Orthotown April 2018 - 24

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I can think of two options:
1. Elimination of the infection by a periodontist, then continued movement of the tooth to
get the root into the bone. Probably another two years of orthodontic treatment, with no
guarantee that the bone will re-form on the palatal side of the tooth.
2. Extraction of the tooth and treatment of the infection at the same time to avoid the creation of a huge defect in the palate, then placement of an implant. Much shorter treatment
time with much better prognosis, I'm afraid. ■
9/17/2015

ndsgajda
Member Since: 01/16/11
Post: 4 of 10

Probably a long shot on this case, but I had one look similar to this. The canine was moving
very slowly and she had a large swelling on the palate. When the tooth finally came in, the problem
was the oral surgeon that attached the gold chain had put a huge amount of composite when he
bonded it. He probably thought it would hold better, but dragging the glob of composite and the
tooth through the gingiva took forever. It all worked out fine in the end, though. ■
9/17/2015

davidharnick
Member Since: 08/28/02
Post: 5 of 10

As a doctor, it is your responsibility to refer to the appropriate specialist when things are out
of your field/experience. Just like we think of GPs doing ortho that they shouldn't. This patient
needs a perio referral. After appropriate consultation, then you decide what is best for your patient.
So off to the periodontist! ■

9/17/2015

Str8edge

This is immediately what I thought of as well, ndsgajda. I've had this happen. ■

Member Since: 07/17/11
Post: 6 of 10

Fenrisúlfr

I've had the same thing happen also ... a huge blob of composite. Worth investigating. ■

Member Since: 02/25/09
Post: 7 of 10

tom525
Member Since: 06/18/08
Post: 8 of 10

9/17/2015

Get a CBT yourself or refer to periodontist. This appears to be a very difficult situation. You
may have to have an implant placed in the #11 site eventually. ■
9/17/2015

Shwan
Member Since: 08/02/10
Post: 9 of 10

Just wanted to share the final results of this case. It turned out very well and the patient was
satisfied. But it was a very long and difficult journey, nearly 4.5 years of treatment. If I'm treating
this case now, I would recommend extraction for the impacted canine; that is my protocol now
for impacted canines in adult crowding cases that will need extraction. If you ask about how
I solved the inflammation, I just followed Fenrisúlfr's advice. Change in the direction of force
with more vigorous hygiene instruction; I spent a lot of time torqueing that canine. Sorry, no
X-rays present at the moment. Thank you, Orthotown community! I learned a lot from you. ■

1/25/2018

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APRIL 2018 // orthotown.com

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