progress so far. I am also wondering why this occurred. She did have her jaw expanded on top and I am thinking this might have caused the tooth to be pushed further upwards. The X-rays showed the tooth coming in behind the molar. I only want the best for her and want her to have a beautiful smile. We have invested around $9000 so far. I also wonder if I should get a second opinion from another orthodontist. Thank you for your time, Leia Alexander

Answer
Leia - First of all, if you have any questions about the orthodontist, get a second opinion.

It is not totally unusual for canine teeth to develop in an altered position.  Some of them are vertical and never erupt and a surgeon needs to expose it in the bone and apply a bracket to allow the orthodontist to pull the tooth down into position.  If your daughter's tooth is not vertical or at an angle then pulling it into position can be very difficult and occasionally impossible.  For a canine to be so far back at the molar location, it is wrong to try to bring it forward, since damage to adjoining teeth could occur.

Cosmetic and functional results are important.  If the tooth cannot be pulled into normal position then the space may be held open for an implant or the space closed and the tooth recontoured and a crown placed.  In this day an age an implant would be great, but it should not be placed until her puberty has ended and her bones have completely formed.

If you have additional question, feel free to contact me again.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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