11y child, fallen out tooth placed back in(2y ago) but now due for surgery to be cut and put a flipper instead

[Mae]

Needing a second opinion:

About 2 years ago my 11 year old daughter had an accident and her front top tooth fell out.

The dentist managed to put it back in and overall its been fine since.

But because the nerves on the root were dead and they cleaned them off that means that basically the tooth is dead and won't grow with the rest of the teeth and jaw.

Because of that the dentist advised that now they cut her tooth all the way up to the gum (while leaving the root inside) and have my daughter wear a flipper tooth instead until she is old enough to have an implant.

They said that if we leave this tooth as it is now, if we leave it like this until she is old enough for an implant then while the rest of her teeth and jaw grows, this dead tooth including its gum will stay up and will look very disproportionate from the rest of her teeth and then when it's time for an implant it will be a very complicated and dangerous process.

Last week we had the impressions done and next week she is due for the surgery to have her tooth cut while leaving her dead root in and she will have her first encounter with her flipper tooth that she will have to wear until she is old enough for an implant.

I would like to know if there is another option for her? I am very relactant of her having this surgery as well having her wear a flipper for the next 10 years at least.

Also I don't understand how leaving the whole tooth on as is now until old enough for an implant will be very complicated and dangerous then but that won't be the case if they cut the tooth now while leaving the dead root in now and having a flipper in as they plan to do?

Also how cutting the tooth now while leaving the dead root in won't have the consequences of it and it's gum being disproportionate with the growth as it would apparently be if they leave the tooth in?

 

[honestdoc]

This doesn't make sense that the dentist has to cut the tooth. Was there a fracture that separated the tooth (crown) from the root? Of course the tooth will be dead because the nerve lost its blood supply. Here in the US, we will do the root canal to clean all the dead nerves and seal it from getting any infection. We try to preserve the tooth as long as possible since the child is still developing and removing the tooth will collapse the developing bone causing some malformation of the facial profile. We would splint the tooth to allow for bone to tighten around the root. Cutting the tooth would be the last resort if there was too much damage. Once the bone is fully developed around 19 years or older, implant would be more predictable.

 

[Mae]

Honestdoc, thank you so much for your reply.

There was no fracture that seperated the tooth(crown) from the root.

And just to add it is the top central incisor tooth.

The trauma and replantation of the tooth happened 2 years ago. The trauma occured in the evening and the replantation the following morning. At the time I believe the dentist did a root canal to clean all the dead nerves and seal it from getting any infection, trying to perserve the tooth for as long as possible. Also about few days later or so, the dentist put a metal splint which my daughter wore for about a week which was a but painful.

At the beginning of this year the little filling at the back of the tooth fell out and she developed an infection which was treated. The dentist cleaned it up inside with a thin tube and sealed the tooth again.


But even when they replanted the tooth at the time 2 years ago they said that at one point the tooth(crown) would need to be cut all the way to the gumline, while leaving the root inside and a flipper will need to be worn until later when my daughter is in her 20's when she would be able to get an implant.

The main reason from what I understood that that needs to happen is to make sure that there is enough bone for the future implant. Otherwise if the tooth is left as is apparently the tooth will become smaller then the rest of the teeth, the gum would pull back in developing an uneven gumline and bone loss will occur which all will be a problem for a future implant. That os what I understood from what the dentist explained. I remember the dentist saying that in that case the future implant would be more complicated as they would have to build on more bone so that the future implant can take hold. Also I was told that the reason this tooth will remain smaller then the rest and the gumline would be pulled in is because the remaining of the teeth and gum would grow as she grows while that tooth will stay the same size which would result in a uneven tooth line and gumline.

What I don't understand is how now cutting the crown from the root and leaving the root inside helps no bone to be lost and that can't be the case leaving the crown to the root as it is now.

And just wanted to find out if there was another option so she doesn't have to go through this surgery and loose the crown which all seems good like this and to have to wear a flipper for at least 10 years which is a very long time for a annoying temporary solution that would also need adjustments along the way.

 

[MattKW]

replanted teeth have a poor success rate by 5 years. Often the root becomes eaten away (like a baby tooth) and replaced by bone. So, unless your child is having pain or infection, I'd suggest leaving it alone and simply X-raying it annually.