Impacted canines in teenager - too many choices?

[IcedMocha]

My DD is 14 and has an impacted canine lying horizontally under her bottom front teeth and an impacted one top left. Both these I’ve been told are beyond being pulled into place and need removing. And she still has a surviving baby tooth in the bottom row that is place holding.
So choices are remove baby tooth and impacted teeth and bridge gaps to have implants later.
Or leave baby tooth and decide on that later.
Or remove two healthy adult teeth and brace to fill gaps so equal each side
Or brace with existing teeth and have uneven amount of teeth on top? Don’t even know if that’s possible with bite alignment.
I can’t get an answer out of orthodontist or hospital about which is best. They say up to me? I don’t know! Argh.
Waiting now for surgical review so will be another six months at least.

I had 4 impacted wisdom teeth removed at 16 years old. They were pushing my teeth in all directions. Had the lot taken out (there was no room for them even if they hadn't been laying on their sides). I'd have the lot taken out, sooner rather than later. Good luck! Layman's opinion, not a dentist!

X-ray..

Yes the two embedded ones will be removed surgically with a GA but it’s deciding on the gaps that’s the issue…

Ah I see, I don't know if you can make that decision til the surgery is done. I am no expert!

Two questions that might help
How narrow is her jawbone?
How big are her existing teeth?

My DS has severe hypodontia. He is missing ten adult teeth that never formed. For the past two years he has been under specialist care at a hospital and I have been amazed by their ability to close gaps. At the start of the treatment they told us to expect bridges and implants but now he is unlikely to need any. This was massively helped by him having a narrow jaw.

I see your DD has wisdom teeth, which might also help fill the gaps.

I had similar. No baby teeth left, but it was my upper right canine that was embedded in the roof of mouth.
I had that removed, along with an upper left premolar and all 4 wisdom teeth removed. I then had braces for 3 years to get everything aligned.
It meant I had all my dental treatment done in one go, it was all done and dusted well before I reached the threshold where I was no longer eligible for NHS treatment and I don't have any dental prosthetics that may need replacing or repairing in the future.
When I smile, you absolutely cannot tell I only have one upper canine - I used to work at a dentist and none of the dentists/hygienists realised until I told them!

So if there's an option to remove baby tooth and impacted teeth, then have braces to get alignment right, that's the one I'd be going for, even it meant removing healthy adult teeth as well.

ETA: If possible, I would try to avoid dental prosthetics as they will inevitably needs repairs or replacement in the future and there's a financial cost involved in that. I would try to avoid retaining a baby tooth.

Yes this is what seems sensible to me also. To brace the gaps. Bridges and implants sound so awful and time consuming and expensive and need upkeep etc. I’d rather she had her real teeth even if a few fewer? Would she need healthy teeth pulled as well though to get the alignment right? That seems so awful to pull out perfectly healthy teeth.

I had an impacted upper canine surgically removed (fascinating to see this x-ray - I’m not sure exactly where my wandering tooth got to but I know they had to remove a bit of bone to get to it). Didn’t have any rogue ones on the lower set though. As well as removing the canine they took out an upper premolar on the opposite side and closed the gap with braces, so my upper teeth don’t match on either side but it’s not particularly noticeable - usually just a talking point if I see a new dentist.

This was in the 90s though and I don’t know what the current thinking would be. How unhelpful that the orthodontist isn’t giving you much guidance! Personally I think I’d want to avoid leaving a baby tooth in place since presumably it’s less likely to survive the long term and your DD might end up with a gap later. I’m no expert though.

I have one similar to bottom one in X-ray. I had braces etc when younger but it was left in place. It’s still there and I’m 55

Wow yes I wondered about leaving that bottom one there as it looks so embedded. But the orthodontists have all agreed it threatens pushing her bottom teeth out?

My DC is 12 so a bit younger, but her upper 2 canines are lying horizontally in her jaw and baby canines still in place. NHS dentist has referred her for removal of all the upper canines (baby and adult) then braces to close the gaps. She does have quite a little face/small jaw.

The lower one, I would leave the baby canine in and remove the ectopic tooth. The primary canine looks fine at the moment and can be replaced at a later date with an adhesive bridge or implant. I have plenty of patients who are 50+ and still have retained primary teeth.
The upper one is a bit more complex, I would remove the tooth and then open up the gap to accommodate an adhesive bridge to be replaced with an implant. You can have a denture made to replace the missing canine until the upper jaw is aligned. Adhesive bridges are ideal for maintaining space since they don’t require any tooth preparation.

Thanks @Angrymum22 is there an option of having braces to close the gap on the upper one without needing a bridge/future implant? She has had a gap for a couple of years and not an issue looks wise.

I guess years ago they left well alone. I had too and bottom braces at 16-18 with four teeth out but they left impacted one there and it’s still in.. hasn’t caused problem yet but who knows.. maybe I was lucky? Dentist never even mentions it anymore

@IcedMocha the unerupted teeth can drift and cause damage to the roots of the other teeth so usually best removed. It's possible to get really good results with different numbers of teeth on either side. Premolars can be made to look like canines with good positioning by the orthodontist.
The best result will depend on how crowded your dd is. In an ideal world she gets the baby teeth removed as well and balanced with a premolar on the other side but if that is going to mean spaces it would be better to not balance the baby teeth extractions as premolars can do pretty good imitations of canines provided her canines are not too dark (and you can already see the opposite ones to check)
Personally I'd aim not to retain baby teeth or rely on bridges or implants to avoid ongoing maintenance/replacement but that is very much my feelings. As @Angrymum22 says their recommendation would be bridges.