What do you guy think

[Steven Prince]

I actually have five minutes in between patients for once and I thought I would send this pano of a patient I saw yesterday. Obviously issue the impacted upper right 3 and 4, maybe 5 with potentially ankylosed upper primary teeth. Basically the main issue hasn't been addressed and we are 11 months into treatment :) I wanted to send for extractions of remaining primary teeth but then I  thought maybe it would be worth to bond and at least see if I can get those teeth to come down to help with arch development . What do you guys think, should I just extract and see what happens or is there something else you would try

[Hemali]

Hey Steve,

This is really interesting. First I think it's weird how the upper left 3,4,5 have not really developed or had any root development between the two time points. Because of this, I would wait a little more before extracting the primary teeth. Maybe they are just super slow to develop or maybe there is something else? Either way, I think we would expect to see some more root development in 10-11 months of treatment. I'm curious to see what everyone else thinks of this. 

When looking at the panos I think some of the problem is due to the UL2 which is misshapen and looks ankylosed. It looks like the alveolar ridge on the left goes up mostly around the UL2. So, perhaps try to see if that tooth is ankylosed first by having it exposed and luxated and try to bring it in. If it doesn't move then think about extraction or surgical repositioning. In the meanwhile hopefully the canine and premolar roots will develop and and you can have the primary teeth extracted or re-eval what to do about the delayed development. 

Let's see what everyone else says! Cool case! I've never seen so many teeth delayed like this.

Hemali 

Sent from my iPhone

On Mar 17, 2015, at 7:50 AM, Steven Prince <steven...@gmail.com> wrote:

I actually have five minutes in between patients for once and I thought I would send this pano of a patient I saw yesterday. Obviously issue the impacted upper right 3 and 4, maybe 5 with potentially ankylosed upper primary teeth. Basically the main issue hasn't been addressed and we are 11 months into treatment :) I wanted to send for extractions of remaining primary teeth but then I  thought maybe it would be worth to bond and at least see if I can get those teeth to come down to help with arch development . What do you guys think, should I just extract and see what happens or is there something else you would try

--

---
You received this message because you are subscribed to the Google Groups "ASDOHortho2014" group.
To unsubscribe from this group and stop receiving emails from it, send an email to asdohortho201...@googlegroups.com.
For more options, visit https://groups.google.com/d/optout.

<20140291-Initial-13.jpg>

<20140291-Initial-22.jpg>

<20140291-Progress-22.jpg>

[Payam Owtad]

I am wondering how did this happen ! trauma, genetics, syndrome, … ? any ideas? 

Do you have a clinical picture of the appliance of the last pano, and progress clinical pictures? 

1 year time between the two panos, basically no changes, and no roots, I don’t think waiting is gonna change anything. Surgical exposure sounds good to me, even though they might be ankylosed.  

Payam 

[Jeremiah Sturgill]

Hard case, I definitely wouldn't bond the primary teeth  bc/ they for sure seem ankylosed so I think you'll get even more of a cant.  Do you have a tongue crib in him?  Did they originally think it was a tongue thrust?  I agree that something developmental seems to be going on, I would exo the UL # C and UL#E, and warn parents the UL#2 may have to be exo'd as well- then place OCS from the UL1-6 because it seems the 6 has moved mesially due to early lose of the #D.

I would exo bc/ they are ankylosed and nothing good will come from them staying there, I think the 3/4/5 roots are not forming bc/ they are trapped against the cortical plate of the palate, so there's no trabecular bone around the apex to allow root formation...just a JS theory, after exo's then take a CBCT in 4-5 mo to get a better look at the roots, there could be something weird going on that we can't really see on the pano

[Hemali]

I showed it to the pediatric dentist at the craniofacial team and he also said  to take a CBCT. He thought the canine could be laying flat across the palate--hence the lack of visible root development. He also said, let the family know that those permanent teeth may never develop and then the patient may need some involved restorative consisting of bone grafting and implants. 

Sent from my iPhone

[Carolyn Gardiner]

Wow, crazy case. I think you should extract the primary teeth on the UL as well as they seems ankylosed and are doing more harm leaving them (bone defect). Did you ask about trauma...just odd b/c the right side has normal eruption...

I do think that UL2 might also be ankylosed, but I would get ULc out first and see what happens.

Although the JS theory could be right, we really have no idea...might want to warn parent that there is a potential that after the baby teeth are removed...2,3,4,5 could all be ankylosed as well.

Please let us know what you do and send follow up xrays!

Carolyn

[Jeremiah Sturgill]

Did Carolyn just say in written form that "JS theory COULD be right?!?!?!"  -- so you're saying there's a chance!

:)