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Orthodontics/Removal of Canine DeciduousTooth due to in-growth of permanent tooth


Real Picture of Teeth
Real Picture of Teeth  

X Ray Image
X Ray Image  
First of all my Apologies, because I am not Medical expert to use medical terminology and trying to explain my problem in the best of my capacity.
I am 26 year old female, having a deciduous canine tooth. This has been strong enough all these years and not showing any signs of falling down sooner or later. However above this, there is a visible growth of permanent tooth. This tooth is growing in diagonal direction and is visible in gums over and above the milk tooth.
Please have a look at the attached OPG X-Ray image.
What are the possible ways to keep one of the these teeth and remove the other ? Or, is it a better idea to live with both of them for next 1 year harmlessly.

Dear Neha,

Thank you for your patience. I know there has been somewhat of a delay in replying, but I have been showing this case to several other doctors in order to f=give you a collective opinion. Again, let me say the following:

What I write here are only my opinions based on very limited information. My comments should not be viewed as any form of diagnosis, definitive or otherwise,  or any form of  treatment recommendation.  Indeed, in the ultimate analysis all final decisions, particularly clinical ones, should  only be made by qualified doctors who have had a chance to see you in person and who have had an opportunity to take and analyze proper diagnostic records.

Okay… having said  that…  your  questions focused on the erupting adut tooth ( canine ) and other issues w=shown in the attached panoramic radiograph. As to your options in conjunction with orthodontic treatment. You  wrote: "  What are the possible ways to keep one of the these teeth and remove the other ? Or, is it a better idea to live with both of them for next 1 year harmlessly.   "

Neha, it appears that there are several options for you. Based on the radiograph, you could have your doctor consider the following

1)  Maintain the existing teeth which have erupted, including the "baby" teeth also known as the  "deciduous" teeth and extract the two impacted adult canines. This would be followed up with a periodontal consultation to evaluate bone support and then use limited orthodontics to align the teeth, including the deciduous teeth which have been bonded.

2)  Another option would be to extract the two upper deciduous teeth. An oral surgeon or dentist would also attach small pads and a gold chain on the adult impacted canines.Your doctor would also then place braces on the upper ( and maybe also lower) teeth to enlarge the spaces created by the extractions. This will permit the impacted canine teeth to erupt with the help of the gold chains. This is active guided eruption. These adult canines are in effect being "dragged" down into the proper position.   

Nena, you have a very complex case. I hope you have access to well trained clinicians who have the experience to provide you with the care that you need.  


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Paul Supan, DDS, MA, MPH


First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites and are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.


Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

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BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

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