Impacted canine teeth - please help me decide what’s best?

[Username747294]

Hi

my 14YO son has impacted/buried upper canine teeth. He has a very small and high palate and there is no space for them to come down.

he has had a CT scan to see what to do to help. The oral surgery team said they should be completely removed and his other teeth cosmetically made to look like canines?

has anyone ever heard of this? They said can cause cysts if left in but tbh, I can’t see it. I originally was told they would expose them and bring them down. it seems unnecessary just to get rid of them and very invasive.

what would you do?

I appreciate your advice/experience on this

thanks

Has no one suggested that it might be possible to widen his palate and make space for them?

DD had this done, also others brought down with a ball kind of thing. They look absolutely beautiful and natural.

Dd had braces which somehow made space for the buried canine to come down. It took two years.

Dd had exactly the same. Extraction followed by braces for 15 months. They look great and was all very straightforward. They did talk about the chain option but weren't convinced it would be very successful so went for extraction.

In the 90s i had to have my baby canines removed and something put on my braces to bring down the impacted canines. They're great now. Despite how crappy it sounds, that was one of the least troublesome things I endured over 5 years of orthodontic treatment.

They should be able to use manipulation through braces to create space and then bring them down.

My DD had the op to have the chain attached earlier this year. Op went really well but it's a very slow process to bring the tooth down and get it into place – going to take about two years!

My son had canines buried in the roof of his mouth, growing the wrong way. They have almost finished pulling his teeth completely around into the right place. It has taken a lot of time and effort, but he has kept all his teeth and avoided implants.

I’m amazed at what they have achieved, and I have a great deal of faith in his consultant. I’d get a second opinion if I were you.

I’d 100% get a second opinion purely to see if there are alternatives. I had the teeth behind my canines removed to make space for the canines and then had years of retainers and braces to try and bring them down - you wouldn’t even know I have several missing teeth to make room in my “small” mouth (which is crazy, cause I’ve always been told I have a big mouth 😂)

I think with the continuous advance in medical care but orthodontic alone (some of the stuff they can do is mind boggling) it might be worth just having a conversation about other alternatives just so you have informed consent for any procedure your son should have. Best of luck 🥳

2 children. Canines located, bracket and chain added during op (local). Pulled into place using brace/chain.

Thanks for your responses so far :)

So he had a removable brace for 2 years to widen his palate but it didn’t create much space :(

i thought the plan was to pull them down like many of you said but they said no because there is not enough space so they are just going to completely remove them? Then cosmetically make his other teeth to “look” like canines…
just sounds strange to me so wanted to see what others thought?

thanks again

Orthodontist here. These are our every day cases in the hospital dept where i work.
The reasons for choosing extraction or attaching gold chains to align ectopic canines depends on many things.
Position of the tooth and how far out of line it is
Evidence of any cystic area around the tooth
How close the tooth is to other tooth roots and whether it has already caused damage to them
Likelihood of damage /further damage to other teeth as it aligns
How crowded (short of space) the whole mouth is
Whether there are any missing permanent teeth in the mouth
What the skeletal pattern is (front teeth forward, prominent chin)
Whether there is a high or low jaw angle.
And also - the basics - how motivated is the patient, what is their level of oral hygiene and mouth health, any medical issues, and how reliable they are to attend throughout a long course of treatment
I am sure more things could be added to my lists too!

Different clinicians will have different slants on treatment, so a second opinion could be valuable.

@PC20wow that’s really informative thank you. I will try and obtain another opinion but I’m not even sure how too tbh? My son was referred to an orthodontist via dentist, then onto hospital oral surgery team who we had last appointment with. I’ve said yes to the op but having second thoughts. Shall I go back to the orthodontist even though we haven’t seen them for a while?

thank you again

If there is no space then surely there is no space. I don’t see the issue with having them removed and shaped tbh.

I had this done except I had room for them so they brought one down and fit it into place however they discovered I actually had two sets of adult canines. So one is the original with a spare canine up in my palate and the other is the brought down canine. The surgery wasn’t pleasant (they did mine under local for some bizarre reason) but the braces etc were fine. The canine left in my palate hasn’t caused any issues at 30. only difference is the newer canine is sharper.

However I’d probably listen to the experts.

My daughter had very impacted canines, each growing towards the other side of her face and a little up too, sort of towards the opposite ear if that makes sense? They've been removed and she will just do without canines, a colleague has none either and they look fine, the first molars are a bit pointy actually!

We have had second and third opinions though for aspects of her treatment where there's been any debate.

Sounds like usual referral route.
General dentist referring to specialist orthodontic practice.
If specialist has referred to hospital oral surgery then it sounds like they are planning to carry out the orthodontics after the surgery at the practice. (So complex treatment but not v complex)
In our hospital orthodontic dept we are referred patients from the specialist orthodontist with the cases which are more severe than the specialists are comfortable doing.
I am sure orthodontist and hospital oral surgery dept are liaising well.

Hi

i wondered what you decided to do? I think we will be facing a similar situation.

Any update on the thread? We are in similar situation..
@Username747294

Hi @Ingi805

no unfortunately not. My son is on a waiting list for the surgery but was told could be a year or more. Still feel in two minds about it. How old is your child? What’s their story? It’s hard to know what to do for the best

My 14 year old son had two impacted canines removed under GA last August. The op was very straightforward, he went down to surgery about 10.30am and we were on our way home by 2pm. He had some swelling and pain for about a week afterwards.

He had his braces put on in December to straighten everything up. There's no plan to alter any of his other teeth. As someone else said, his first molars look a bit pointy so you'd never notice that his canines were missing.

They did initially give the option of having two molars taken out by the dentist under local anaesthetic and seeing whether the canines would come down once there was space. However the orthodontist was concerned that the canines were quite high up and if they couldn't be brought down he could end up with gaps and need false teeth.

Definitely glad that we went for the surgery option, it was all very straightforward.

all the kids i knew at school had some teeth out followed by a brace.

thats back in the day and treatment may be different now and i know your son has a different issue but the point im trying to make is not to worry about losing a couple of teeth. at that age they have lots as they are young snd the mouth seems to be a very overcrowded place, especially if it’s a small mouth like mine!

my wisdom tooth couldnt be root treated as it’s so tight and near the back. so having teeth towards the front of a small mouth soumds like a plan to me, easier to care for them.

nobody wants big wolfy pointy canines (i got mine rounded off to look like other teeth) so he will actually look better with not so pointy teeth. depending how they look he may not need anything done to them at all. better not to start shaving bits off if you don’t have to i would think.

and finally i was scared do waited till my twenties to get a brace. nowadays it’s like £3k and allsorts to get one. Definitely better to get done on the nhs asap for free.

and getting one root teeth out is a breeze so i wish i’d done it earlier. not sure about the difficulties of getting your sons teeth out when he has a different issue but children heal well and fast so im sure it will be fine. go for it.

Hi @Username747294
Same 14y old son, been told baby and adult canine teeth need to come out, not sure about adult ones though, I seeking second opinion, but so confused what to do as this is not very common.
Don't understand why sometimes they say they can pull them down, and other times they need to be surgically removed...

My ds had one canine lying sideways in his upper jaw, with the crown pressing on the root of an incisor. He was offered several options, and chose just surgical removal. He chose not to have braces to widen the gap and then have an implant because he felt it was unnecessarily invasive and would prolong treatment into exam years that were very important to him. He also chose not to have an existing tooth remodelled to look like a canine - why damage a healthy tooth? Adult canines eventually lose their points, anyway. The gap started closing very quickly. It is so unnoticeable in his mouth that I'm not even sure whether or not it has completely closed. Ds is perfectly happy with the look and function of his teeth.