Right lateral incisor and canine

[Mellanie Wangare]

my 11 year old daughter's teeth right lateral incisor and canine has not grown for the last 4 years after extraction.
A visit to the dentist has shown the teeth do not have space to grow as they have no space.I was advised on braces.
Kindly advise am a very worried mum!

 

[MattKW]

You have to start with an Xray to see where the lateral incisor is hiding. Sometimes they don't grow at all. A canine would be expected any time from now on, so that's still within the right time. Get an Xray, and go to an orthodontist for an opinion.

 

[billw3r]

I would like to know if It is upper or lower lateral. Most likely it would be a lower lateral.
This happens quiet frequently. If your child's deciduous teeth were perfect, then your permanent teeth are larger than the deciduous teeth so you got a crowded problem to start with.
Frequently you would need some additional room on the 4 lower anteriors to get them to come in straight.
You can have a lower lateral come up and eat a part of the root of the decidous cuspid when it gets to an enamel part of the deciduous tooth, it cannot absorb the enamel portion of the baby tooth, so it gets stuck.
You can extract the deciduous cuspids, which will give you more room than you need.
If you can take away from both deciduous cuspid a portion of the tooth, it is better to do a pulpotomy and take only portion of the cuspid you need.
I show this in detail in this video:

You have to provide this room on both cuspids to keep the midline on. If you give the teeth too much room, the permanent cuspids will move forward into that room, and you will loose arch length, so it is normally not good to extract the cuspids, but this is more complicated than most people like to deal with.

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[MattKW]

Uh, no, have to disagree. Most congenitally missing laterals or unerupted laterals are uppers. Similarly, most impacted canines are upper canines. I don't know if I have ever seen an unerupted lower lateral; they always come up, either twisted, or lingually or laterally displaced (and resorb the adjacent canine). It's more likely to assume that the lady is talking about an upper tooth.

 

[billw3r]

Uh, no, have to disagree. Most congenitally missing laterals or unerupted laterals are uppers. Similarly, most impacted canines are upper canines. I don't know if I have ever seen an unerupted lower lateral; they always come up, either twisted, or lingually or laterally displaced (and resorb the adjacent canine). It's more likely to assume that the lady is talking about an upper tooth.

You are right about trying to give a diagnosis with almost no information on the case, but I have seen many lower laterals that get caught on the way up. I have lectured to many paediatric dentist and also orthodontists who deal with children all the time. I have devised a method where you can bring in the permanent teeth and dole out the space they need. I published an article on this, about 45 years ago and its still in use. I have several videos that you might like to look at, about how we do pulpotomy and reduce the deciduous cuspid to help bring the teeth in properly.
[video deleted by admin]

 

[MattKW]

Thank you, yes, I did watch your video. It looked like a variation of sorts on the idea of serial extractions. The end result of the video appeared to show that the girl had straightish front teeth, but with a deep overbite, so I wonder what benefit on balance has been achieved. I've been in the game for 35 yrs (you for 42 yrs), so we have almost equivalent experience with the changes that have occurred orthodontically. I have passed through the serial extraction phase, the 1st premolar extraction phase, and the 2nd premolar extraction phase. The latest techniques mean that rarely are extractions required, which I accept give a much better experience for all (I always disliked taking out healthy premolars), and a more pleasing aesthetic and functional result.