Orthodontic Surgical Services
If your child’s orthodontist,or general dentist, feels your child is holding on to the primary or baby teeth too long, and this is having a negative effect on the proper eruption and spacing of the permanent teeth, they may recommend planned removal of the baby teeth rather than allowing them to get loose and come out on their own. These timed extractions can have a great positive effect on the success of the teeth to erupt in a timely fashion, and in a better position, thus resulting in shorter, and less complicated, orthodontic treatments. Prolonged retention of baby teeth can affect many teeth or just individual teeth.
Prolonged retention of individual baby teeth
Usually these are caused by a disturbance of eruption or formation of the successor permanent tooth. A mild form of this problem is seen when the permanent tooth is slightly tilted, or “off target”, and the roots of the baby tooth don’t completely resorb. Sometimes the permanent tooth will erupt to the side of the baby tooth, but the baby tooth can’t fall out due to an intact root system; this is called ectopic eruption. Many times the baby tooth can be removed, and this will allow for the permanent tooth to continue to move into its intended position.
Blocked path of eruption
In some patients’ mouths, permanent teeth don’t successfully “push out” the baby teeth due to the presence of other dental structures (usually supernumerary teeth or abnormal teeth – containing growths called odontomas). These problems can usually be corrected by removal of the primary tooth, or the abnormal, or extra, tooth that blocked the path of eruption of the permanent tooth. Occasionally, the permanent tooth may need to have an orthodontic bracket bonded to it and be lead into the proper position by gentle orthodontic traction forces.
Another way permanent teeth can become blocked from eruption, or impacted, is through the development of a dentigerous cyst. In this situation, the developmental tissue surrounding the tooth (dental follicle) has enlarged abnormally and transformed into a round, fluid-containing cyst. Much like a supernumerary tooth, a dentigerous cyst blocks the movement of the permanent tooth towards its proper position in the mouth. Treatment consists of surgical removal of the cyst, together with removal of any involved baby teeth and orthodontic bracket bonding of the affected permanent tooth, if indicated.
The most frequent teeth (other than wisdom teeth) that fail to erupt on their own into their correct positions in the mouth are the maxillary cuspids (upper canine teeth). The cuspid tooth is a critical tooth in the dental arch and plays an important role in your “bite”. The cuspid teeth are very strong biting teeth and have the longest roots of any human teeth. They are designed to be the main teeth that touch when your jaws move side to side, or forward when you chew, so they guide the rest of the teeth into the proper bite and protect the other teeth from strong lateral forces.
Normally, the maxillary cuspid teeth are the last of the “front” teeth to erupt into place. They usually come into place around age 13 and cause any space left between the upper front teeth to close tighter together. If a cuspid tooth gets impacted, every effort is made to get it to erupt into its proper position in the dental arch.
Often, the failure to erupt is not due to a blocked path of eruption, but as a result of the tooth forming in an unfavorable angulation, or position. Left alone, these teeth will generally stay impacted (embedded) and sometimes will cause resorption (dissolving) of the roots of neighboring teeth and sometimes early loss of teeth. Treatment generally involves exposure and bonding of the embedded tooth in coordination with orthodontic maneuvers to open space for the tooth and bring it into the arch with gentle orthodontic traction.
It is important that impacted cuspids be recognized at the earliest age possible (usually 11- 15), as the success of guiding eruption with braces is higher in teenagers than at older ages. If the tooth does not successfully come into the dental arch, usually extraction and placement of an implant is recommended.
A mismatch between the size of the teeth and the size of the jaw space available for them will lead to dental crowding and malposition of teeth. Sometimes, minor crowding can be alleviated by selective reshaping of teeth to make them narrower. Other times, one or more teeth should be removed in order to provide adequate space for the remaining teeth. The most commonly removed teeth are upper and lower bicuspids. Lower incisors are also occasionally recommended for extraction if the crowding is more pronounced in the anterior teeth.
Diastemas and frenulums
A diastema is a gap between two teeth, most frequently the 2 maxillary central incisors (upper front teeth). In the upper incisor area, there is a normal muscle attachment from the upper lip to the gum. Sometimes, this muscle attachment (frenulum) is abnormally wide or thick, or attaches too low on the gum and prevents the upper incisors from moving all the way together resulting in a gap between the teeth. Diastemas are corrected with orthodontic movements in conjunction with a minor surgical procedure called a frenuloplasty, in which the position of the frenulum is changed, or the size is reduced, or both. Occasionally, diastemas can be caused by excessively hard bone in the midline suture of the upper jaw. In this situation, proper closure of the gap may need to be preceded by removal of some of this dense bone between the roots of the incisors. These are minor in office procedures that typically take less than 30 minutes to accomplish.