My lateral incisor is pushing behind the central incisor after extraction, and I could use some advice.

[B747Man]

Hello, I will try to make this as short as possible however, I could use some advice on the situation with my teeth. So I have had a bad history regarding taking care of my teeth due to autism, which has also caused me to avoid the dentist, but I finally went to the dentist to get started on fixing things, and have been much better with brushing after I started having some issue.

So when I finally went to the dentist, they unfortunately had to extract both of the upper canines, which was a little over a month ago due to decay and was told they would eventually be replaced with implants and that I would also need a bone graft. For the most part, things haven't been too bad; however, on one side, things have never felt quite right like something is pressing against the lips a little so they don't sit right. Then, at some point, I noticed my lateral incisor had become slanted, so it was slightly pushing behind the central incisor, causing that tooth to be pushed out some. Now, for the most part, it is not painful, but it does feel a little uncomfortable, and I worry that it might continue to get worse, causing the tooth to crack or cause pain. The other thing is, I only have state insurance, and I was lucky enough to have a family member help me pay for the 2 canines to be extracted and replaced, but I will have to go somewhere else for the other stuff, and I'm not sure how long it will take to get in to see someone. I do have an appointment with the dentist who did the extractions soon, so I plan to ask him about it, however in the meantime, I thought I would ask about it here to calm my nerves

So, based on the pictures of the teeth, how concerned should I be about this getting worse in the short or medium term, and what would be the most likely way of fixing it? I’m not sure if the issue could be caused by a loss of bone from the extraction, and would be something that is resolved once the bone graft is done, or if it's something that would require more work, like braces or Invisalign Also if I have to use braces, I'm not sure how that would work because I am also using a stayplate, which has a fake tooth that fits where the old tooth was to keep the space preserved for the implant so i’m not sure if that would cause an issues with the braces being effective.

Thanks for the help

 

[Dr M]

The teeth are most likely shifting due to the loss of the canines. Are you wearing the plate often or not? If you are not wearing the plate, the teeth can shift quite quickly.
The best way to fix this, would be most likely fixed braces, to align the teeth and to ensure adequate dimensions for the planned implants or bridges or whatever replacements you decide on.
This would need to happen first. While the braces are on, you won't be able to use the plate, but the orthodontist sometimes incorporates another temp tooth as part of the braces in order to cover up the gaps.
So see if you can get an appointment with an orthodontist first, so that you can start planning with regards to costs. In the mean time, make sure that you use your plate as often as possible. If it feels like the plate might be pushing on the adjacent teeth as well, go back to your dentist to have it adjusted slightly.

 

[B747Man]

Thank you for the reply. I was wearing the stay plate as often as I could when I first got them, which didn't happen until 3 weeks after the surgery anyway, but then I got to a point where I was having trouble getting myself to wear them, so I unfortunately went a few weeks without them. I have started to wear them again, but I do think they need re-adjusting as it feels a little tight in that spot. I did go to the office yesterday about it, but was only able to speak to the hygienist/assistant, and he said they seem to be fitting fine, but the top part of the fake tooth on the stay-plate doesn't sit flush with the gums.

Also, I am wondering if you think it is possible that the tooth could have moved before I got the stayplate, because as I said, I didn't get it until 3 weeks after the extraction, and at the other extraction site, I barely noticed anything wrong after the extraction, while with this one, things never felt quite right, even after the initial swelling went down it felt like there was something that was preventing the lip from resting naturally over the spot and a senastion that something was pressing against them slightly.

And finally, you said something about getting the plate adjusted if it feels like it's pushing against the other teeth, which might be the case, but even when I wasn't wearing the plate or before I got it, I would notice that in the morning, things would feel a little better on that side, for example, I can feel the line where the tooth are overlaping and in the morning it feels much less pronounced but then a little later in the day I noticed more when my tounge moves across it. Any ideas on why that might be?

Thanks

 

[Dr M]

It is possible that the tooth might have moved in that 3 weeks.
I think start with the adjustment of the plate first. If the teeth still feels strange, then the bone quality surrounding the affected teeth should be evaluated.

 

[B747Man]

It is possible that the tooth might have moved in that 3 weeks.
I think start with the adjustment of the plate first. If the teeth still feels strange, then the bone quality surrounding the affected teeth should be evaluated.

Thank you. So I did see the dentist and he said that the tooth wouldn't have shifted that much within that timeframe but he didn't really say specifically whether it was already like that before the extraction or not and I forgot to ask. Also he said the sensation I am feeling when tooth hits the other tooth is because of a large cavity on the tooth. I knew I would need more done from the beginning but I could only afford to do so much at the time.

Again it's not necessarily painful (maybe a little) but it mostly just feels uncomfortable especially when I'm not expecting it like my brain goes I dont like that. Also as to your point about checking the bone quality I am already aware that I need a bone graft at least on that site before the implant can be done so that could be affecting the surrounding teeth but they don't feel loose as far as I can tell.

And finally he did adjust the plate a little bit, but said he doesn't want to adjust it too much just yet because he is still waiting for the gums to heal more and said that is the reason why there is a gap where the fake tooth sits and the gum line.

I know it might be hard to say without evaluating everything for yourself but does what he said seem plausible to you? It been a little over 7 weeks since the extraction so I'm not sure how likely it is that the gums are stealing and growing in at this point.

Thanks

 

[Dr M]

It is difficult to give an accurate opinion without seeing you in person, but it is plausible what he is saying. The sensation could be due to one or more cavities that need to be sorted out. Once a tooth is extracted, the socket can take up until 6 months to fully heal, and the tissue changes as the bone changes. So any adjustment to early, could lead to more spaces at a later stage.

 

[B747Man]

It is difficult to give an accurate opinion without seeing you in person, but it is plausible what he is saying. The sensation could be due to one or more cavities that need to be sorted out. Once a tooth is extracted, the socket can take up until 6 months to fully heal, and the tissue changes as the bone changes. So any adjustment to early, could lead to more spaces at a later stage.

Thank for you the help. Another quick question I have which will be that last one is about crowns. I need to try to get the cavity taken care of as soon as possible and will need a crown most likely. I know there are different crown materials with some being stronger than others but I'm curious how big the difference actually is since I would be worried about breaking them especially when eating. For example If the put in something that is all procelain emax would that still be strong enough to handle most foods like chips or say cashews or would that be something I would need to be careful with. What about with zirconium? Also I was thinking since when doing a root canal they usually take off some of natural tooth and also shape in preparation for the crown I don't know if possible that the crown would small enough that the tooth no longer site behind the other tooth.

 

[Dr M]

Modern zirconium crowns are very strong and also have good aesthetics. I would consider this option if you are concerned about eating different foods and risk of breakage.

 

[B747Man]

Modern zirconium crowns are very strong and also have good aesthetics. I would consider this option if you are concerned about eating different foods and risk of breakage.

Are you saying something like porcelain Emax wouldn't be strong enough for stuff like chips or nuts, or just that the zirconia is stronger? A few dentists' websites I have checked out only mention full procelain crowns, so I'm unsure if I will be given the option to choose zirconia or what the price will be. I would be fine with Emax if I knew it was strong enough to handle what I mentioned.

 

[Dr M]

E-max crowns are also strong, and can be used for front teeth. But for a back tooth, I would recommend Zirconia definitely.
Unfortunately all crowns can fracture when biting into nuts. There is no guarantee. But Zirconia crowns should handle most foods better than e-max.
The problem with Porcelain crowns is that the porcelain can chip off, exposing the silver metal base underneath. This could lead to an unaesthetic appearance.

 

[B747Man]

E-max crowns are also strong, and can be used for front teeth. But for a back tooth, I would recommend Zirconia definitely.
Unfortunately all crowns can fracture when biting into nuts. There is no guarantee. But Zirconia crowns should handle most foods better than e-max.
The problem with Porcelain crowns is that the porcelain can chip off, exposing the silver metal base underneath. This could lead to an unaesthetic appearance.

Do all porcelain crowns have metal underneath? I know there is porcelain fused to metal, but I thought that was separate from standard porcelain. Also, since you're saying there's metal underneath, does that mean any breakage would most likely just be cosmetic from the porcelain chipping off, or is there still a risk of the metal part also breaking that would make it not as strong as zirconia?

 

[Dr M]

Most porcelain crowns are porcelain fused to metal. The other crowns,although they appear similar to porcelain, is technically lithium disilicate crowns, such as emax crowns. They are pure white.
If the porcelain chips off, it is mainly an aesthetic issue. The metal underneath does not usually break.