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Oral Surgery/What treatment option to go for?


Dear Doctor,

I had submitted a question before and its a follow up. I hope you will remember but I am describing it again in any case.

I had a broken first molar on the right side that couldn't be restored after a root canal with a crown for a year as I was out of my home country and it was too expensive to get it in Europe. It caused the upper molar to supraerupt. I don't have a good bite with very limited anterior guidance and mild crowding. (The ortho treatment years ago with metallic braces had failed after I developed an allergy to the brackets) The situation started causing my jaw some trauma which was manifesting in TMJ pain episodes. On return to my country, I met an oral surgeon who recommended an orthodontic treatment to intrude the upper molar, followed by restoration of the lower one at a proper height. He recommended that I get full braces to get a good bite and ease the stress on my jaw.

I met the orthodontist who placed two titanium mini-screws connected with an elastic and said that the tooth should intrude in 3-5 months. Since I had developed an allergy to metallic braces in childhood, we had to decide to get clear aligners for the remaining orthodontic work. ClearPath is what is available in my country. I paid the first installment for the aligner treatment as well. Unfortunately the miniscrew on the palate side became loose in a month and had to be removed. My orthodontist tried three more places but it didn't work as 'the bone was giving way' he said.

Now I am stuck with a crucial decision. He has given me three options:

1. Get traditional braces that have been introduced recently that have nickel free wires and brackets and are less likely to cause allergic reactions. He said it would enable him to intrude the supraerupted molar with just one screw that is still in my mouth on the lip side. He agreed to put two test brackets for a week to see if there was a bad reaction.

2. Get a root canal on the supra erupted tooth with a crown, They can shave the tooth by 3 mm and put the crown on both upper and lower molars to stabilize the bite. The height of both the teeth will be compromised but I can go through aligner treatment after that. This way I don't stand to lose a part of my installment that I have paid for clear aligners. I must add that the supraerupted molar does have a big filling already.

3. Get the lower root canaled molar restored at a compromised height, leave the supraerupted tooth alone. He said its not considered an emergency if the upper tooth is extruded by 2 mm as is my case. Then also, I can go ahead with aligner treatment and not get an unnecessary root canal.

I would like to know what would be your suggestion for my case. I am a little disheartened by the failure of TAD screw treatment and its been a financial dent too. But finances aside, what would be your advice for a long term prognosis.

Lily - From what you are describing, getting a crown on the super erupted tooth with a large filling makes the most sense.  Not only is it a simple procedure, it will allow a stabilization of your bite once the lower molar will also have a crown placed.  One of the problems with adult orthodontics is that the bone is more dense and besides the longer time to produce movements, intrusion can cause compression of the nerve and blood vessels entering tooth.  That can damage the nerve and blood vessels entering the tooth, unless a very long time is used to intrude the tooth.

So the cutting of the teeth and placement of crowns is a much predictable procedure and the final outcome will be stable and support your bite.  If the orthodontics is not perfect, a crown may need placement any way.  

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Joel S. Teig, DMD, Diplomate ABOMS, retired


I am a board certified oral and maxillofacial surgeon 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.


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

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

BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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